Presentation on theme: "Arthroscopic Rotator Cuff Repairs"— Presentation transcript:
1Arthroscopic Rotator Cuff Repairs Presentation Designed For Patient EducationUpdated 2/11
2University Orthopaedics & Sports Medicine OfficesClifton (Medical Arts BuildingWestchester
3University Orthopaedics & Sports Medicine SurgeryHolmes Hospital (Clifton)Outpatient Surgery CenterMercy FairfieldMainWestchester Medical CenterUniversity Pointe Ambulatory Surgical Hospital (ASH)University Hospital
4Anatomy What is the rotator cuff? What does the rotator cuff do? SupraspinatusInfraspinatusTeres MinorSubscapularisWhat does the rotator cuff do?Holds the humeral head (ball) in glenoid (cup)Stabilizes the shoulder joint
5Rotator Cuff Tears Signs and symptoms Incidence Pain ShoulderSide of armOften worse at nightOften worse with overhead activitiesWeaknessVery large tearsIncidenceHow common is it? VeryRare in patients younger than 40Incidence steadily increases with age
6What causes Rotator Cuff Tears? Sometimes they are simply degenerativePatients who perform a lot of repetitive overhead activities may develop rotator cuff tearsTraumatic-fall on the shoulder, or pull on the armIncidence increases with age
7Natural History of RCTs Usually begins in anterior insertion of supraspinatus tendonUsually begins on articular surface as partial tear and progresses to full thickness tearsProgresses from tendon to tendon enlarging like a “hole in a sock”Once full thickness tear occurs it does not heal back to bone without help→Rotator Cuff Tear↑Exposed cartilage on the humerus bone (ball)
8“Footprint” of cuff Broad area of greater tuberosity (supraspinatus) Other tendons are similarFrom the articular margin to the “shoulder” of the greater tuberosityNOT just a linear stripe!
10Rotator Cuff Tears-Treatment Anti-inflammatory medications-decreasing inflammation causes decreased painSelective cortisone shots-steroids are very potent anti-inflammatory medications and go directly to the source with little systemic absorptionPhysical Therapy-strengthening the remaining intact rotator cuff stabilizes the shoulder. Treatment of choice for partial thickness tearsSurgery-most full thickness tears of significant size should be surgically repaired. The fully torn cuff will not heal down to bone without help and will likely get bigger.
11Surgery Open Arthroscopic Make incisions and move muscle out of the way in order to expose the torn tissueArthroscopicArthro=jointScope=camera“Look around joint with camera”
12Arthroscopic Repair-Advantages Less dissection = less stiffnessPreserves deltoid muscleLower infection rateBetter visualizationAbility to evaluate/address other pathologies“Shopping Spree”Less pain in early post-op periodDECREASE RISK OF MAKING PATIENT WORSE↑Torn biceps tendon that can be addressed arthroscopically at the time of surgery
13Arthroscopic Repair-Advantages Small tears easily repairedBiggest advantage is with larger tearsCan see betterEasier to mobilize torn tissueDetermining if it is can be fixedAvoid big muscle dissection
14Arthroscopic Rotator Cuff Repair First performed in mid 90’sTechniques and equipment continue to evolve such that it is an excellent option
15AnesthesiaAnesthesiologist administers nerve block in pre-op holding area after giving some IV medicationsTypically lasts about 18 hoursGeneral anesthesiaPatient then placed under general anesthesiaPatient is positioned such that full access to the shoulder can be obtainedSkin cleaned with sterilizing prep
16Portals Surgery done thru poke holes called portals Typically 4-5 portals are utilizedCannulas are placed thru the portals for easier passage of instruments and sutures
17TechniqueComplete inventory of the shoulder is performed with the cameraGoal is to fix the rotator cuff to its anatomic positionTherefore, the pattern (personality) of the tear is evaluatedNext the cuff is fixed to bone with various techniques depending on the tear pattern
18RepairSutures can be used to close the tear side to side like a zipperFinally, suture anchors (screws with attached sutures are used to fix the cuff to boneScrew goes in boneSuture passed thru the cuff and tied to bring the tissue back to bone
19Address Associated Pathology Sometimes other parts of the shoulder also cause pain and can be addressed at the time if surgeryBiceps tendonThe tendon can simply be cut (tenotomy) or cut and sewn down to bone (tenodesis)End of the collarbone (clavicle)Take out end of collarbone (distal clavicle resection)Bone spurs on the shoulder blade bone (acromion)Smooth bone (subacromial decompression)↑Torn biceps tendon↑Smooth shoulder blade bone
20Surgery Most surgeries can be done with all arthroscopic techniques Sometimes incisions must be made to address pathology that cannot be fixed with the cameraThis decision is often made at the time of surgery after the shoulder is evaluated with the camera
21Post op Wake up in a sling If pre-op block was successful then you should be pretty comfortable with a numb armGo home same dayStart taking your pain medications as soon as you get home prior to your block wearing off.It can be very difficult to “catch up” if you have no pain medication in your system when your block wears off.
22Post-op-Medications Pain medications Nausea medications Take these as neededNot well tolerated on an empty stomach so make sure you eat something first even if just crackersNausea medicationsSometimes patients are nauseated after surgery from the anesthesiaUsually wears off in 24 hoursCan take medication if needed
23Post opLeave dressing intact for first 72 hours after surgery. Reinforce if neededMay remove and shower at 72 hours post opDo not scrub your woundsSimply wash your neck with soap and water and let the soap and water run offDo not soak your wounds until permitted to do so by your physician. NO BATH, SWIMMING OR HOT TUBS.If your wounds are dry, may leave open to the airIf oozing then put on a clean dry dressing and call your doctorDo not put any ointments on your wounds. This includes antibiotic ointments (Neosporin, Polysporin, etc)It is easiest to wear a button shirtWear your sling all the time except to shower
24Post op Your first follow-up appointment should be 5-7 days post op Please make an appointment to go to physical therapy immediately after your first post op appointment.
25Post-Op RehabStart passive range of motion (the therapist moves your shoulder for you) at 1 weekSling for 4-6 weeksStart active range of motion (you move the shoulder yourself) when sling comes offStart strengthening at 8-12 weeksNo sports, lifting for 4-6 months
26Frequently Asked Questions Will I have therapy post op?Yes. Initially 2-3 times per week then less often. Exercises must be done at home too!How long do I have to wear the sling?4-6 weeks. Longer when in an uncontrolled environmentWhen can I go back to work?This is highly variable depending on what you doFor desk jobs it could be as early as a couple daysLabor jobs with lifting, 4-6 months
27QuestionsAny further questions should be directed to your therapist or surgeonPlease call the office with questions or concerns