Athroscopic Rotator Cuff Repair
The rotator cuff (RTC) is the consolidation of four tendons across the shoulder joint. The intact RTC is important in maintaining shoulder function. Tears in the RTC can result from trauma, overuse, and often develop over time in a degenerative process. Patients often complain of pain with overhead activities, pain at night, weakness and loss of function.
Treatment for RTC tears are individualized for each patient depending on the degree of pain, dysfunction, and physical demands. In general, physical therapy is used initially to maximize the function of the intact musculature of the shoulder joint. It is especially important to maintain a stretching program to preventing the injured, painful shoulder from becoming stiff. Steroid/novocaine injections are sometimes helpful with pain.
Some patients are good candidates for RTC repairs. There are many variables which affect the decision whether to proceed with a repair. These include tear acuity, age, physical demands, pain level, and arthritis. The purpose of a repair is to restore the normal attachment of the RTC within the shoulder. Traditionally, RTC repairs were done with standard surgical incisions that split the deltoid muscle to expose the RTC. Newer techniques using arthroscopy allow repairs to be performed through a series of small (one centimeter) incisions, thereby sparing the deltoid muscle from the added dissection. The goal of both surgeries is the same: to restore the attachment of the RTC to the bone. The arthroscopic technique often permits better visualization of the RTC tears so that the tear can be better defined and anatomically repair. Patients having an arthroscopic repair may also be more comfortable in the early post-operative period, facilitating early rehabilitation. Regardless of technique, post-operative rehabilitation is essentially the same, as is the time required for the RTC to heal. While the application of arthroscopic techniques continues to grow, there remain special circumstances where the open technique remains useful. The open technique has evolved to utilize smaller incisions, requiring less muscle dissection.