Arthroscopic Rotator Cuff Repair
Rotator cuff disease is a common disorder and can result in significant pain and dysfunction in the shoulder (See “Rotator Cuff Disease”). The rotator cuff is a blending of 4 tendons together, which envelop or ‘cuff’ the ball of the shoulder joint and assist in stabilizing and rotating the shoulder. Rotator cuff tears may occur following a traumatic injury to the shoulder often from a fall onto the arm, elbow or outstretched hand. Alternatively, tears may evolve slowly from chronic demand and / or abrading on the roof of the shoulder (acromion). Tears may be partial thickness in nature when they are first detected and later progress to full thickness defects. The tendon defect may be full thickness when first diagnosed. Rotator cuff tears may not be particularly painful. Conservative treatment with ice, non-steroidal anti-inflammatories, occasional cortisone injections, and physical therapy may be effective in managing symptoms. When pain and shoulder dysfunction persist, arthroscopic repair results in symptom relief in more than 85% of patients. Through tiny incisions, small arthroscopic instruments are delivered to remove inflamed tissue, debride the torn rotator cuff, and prepare the bone for optimal healing. Small anchors with attached sutures are inserted into the bone of the upper arm where the cuff normally attaches. The rotator cuff is brought back to its normal position and the anchor sutures are delivered through the tendon margin. Multiple anchors and tendons are often needed. Once passed, each of the suture pairs is tied to secure the cuff tendon back to bone. Healing is somewhat slow, in part due to poorer blood supply of the torn tendon. With advanced arthroscopic techniques, even complex tears can be managed effectively. Physical therapy as well as home exercises contribute to regaining shoulder motion and strength. Complete healing may require as long as 9 months.