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Arthroscopic Rotator Cuff Repairs Presentation Designed For Patient Education Updated 2/11.

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Presentation on theme: "Arthroscopic Rotator Cuff Repairs Presentation Designed For Patient Education Updated 2/11."— Presentation transcript:

1 Arthroscopic Rotator Cuff Repairs Presentation Designed For Patient Education Updated 2/11

2 University Orthopaedics & Sports Medicine Offices Clifton (Medical Arts Building Clifton (Medical Arts Building Westchester Westchester

3 University Orthopaedics & Sports Medicine Surgery Holmes Hospital (Clifton) Holmes Hospital (Clifton) Outpatient Surgery Center Outpatient Surgery Center Mercy Fairfield Mercy Fairfield Main Main Outpatient Surgery Center Outpatient Surgery Center Westchester Medical Center Westchester Medical Center University Pointe Ambulatory Surgical Hospital (ASH) University Pointe Ambulatory Surgical Hospital (ASH) University Hospital University Hospital

4 Anatomy What is the rotator cuff? What is the rotator cuff? Supraspinatus Supraspinatus Infraspinatus Infraspinatus Teres Minor Teres Minor Subscapularis Subscapularis What does the rotator cuff do? What does the rotator cuff do? Holds the humeral head (ball) in glenoid (cup) Holds the humeral head (ball) in glenoid (cup) Stabilizes the shoulder joint Stabilizes the shoulder joint

5 Rotator Cuff Tears Incidence Incidence How common is it? Very How common is it? Very Rare in patients younger than 40 Rare in patients younger than 40 Incidence steadily increases with age Incidence steadily increases with age Signs and symptoms Pain Shoulder Side of arm Often worse at night Often worse with overhead activities Weakness Very large tears

6 What causes Rotator Cuff Tears? Sometimes they are simply degenerative Sometimes they are simply degenerative Patients who perform a lot of repetitive overhead activities may develop rotator cuff tears Patients who perform a lot of repetitive overhead activities may develop rotator cuff tears Traumatic-fall on the shoulder, or pull on the arm Traumatic-fall on the shoulder, or pull on the arm Incidence increases with age Incidence increases with age

7 Natural History of RCTs Usually begins in anterior insertion of supraspinatus tendon Usually begins in anterior insertion of supraspinatus tendon Usually begins on articular surface as partial tear and progresses to full thickness tears Usually begins on articular surface as partial tear and progresses to full thickness tears Progresses from tendon to tendon enlarging like a hole in a sock Progresses 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 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) Broad area of greater tuberosity (supraspinatus) Other tendons are similar Other tendons are similar From the articular margin to the shoulder of the greater tuberosity From the articular margin to the shoulder of the greater tuberosity NOT just a linear stripe! NOT just a linear stripe!

9 Rotator Cuff Tears-Diagnosis History History Physical Exam Physical Exam X-rays X-rays Often normal Often normal MRI MRI Best test Best test Rotator Cuff Tear

10 Rotator Cuff Tears-Treatment Anti-inflammatory medications-decreasing inflammation causes decreased pain Anti-inflammatory medications-decreasing inflammation causes decreased pain Selective cortisone shots-steroids are very potent anti- inflammatory medications and go directly to the source with little systemic absorption Selective cortisone shots-steroids are very potent anti- inflammatory medications and go directly to the source with little systemic absorption Physical Therapy-strengthening the remaining intact rotator cuff stabilizes the shoulder. Treatment of choice for partial thickness tears Physical Therapy-strengthening the remaining intact rotator cuff stabilizes the shoulder. Treatment of choice for partial thickness tears Surgery-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. Surgery-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.

11 Surgery Open Open Make incisions and move muscle out of the way in order to expose the torn tissue Make incisions and move muscle out of the way in order to expose the torn tissue Arthroscopic Arthroscopic Arthro=joint Arthro=joint Scope=camera Scope=camera Look around joint with camera Look around joint with camera

12 Arthroscopic Repair-Advantages Less dissection = less stiffness Less dissection = less stiffness Preserves deltoid muscle Preserves deltoid muscle Lower infection rate Lower infection rate Better visualization Better visualization Ability to evaluate/address other pathologies Ability to evaluate/address other pathologies Shopping Spree Shopping Spree Less pain in early post-op period Less pain in early post-op period DECREASE RISK OF MAKING PATIENT WORSE DECREASE RISK OF MAKING PATIENT WORSE Torn biceps tendon that can be addressed arthroscopically at the time of surgery

13 Arthroscopic Repair-Advantages Small tears easily repaired Small tears easily repaired Biggest advantage is with larger tears Biggest advantage is with larger tears Can see better Can see better Easier to mobilize torn tissue Easier to mobilize torn tissue Determining if it is can be fixed Determining if it is can be fixed Avoid big muscle dissection Avoid big muscle dissection

14 Arthroscopic Rotator Cuff Repair First performed in mid 90s First performed in mid 90s Techniques and equipment continue to evolve such that it is an excellent option Techniques and equipment continue to evolve such that it is an excellent option

15 Anesthesia Anesthesiologist administers nerve block in pre-op holding area after giving some IV medications Anesthesiologist administers nerve block in pre-op holding area after giving some IV medications Typically lasts about 18 hours Typically lasts about 18 hours General anesthesia General anesthesia Patient then placed under general anesthesia Patient then placed under general anesthesia Patient is positioned such that full access to the shoulder can be obtained Patient is positioned such that full access to the shoulder can be obtained Skin cleaned with sterilizing prep Skin cleaned with sterilizing prep

16 Portals Surgery done thru poke holes called portals Surgery done thru poke holes called portals Typically 4-5 portals are utilized Typically 4-5 portals are utilized Cannulas are placed thru the portals for easier passage of instruments and sutures Cannulas are placed thru the portals for easier passage of instruments and sutures

17 Technique Complete inventory of the shoulder is performed with the camera Complete inventory of the shoulder is performed with the camera Goal is to fix the rotator cuff to its anatomic position Goal is to fix the rotator cuff to its anatomic position Therefore, the pattern (personality) of the tear is evaluated Therefore, the pattern (personality) of the tear is evaluated Next the cuff is fixed to bone with various techniques depending on the tear pattern Next the cuff is fixed to bone with various techniques depending on the tear pattern

18 Repair Sutures can be used to close the tear side to side like a zipper Sutures can be used to close the tear side to side like a zipper Finally, suture anchors (screws with attached sutures are used to fix the cuff to bone Finally, suture anchors (screws with attached sutures are used to fix the cuff to bone Screw goes in bone Screw goes in bone Suture passed thru the cuff and tied to bring the tissue back to bone Suture passed thru the cuff and tied to bring the tissue back to bone

19 Address Associated Pathology Sometimes other parts of the shoulder also cause pain and can be addressed at the time if surgery Sometimes other parts of the shoulder also cause pain and can be addressed at the time if surgery Biceps tendon Biceps tendon The tendon can simply be cut (tenotomy) or cut and sewn down to bone (tenodesis) The tendon can simply be cut (tenotomy) or cut and sewn down to bone (tenodesis) End of the collarbone (clavicle) End of the collarbone (clavicle) Take out end of collarbone (distal clavicle resection) Take out end of collarbone (distal clavicle resection) Bone spurs on the shoulder blade bone (acromion) Bone spurs on the shoulder blade bone (acromion) Smooth bone (subacromial decompression) Smooth bone (subacromial decompression) Torn biceps tendon Smooth shoulder blade bone

20 Surgery Most surgeries can be done with all arthroscopic techniques Most surgeries can be done with all arthroscopic techniques Sometimes incisions must be made to address pathology that cannot be fixed with the camera Sometimes incisions must be made to address pathology that cannot be fixed with the camera This decision is often made at the time of surgery after the shoulder is evaluated with the camera This decision is often made at the time of surgery after the shoulder is evaluated with the camera

21 Post op Wake up in a sling Wake up in a sling If pre-op block was successful then you should be pretty comfortable with a numb arm If pre-op block was successful then you should be pretty comfortable with a numb arm Go home same day Go home same day Start taking your pain medications as soon as you get home prior to your block wearing off. Start 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. It can be very difficult to catch up if you have no pain medication in your system when your block wears off.

22 Post-op-Medications Pain medications Pain medications Take these as needed Take these as needed Not well tolerated on an empty stomach so make sure you eat something first even if just crackers Not well tolerated on an empty stomach so make sure you eat something first even if just crackers Nausea medications Nausea medications Sometimes patients are nauseated after surgery from the anesthesia Sometimes patients are nauseated after surgery from the anesthesia Usually wears off in 24 hours Usually wears off in 24 hours Can take medication if needed Can take medication if needed

23 Post op Leave dressing intact for first 72 hours after surgery. Reinforce if needed Leave dressing intact for first 72 hours after surgery. Reinforce if needed May remove and shower at 72 hours post op May remove and shower at 72 hours post op Do not scrub your wounds Do not scrub your wounds Simply wash your neck with soap and water and let the soap and water run off Simply wash your neck with soap and water and let the soap and water run off Do not soak your wounds until permitted to do so by your physician. NO BATH, SWIMMING OR HOT TUBS. Do 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 air If your wounds are dry, may leave open to the air If oozing then put on a clean dry dressing and call your doctor If oozing then put on a clean dry dressing and call your doctor Do not put any ointments on your wounds. This includes antibiotic ointments (Neosporin, Polysporin, etc) Do not put any ointments on your wounds. This includes antibiotic ointments (Neosporin, Polysporin, etc) It is easiest to wear a button shirt It is easiest to wear a button shirt Wear your sling all the time except to shower Wear your sling all the time except to shower

24 Post op Your first follow-up appointment should be 5-7 days post 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. Please make an appointment to go to physical therapy immediately after your first post op appointment.

25 Post-Op Rehab Start passive range of motion (the therapist moves your shoulder for you) at 1 week Start passive range of motion (the therapist moves your shoulder for you) at 1 week Sling for 4-6 weeks Sling for 4-6 weeks Start active range of motion (you move the shoulder yourself) when sling comes off Start active range of motion (you move the shoulder yourself) when sling comes off Start strengthening at 8-12 weeks Start strengthening at 8-12 weeks No sports, lifting for 4-6 months No sports, lifting for 4-6 months

26 Frequently Asked Questions Will I have therapy post op? Will I have therapy post op? Yes. Initially 2-3 times per week then less often. Exercises must be done at home too! 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? How long do I have to wear the sling? 4-6 weeks. Longer when in an uncontrolled environment 4-6 weeks. Longer when in an uncontrolled environment When can I go back to work? When can I go back to work? This is highly variable depending on what you do This is highly variable depending on what you do For desk jobs it could be as early as a couple days For desk jobs it could be as early as a couple days Labor jobs with lifting, 4-6 months Labor jobs with lifting, 4-6 months

27 Questions Any further questions should be directed to your therapist or surgeon Any further questions should be directed to your therapist or surgeon Please call the office with questions or concerns Please call the office with questions or concerns

28 Thank You


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