SHOULDER ROTATOR CUFF

Rotator Cuff

The shoulder is a ball and socket joint made up of the scapula (shoulder blade), clavicle (collar bone) and humerus (upper arm bone). The scapula forms the socket and the upper part of the humerus forms the ball. This configuration enables motion in the three planes.

A group of four tendons and muscles called the rotator cuff, maintain stability of the joint and preventing dislocation. The rotator cuff attaches the humerus to the shoulder blade and it helps to lift and rotate your arm.

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What is a Rotator Cuff Injury?

Rotator cuff injuries can be sudden or gradual and is generally in the form of a tear. It is a common causes of shoulder pain in middle aged adults and older individuals. It may occur with repeated use of arm for overhead activities, while playing sports or during motor accidents.

Rotator cuff tear causes severe pain, weakness of the arm, and crackling sensation on moving shoulder in certain positions. There may be stiffness, swelling, loss of movements, and tenderness in the front of the shoulder.

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Arthroscopic Surgical Repair of the Rotator Cuff

Diagnosis for a rotator cuff tear is best observed on an MRI image. Symptomatic relief may be obtained with conservative treatments – rest, shoulder sling, pain medications, steroidal injections and certain exercises. However surgery is required to fix the tendon back to the shoulder bone.

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Arthroscopic rotator cuff repair is a minimally invasive surgery performed through tiny incisions, about 1 cm each, with an arthroscope. An arthroscope is a thin flexible fiber optic scope which is introduced into a joint space through a small incision in order to carry out diagnostic and treatment procedures within the joint.

An arthroscope is about the diameter of a drinking straw. It is fitted with a miniature camera, a light source and precision tools at the end of flexible tubes.

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An arthroscope can be used not only for diagnostic procedures but a wide range of surgical repairs, such as debridement, or cleaning, of a joint to remove bits of torn cartilage, ligament reconstruction, and synovectomy (removal of the joint lining). All are done without a major, invasive operation, and, since arthroscopy requires only tiny incisions, many procedures can be done on an outpatient basis with local anaesthetic.

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The television camera attached to the arthroscope displays the image of the joint on a television screen, allowing the surgeon to look throughout the shoulder-at cartilage, ligaments, and the rotator cuff. The surgeon can determine the amount or type of injury, and then repair or correct the problem.

An arthroscopic procedure to repair rotator cuff tendons will allow sutures to be introduced to the affected area in order to close either side of the tear and reattach the tendons to the shoulder bone.

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Benefits of arthroscopic repair

The benefits of arthroscopy compared to the alternative, open shoulder surgery, include:

• Smaller incisions

• Minimal soft tissue trauma

• Less pain

• Faster healing time

• Lower infection rate

• Less scarring

• Earlier mobilization

• Usually performed as outpatient day surgery

Will I be awake during the procedure?

Along with Mr Leonard the anaesthetist will be present. He/She will evaluate you and decide if your anaesthetic will be a spinal or general anaesthetic. Most commonly a general anaesthetic is used allowing you to go asleep for the operation. This will be decided beforehand.

How long will I be in hospital?

Shoulder arthroscopy is a day procedure. You should make arrangements to have a family member or friend to bring you home.

How long will it take?

Shoulder arthroscopy shouldn’t take more than an hour. In saying this however it will depend on the amount of repair work to be done.

Possible complications

Complications are rare. However, and although shoulder arthroscopy is considered a less invasive surgical procedure it is still surgery and therefore carries a certain amount of risk. Irritation to the surrounding nerves, blood vessels or the joint itself. As with all surgery there is a risk of infection.

Recovery

You will experience a certain amount of pain after the procedure. Paracetamol or anti-inflammatory medication will help with this. Pain should decrease over the few days following the surgery. Returning to sport following arthroscopy will depend on the extent of the intervention and the damage that was previously there. As always a properly designed rehabilitation programme will help to give the best possible post op results.