Repair of Rotator Cuff Tears: Surgery for shoulders with torn rotator cuff tendons can lessen shoulder pain and improve function without acromioplasty.
Edited By: Winston J. Warme, MD, Frederick A. Matsen III, M.D.
Last updated Wednesday, May 14, 2008
Figure 4 - Location of incision About the procedureWhat are the technical details of rotator cuff surgery for rotator cuff tears? What is actually done? Rotator cuff surgery is a highly technical procedure; each step plays a critical role in the outcome.
After the anesthetic has been administered and the shoulder has been
prepared, a cosmetic incision is made over the top front corner of the
shoulder, as shown in figure 1.
This incision allows access to the seam between the front and middle
parts of the deltoid muscle. Splitting this seam allows access to the
rotator cuff without detaching or damaging the important deltoid
muscle, which is responsible for a significant portion of the
shoulder's power. All scar tissue is removed from the space beneath the
deltoid and the acromion (part of the shoulder blade to which the
deltoid attaches). Thickened bursa and the rough edges of the rotator
cuff and humerus (upper arm bone) are also smoothed to make sure that
they pass smoothly beneath the acromion and deltoid.
The edges of the cuff tendons are identified and the quality and quantity of the cuff tissue is determined.
The goal of the repair is to reattach good quality tendon to the
location on the arm bone from which it was torn. If the tendon cannot
reach this spot with the arm at the side of the body, the shoulder
surgeon releases the tendon from the surrounding tissues. If good
quality tendon will not reach its attachment site after these releases,
the cuff tear is deemed to be irreparable. In this situation the
useless tendon is cut out and the shoulder is again examined to assure
smooth and full motion. Again, achieving this smooth movement may
require trimming of the tendon edges or the bone of the upper humerus.
Occasionally, it may be necessary to perform an acromioplasty, a
procedure in which part of the bone overlying the rotator cuff is
removed. Acromioplasty is avoided unless it is necessary because it
increases the risk of weakening the deltoid and causing scar tissue.
If the rotator cuff is repairable, a groove or trough is fashioned
in the normal attachment site for the cuff, as shown in figure 2.
Sutures (lengths of surgical thread) draw the edge of the tendon
securely into the groove to which it is to heal. This method of
attachment leaves a smooth upper edge of the cuff repair to glide
beneath the acromion and deltoid and avoids possible problems with
suture anchors. After the cuff is repaired, the deltoid muscle and skin
are closed.
Because the deltoid is not detached from the acromion in this surgical approach, it is called the "deltoid on" approach.
What is the typical anesthetic used for rotator cuff surgery for rotator cuff tears? Rotator cuff surgery may be performed under a general anesthetic or a
brachial plexus nerve block. A brachial plexus block can provide
anesthesia for several hours after the surgery. The patient may wish to
discuss their preferences with the anesthesiologist before surgery.How long does rotator cuff surgery for rotator cuff tears usually take? Rotator cuff surgery usually takes approximately one hour. However, the
preoperative preparation and the postoperative recovery may add several
hours to this time. Patients often spend two hours in the recovery room
and about two days in the hospital after surgery.
Surgery for rotator cuff tears at the University of Washington If you are interested in making an appointment to discuss this procedure, you can request an appointment using our online referrals website. To request a referral online, please click here. You can also call 206-598-7416 to make an appointment.
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