Rotator Cuff repair
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Rotator cuff tears are a common source of shoulder pain. The rotator cuff consists of four shoulder muscles and their tendons. Tendons are strong fibers that connect our muscles to our bones. The shoulder muscles and tendons cover the upper end of our arm bone, forming a cuff.
The glenohumeral joint is not a true ball-in-socket joint like the hip, but it is similar in structure. The top of the humerus is round like a ball. It rotates in a shallow basin, called the glenoid, on the scapula. A group of ligaments, called the joint capsule, hold the ball of the humerus in position. Ligaments are strong tissues that provide stability. In other words, the joint capsule is responsible for holding our upper arm in place at our shoulder.
The four rotator cuff muscles form a single cuff of tendon that connects to the head of the humerus bone. The muscles allow the arm to rotate and move upward to the front, back, and side. A fluid-filled sac, called the subacromial bursa, lubricates the rotator cuff tendons allowing us to perform smooth and painless motions. We use the rotator cuff muscles to perform overhead motions, such as lifting up our arms to put on a shirt, comb our hair, or reach for an item on a top grocery shelf.
These motions are used repeatedly during sports, such as serving in tennis and passing in football. The rotator cuff also provides stability when our elbow flexes and as we lift objects
Sometimes the aging process can cause bone spurs to grow on the scapula, particularly in the acromion area. Shoulder impingement syndrome occurs when bone spurs or bursa inflammation narrows the space that is available for the rotator cuff tendons. The tendons can tear as they rub across the bone spur, particularly when the arm is elevated. Inflamed tendon membranes may develop tendonitis, a painful condition. Shoulder impingement syndrome may even cause the rotator cuff tendons to detach from the top of the humerus.
Rotator cuff injuries can occur in younger people following a shoulder injury, such as a fracture or dislocation. Overuse or repetitive activity can also cause rotator cuff tears. This includes athletes that perform overhead movements during such sports as tennis, swimming, or baseball. This also includes workers who reach upwards repetitively during construction, painting, or stocking shelves.
Your shoulder may feel stiff. It may be difficult for you to move your arm. You may hear a crackling noise when you do so. Your arm may feel weak, especially when your lift or rotate it.
The symptoms of a rotator cuff tear caused by traumatic injury occur suddenly. You may feel a snap and sudden pain. Your arm will immediately feel weak, and you will have difficulty moving it.
Your physician will order X-rays to see the condition of the bones in your shoulder and to identify arthritis or bone spurs. A special dye may be used with the X-ray in a procedure called an Arthrogram. Sometimes a soft tissue injury does not show up on an X-ray. In this case, your doctor may order a Magnetic Resonance Imaging (MRI) scan or an ultrasound. A MRI scan will provide a very detailed view of your shoulder structure. It will help your doctor determine the location and type of your rotator cuff tear. An ultrasound uses sound waves to create an image when a device is gently placed on your skin. These tests do not hurt but require that you remain very still while a camera takes images.
Open Surgical Repair is the original type of surgery for rotator cuff tears. During Open Surgical Repair, the surgeon opens the shoulder complex to gain access to the torn rotator cuff. Your surgeon will make an incision over your shoulder and detach a small portion of the deltoid muscle for the surgery. An Acromioplasty is often performed at the same time. An acromioplasty removes bone spurs from underneath the acromion.
A Mini-Open Repair of the rotator cuff is a variation of the Open Surgical Repair. The Mini-Open Repair uses much smaller incisions, typically 3 to 5 cm. in length. The deltoid muscle is not detached in this procedure. Instead, the surgeon views and evaluates the joint using an arthroscope.
An arthroscope is a very small surgical instrument. It is about the size of a pencil. An arthroscope contains a lens and lighting system that allows a surgeon to view inside of a joint. The arthroscope can be attached to a miniature camera. The camera allows the surgeon to view the magnified images on a video screen or take photographs and record videotape. With this technology, your surgeon will only need to make small incisions and will not need to open up your joint fully.
The arthroscope is used to remove bone spurs under the acromion and to treat other structures in the shoulder joint. Your surgeon will then use a mini-open incision to repair the rotator cuff. Results of the Mini-Open Repair are equal to the Open Repair surgical method.
Your surgeon will make one or more small incisions, about ¼” to ½” in length, near your shoulder joint. Your surgeon will fill the joint space with a sterile saline (salt-water) solution. Expansion of the space allows your surgeon to have a better view of your joint structures. Your surgeon will insert the arthroscope and may reposition it to see your joint from different angles.
Your surgeon may make additional small incisions and use other slender surgical instruments for surgical treatments. Because the surgical incisions are so small, they will require just a few stitches or Steri-Strips. Your surgeon will cover them with a bandage.
If you have surgery, your surgeon will restrict active arm movements for a period of time following your procedure. You will most likely wear an arm sling for four to six weeks. An occupational or physical therapist will gently help you move your arm at first with exercises called passive range of motion. As you heal, you will progress to performing arm motions without assistance. Eventually, you will learn exercises to strengthen all your shoulder muscles. Home exercises are added during the rehabilitation process, and are continued after formal therapy sessions have ceased.
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This information is intended for educational and informational purposes only. It should not be used in place of an individual consultation or examination or replace the advice of your health care professional and should not be relied upon to determine diagnosis or course of treatment.
The iHealthSpot patient education library was written collaboratively by the iHealthSpot editorial team which includes Senior Medical Authors Dr. Mary Car-Blanchard, OTD/OTR/L and Valerie K. Clark, and the following editorial advisors: Steve Meadows, MD, Ernie F. Soto, DDS, Ronald J. Glatzer, MD, Jonathan Rosenberg, MD, Christopher M. Nolte, MD, David Applebaum, MD, Jonathan M. Tarrash, MD, and Paula Soto, RN/BSN. This content complies with the HONcode standard for trustworthy health information. The library commenced development on September 1, 2005 with the latest update/addition on April 13th, 2016. For information on iHealthSpot’s other services including medical website design, visit www.iHealthSpot.com.