Rotator cuff tear treatments
Surgical treatment of rotator cuff tears
Surgery is indicated for rotator cuff tears that cause a significant loss of function or chronic pain and fail to respond to nonsurgical treatment. The torn tendon cannot heal on its own. Also, when a tendon is completely torn, it implies that the corresponding muscle cannot work and consequently, atrophies. If this atrophy becomes chronic, it may be irreversible.
Therefore, the best surgical outcomes are achieved when the rotator cuff is repaired within weeks or months of the tear. On the other hand, repairing a muscle that is chronically atrophied by fatty material (fatty metaplasia) will not be very effective in terms of restoring function. Hence the importance of early diagnosis and management.
There are a number of possible techniques, but I will describe only the one I use. Since the patient stays awake during the procedure, regional or local anesthesia to numb the entire shoulder and upper limb is administered. The patient is then placed in a semi-seated position on the operating table. If he wants to, he can watch the surgery on a video monitor. He can also bring a device and listen to music quietly until the operation is over.
After cleaning and sterilizing the skin, I insert the arthroscope through a tiny incision a few millimetres long and fill the shoulder with water to expand the joint. The image appears on my video screen (with the movement of the water, it resembles the underwater images in Cousteau’s films). One or two additional tiny incisions are made to insert instruments to repair the bursa, calcium deposits or any prominent bone spurs that are causing impingement or to repair and reinsert the tendon into the bone. To reattach the torn tendon to its bone bed, I anchor small NON-METALLIC rivets (they don’t set off the metal detectors at airports!) into the humerus. The sutures are attached to the anchors, which tie the tendon back to the bone. Sometimes, the tendon is reattached after passing sutures through small tunnels drilled in the greater tuberosity. This is actually the same reattachment technique that was practised in the days of “open” shoulder repair and which fell into disuse following the advent of arthroscopy, for it could no longer be reproduced. However, since more suitable instruments have been developed, we have been able to resume using this technique, which eliminates the need for foreign materials, for most of our repairs.
The surgery usually lasts 30 to 90 minutes and after an hour or so under observation in the recovery room, the patient is allowed to leave the clinic with the person who is accompanying him. Before the patient leaves, I determine the follow-up and/or physiotherapy protocol. Appointments are scheduled, pain medication is prescribed. My assistant gives the patient a document with all the postoperative instructions and useful telephone numbers.
Most patients are not immobilized after surgery. An abduction sling is provided after the surgery (“airplane type” to support the arm) to all patients and it is used mainly at night or a few hours during the day for resting during the first month, but it can be taken off for showering, driving or light use of the hand (e.g. eating, keyboard, etc,) in the days that follow surgery.