||SHOULDER ROTATOR CUFF REPAIR
Since many patients with partial tears and some even with complete tears can respond to non-operative management, generally conservative care is offered first. If a significant trauma such as a shoulder dislocation, or fracture, or high energy force is known to have been followed by complete to near complete loss of rotator cuff- mediated motion and strength, then an operative work-up is initiated with plans to proceed with a shoulder replacement, if confirmatory.
The three commonly used surgical techniques for rotator cuff repair are:
Mini-open repair and
An individual surgeon's ability to repair a torn rotator cuff and achieve a satisfactory result varies by technique. Variation is based on experience and familiarity with the technique. Although one surgeon may be capable of achieving a quality repair through all-arthroscopic means, another may have better results with mini-open repair. Prior to surgery, patients should discuss the options available to them with their surgeon. The surgeon can share results of using different techniques so that the most appropriate treatment plan can be designed.
Open repair is performed without arthroscopy. The surgeon makes an incision over the shoulder and detaches the deltoid muscle to gain access to and improve visualization of the torn rotator cuff. The surgeon will usually perform an acromioplasty (removal of bone spurs from the undersurface of the acromion) as well. The incision is typically several centimeters long. Open repair was the first technique used to repair a torn rotator cuff; over the years, the introduction of new technology and improved surgeon experience has led to the development of less invasive surgical procedures. Although a less invasive procedure may be attractive to many patients, open repair does restore function, reduce pain, and is durable in terms of long-term relief of symptoms.
As the name implies, mini-open repair is a smaller version of the open technique. The incision is typically 3 cm to 5 cm in length. This technique also incorporates arthroscopy to visualize the tear and assess and treat damage to other structures within the joint. Arthroscopic removal of spurs (acromioplasty) avoids the need to detach the deltoid muscle. Once the arthroscopic portion of the procedure is completed, the surgeon proceeds to the mini-open incision to repair the rotator cuff. Mini-open repair can be performed on an outpatient basis. Currently, this is one of the most commonly used methods of treating a torn rotator cuff; results have been equal to those for open repair. The mini-open repair has also proven to be durable over the long-term.
This technique uses multiple small incisions (portals) and arthroscopic technology to visualize and repair the rotator cuff. All-arthroscopic repair is usually an outpatient procedure. The technique is very challenging, and the learning curve for surgeons is steep. It appears that the results are comparable to those for mini-open repair and open repair.
Recovery for all surgical options can take as long as 3–6 months, with a sling being worn for the first 1–6 weeks.
CONDITIONS TREATED BY SHOULDER ROTATOR CUFF REPAIR
SYMPTOMS TREATED BY SHOULDER ROTATOR CUFF REPAIR
Loss of motion in shoulder
Shoulder pain when leaning on
Shoulder pain when lifting overhead
|Shoulder pain when lying down
Shoulder pain when reaching forward