Michael Krinsky

Hayward Orthopedic Surgeon on Understanding Rotator Cuff Surgery

Shoulder surgery may be the only feasible option for those patients who have sustained a rotator cuff tear that fails to show progress after non-surgical efforts have been exhausted.

Shoulder surgery may be the only feasible option for those patients who have sustained a rotator cuff tear that fails to show progress after non-surgical efforts have been exhausted. This may be denoted by increased weakness, loss of function, and limited motion in the joint. Most surgeons consider a course of non-surgical treatments to be advisable. For those tears that are associated with extreme loss of strength, the result of acute trauma, and/or are larger than average (exceeding 3 centimeters in length) at the time of the primary evaluation, early surgery may be considered a viable option. The procedure for repairing a torn rotator involves reattaching the tendon back to the ball of the shoulder joint (humeral head) from where it was separated. There are several methods for doing this. Each approach has its own pluses and minuses; all have the same end result in mind – encourage the tendon to adhere to the bone. Selecting the appropriate surgical technique is dependent upon a variety of factors. These include the familiarity and experience of Hayward area orthopedic surgeons with any given procedure, the extent of the injury, the patient’s healthy body type, and the condition of the tendon and bone. Regardless of which approach is selected, medical studies have shown similar degrees of pain relief, strength progression, and patient satisfaction.

There are three most commonly performed techniques for rotator cuff surgery:

1.       Open

2.       Mini-open

3.       All-arthroscopic

Any orthopedic surgeon’s ability to repair a torn rotator cuff and accomplish a suitable result will vary by technique depending on their experience with each technique. Whereas a certain surgeon may achieve acceptable results using only arthroscopy, another may do better with a mini-open method. Before orthopedic surgery, patients should discuss their available options with their orthopedic surgeon.

Open
There is no arthroscopy involved with open repair other than possible diagnostic arthroscopy then, an incision is made over the shoulder to detach the deltoid muscle and gain visual access to the torn rotator cuff. It is also common for the surgeon to perform an acromioplasty which is the extraction of bone spurs from the bottom of the acromion. This incision is usually several centimeters in length. Originally, pen repair was the only technique available for surgically repairing a torn rotator cuff. As time progressed and technology improved, less invasive procedures were developed. Even though less invasive techniques are typically more desirable to most patients, the open repair is effective at restoring function, reducing pain, and providing lasting relief from symptoms.

Mini-Open
As the moniker would suggest, the mini-open repair is a smaller variation of the open technique. Incisions are usually 3 cm to 5 cm long. This approach integrates arthroscopy to view the tear. Injury to other tissues in the joint can also be assessed. There is no need to detach the deltoid muscle when performing arthroscopic acromioplasty. Upon completion of the arthroscopy, the surgeon will continue on to the mini-open incision and repair the rotator cuff. This operation can be performed on an outpatient basis as are the other two approaches. The patient outcomes are comparable to those of open repair and have proven to be long-lasting.

All-Arthroscopic
In this approach, several small incisions called “portals” are made in the shoulder joint allowing an arthroscope to view and repair the rotator cuff. There is a steep learning curve for surgeons as the technique is not easily mastered. This procedure is also performed on an outpatient basis and results appear to be comparable to those for mini-open repair and open repair.

Results
Following the repair of a rotator cuff, 80% to 95% of patients attain acceptable results, such as satisfactory pain relief, restored joint function, and increased range of motion.

There are some factors that may reduce the probability a desirable outcome:
- Poor quality of tissue
- Extensive tears
- Lack of full compliance with rehabilitation and restrictions
- Patients older than 65 years of age

Rotator cuff surgery has become less invasive with the passing of time. As advances in techniques are made, surgeons will experience a learning curve in its mastery. At one time, larger tears were deemed untreatable using less invasive techniques but this is changing as surgeons become more adept with progressing technology. Be sure to contact my office for more specific information regarding the limitations of physical activity after recovering fully from rotator cuff surgery.

Committed to getting you back in the game,

Dr. K

Article Tags: Torn Rotator Cuff, Rotator Cuff, Cuff Surgery, Torn Rotator, Open Repair

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