Bone and Joint Specialists of Winchester provides advanced rotator cuff surgery options
Are you one of the millions of adults who suffer from shoulder pain? If so, you may be considering surgery to repair your rotator cuff. We are at an amazing time for rotator cuff surgery, with new techniques and advanced options helping to decrease healing time and improve results. In this blog post, we’ll take a closer look at advanced rotator cuff surgery and advice on how to choose the right procedure for you. So if you’re considering surgery, be sure to read on!
All surgeons at Bone and Joint Specialists of Winchester perform minimally invasive rotator cuff repairs. But Dr. Larson is an expert on all kinds of shoulder injuries and surgery. Dr. Larson happily accepts patients for second opinions on rotator cuff injuries. Many other surgeons in our area refer patients to Dr. Larson for treatment of rotator cuff tears that require advanced management.
What is The Rotator Cuff?
The rotator cuff is a set of four muscles deep in the shoulder. The supraspinatus is the most commonly injured one of them. The rotator cuff keeps the shoulder in place and helps to lift the arm overhead.
Do I have a rotator cuff tear?
You might have a rotator cuff tear if you have the following signs or symptoms:
- Pain in the shoulder and upper arm especially when trying to raise the arm overhead.
- Pain when lowering the arm from overhead
- Lifting light objects may cause more pain than lifting heavy objects
- Weakness in the shoulder
- Pain at night when sleeping on the shoulder
Although it is possible to tear the rotator cuff through an injury such as a fall, many people tear their rotator cuff slowly through repetitive use also.
What are the options for rotator cuff surgery?
There are several options available for rotator cuff surgery. The most common is arthroscopic surgery, which involves making small incisions in the shoulder and inserting a tiny camera called an arthroscope. This allows the surgeon to see the inside of the joint and make repairs without having to make a large incision. Most rotator cuff tears, even large ones, are treated with an arthroscopic repair at Bone and Joint Specialists.
Another option is open surgery, which involves making a larger incision in the shoulder so that the surgeon can get a better view of the joint. This type of surgery is usually only necessary if the damage to the rotator cuff is severe.
But there are advanced options too beyond the basic repairs that can help you heal better and faster. These include:
- Regeneten Bio-Inductive Implant
- Superior Capsule Reconstruction
- Double Row Repair
- Bone Marrow Injection
What is a Rotator Cuff repair?
There are a number of ways to perform a rotator cuff repair. Most of the time we can repair standard tears via arthroscopic techniques, using instruments through small “poke hole” incisions. Arthroscopy allows for better visualization, more precise surgery, less shoulder trauma, less postoperative pain and a better cosmetic appearance, all while having the same ultimate healing, function and pain. Sometimes larger tears may require a larger incision in order to repair the cuff tear directly.
No matter what the incisions are like, the surgery is performed in roughly the same way. Small anchors are placed in the bone where the cuff tendon should be attached. Stitches attached to these anchors are then passed through the rotator cuff tendon. As these stitches are tied together, it brings the rotator cuff back to the bone and locks it into place until it can heal.
What are the restrictions after rotator cuff repair?
For a standard cuff repair, the arm and shoulder must be immobilized in a sling for about six weeks after surgery. We usually start an accelerated therapy protocol within a couple weeks of surgery. But if you do too much, it’s possible to damage the repair.
Sometimes, you will be able to get out of the sling quickly. Regeneten repair for partial cuff tears allows you to be out of the sling after 2 days. The same is true if reverse shoulder replacement is needed for your tear. Other surgeries, like superior capsule reconstruction may require strict use of the sling without therapy at all for the first six weeks.
What happens on the day of rotator cuff surgery?
Rotator cuff repairs are performed as an outpatient. The anesthesiologist will put you to sleep for the surgery. But before that they will administer a nerve block by doing an injection near the collarbone. This will numb your arm and shoulder so that you feel less pain. This also allows them to give you less anesthetic and narcotic medication while you are asleep. That means less nausea, vomiting, or grogginess after surgery.
Once asleep, you will be properly positioned and prepared for surgery. The surgery usually takes an hour or less, but bigger tears may take longer. Once the surgery is completed, a dressing and sling are applied. You are awakened from anesthesia and taken to the recovery area. Once you are awake, drinking, and recovered, the nurses will help you dress and then you are able to go home.
What if my rotator cuff tear is not repairable?
If your tear is not repairable but non-operative treatments are unsuccessful, there are other options:
- Arthroscopic Debridement
- Partial Rotator Cuff Repair
- Copeland hemiarthroplasty
- Superior Capsular Reconstruction
- Reverse Total Shoulder Replacement
Arthroscopic Debridement
Even though your torn rotator cuff may not be repairable, sometimes cleaning out the shoulder joint and removing other causes of pain may help you feel better. This won’t prevent you from having any other treatments for the shoulder down the line. And it can give you some improvement in pain and function.
Partial Rotator Cuff Repair
Sometimes we can repair only a portion of the rotator cuff. But that can provide significant pain relief and improved function. This is because some parts of your rotator cuff are more important that others. By repairing those we can get you closer to normal even though the shoulder isn’t perfect.
Copeland Hemiarthroplasty
A partial replacement of the joint can provide some relief of pain and improved function of the shoulder. The Copeland is a steel cap that fits over the ball of the shoulder joint. It allows the shoulder to move while preventing pain from the lack of rotator cuff. When the shoulder feels better, it is able to move better. This is an option for non-repairable rotator cuff tears in people too young for a reverse shoulder replacement or those who still lead very active athletic lifestyles.
Superior Capsular Reconstruction
Superior Capsular Reconstruction is an advanced arthroscopic surgery where we place a thick tissue patch over the top of the shoulder joint. This is attached to the top of the humerus and the top of the socket. It is also sewn together with any remaining rotator cuff tissue and can help improve pain, strength, and motion. Unfortunately, it takes several months for the repair to heal in well and to get back to normal. But it is a good option for people with non-repairable tears who are too young for reverse shoulder replacements.
Reverse Total Shoulder Replacement
You can read more about this in our full article on it. But in brief, this is a special type of shoulder replacement intended for people with arthritis and cuff tears, or else a huge irreparable cuff tear and loss of motion of the shoulder. The ball and socket are placed in different positions in order to allow for improved leverage of the remaining shoulders to restore function and eliminate pain.
