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Arthroscopic Rotator Cuff Surgery

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Published on Saturday, 26 September 2009 13:46

Written by Vic Goradia, M.D.

An area that can be treated with minimally invasive arthroscopic surgery is the rotator cuff.

The rotator cuff can become irritated and the bursa inflamed from rubbing on the bone above. This is called impingement. Impingement of the rotator cuff can frequently be treated through the arthroscope. The bone is shaved to remove any breaks or spurs and the inflamed bursa can also be removed.

In some cases impingement is associated with pain at the end of the collarbone (acromioclavicular joint). Removing the end of the bones that rub together causing the pain can treat this. The procedure can usually be performed arthroscopically but sometimes requires an open incision.

If the rotator cuff is partially torn

In the case of partial tears, the rotator cuff can be debrided to encourage healing and improve the pain. Complete tears can sometimes be repaired through the arthroscope, but in many cases an incision will have to be made to repair the cuff. If an MRI scan of your shoulder has been done and reveals no tear, or shows a partial tear of the rotator cuff, a complete tear is occasionally found with the arthroscope. In these cases your shoulder may be opened through an incision to repair it. (see box on right for definition of debridement).

Arthroscopy is also very useful in removing loose pieces of cartilage or bone floating in the shoulder from injury or arthritis.

Shoulder Arthroscopy Surgery is Most Often Performed as an Outpatient Procedure

It is performed under general anesthesia, and often a regional anesthetic (interscalene block) is also given. This numbs your shoulder allowing less general anesthesia to be used during the surgery and usually provides six to eight hours of pain relief after surgery. You are usually at the outpatient surgery area for four to five hours. Depending on the procedure, your arm will be either in a sling or a shoulder immobilizer that holds your arm to your side. You will be given written instructions and a prescription for pain medicine at discharge. Your return to work depends not only on the damage and the repair, but also on your job requirements.

Rotator Cuff Repair Explained

Return of full use of your shoulder requires six to 12 weeks after arthroscopy and up to six months if the rotator cuff or labrum has been repaired. Recovery requires rehabilitation exercises and often restricted use of the arm for a period of time. Usually arthroscopy is performed to improve your activity by decreasing or eliminating pain.

Arthroscopy is useful to diagnose and treat damage to the labrum (the ring of cartilage that deepens the socket), defects in the articular cartilage (the covering on the end of the bone), loose pieces of cartilage or bone, damage to the ligaments, and rotator cuff tears (the small muscles surrounding the shoulder joint).

Treatment of the torn labrum (cartilage ring) most often results in removal of the damaged portion. Sometimes, metal suture anchors or absorbable tacks can be used to repair and secure the labrum back to bone.

Ligaments pulled loose when the shoulder comes out of place can occasionally be fixed through the arthroscope with similar suture anchors or absorbable tacks. But sometimes it is necessary to open the shoulder through an incision.

In select cases of shoulder “looseness,” a thermal probe, inserted arthroscopically, can be used to “shrink” and “tighten” the ligaments and joint lining. Even though shrinkage with lasers has been used since the 80s, the thermal shrinkage procedure has only become popular over the past five years. In appropriately selected cases, the procedure has excellent results up to two to four years after surgery. Unfortunately, the long-term outcomes, defined as five to 10 years, have not yet been studied. It is certainly possible that the tissue will stretch and cause the shoulder to become loose again. For this reason, some insurance companies regard this as an “experimental procedure.” I disagree. A large number of shoulder surgeons and sports medicine specialists around the country routinely use this technology to prevent patients from requiring an incision and a much more extensive operation. If your insurance company fails to cover this procedure, I will send a letter explaining my reasons and indicate it is a standard technique used by many surgeons.

Arthroscopic Rotator Cuff Repair with Cadaver Tissue Augmentation