The shoulder is an extremely complex yet elegant piece of machinery. It happens to have the greatest range of motion of any joint in the body. However, this large range of motion can cause the shoulder to become unstable, leading to joint problems and the site of multiple injuries. Your shoulder joint is composed of four joints, over 30 muscles, 6 major ligaments, and three bones: the clavicle (collarbone), the scapula (shoulder blade), and the humorous (upper arm bone). The edge of the scapula, called the acromion, forms the top of the shoulder.
Understanding the different layers of the shoulder and how it is built and connected can help you understand how the shoulder works and how it can become injured. When you realize all the different ways you use and position your hands and shoulders every day, it is easy to understand why they are vulnerable to injury and how hard daily life can be when the shoulder isn’t working well.
Your shoulder happens to encompass the most movable joints in your body, but can become unstable and the site of injuries, such as, sprains, strains, dislocations, separations, torn rotator cuffs, bursitis, tendonitis, frozen shoulder, fractures and arthritis.
What is Your Rotator Cuff?
Rotator cuff tears are one of the most common reasons why people have shoulder pain. The rotator cuff is made up of four muscles which control how well your shoulder works. If a tear in the rotator cuff is large enough it can affect how well the shoulder will function. Rotator cuff tears can occur because of an injury, trauma or simply because our tissue wears out.
Many rotator cuff tears can be treated without surgery. However, your doctor may recommend surgery for a torn rotator cuff if your pain does not improve with nonsurgical methods. Continued pain is the main indication for surgery. More than ever it is important that you have a good understanding about rotator cuff tears.
Treatment:
The three surgical techniques most commonly used for rotator cuff repair include traditional open repair, arthroscopic repair, and mini-open repair. In the end, patients rate all three repair methods the same for pain relief, strength improvement, and overall satisfaction. Over the years, new technology and improved surgeon experience has led to less invasive procedures.
Open Repair
A traditional open surgical incision (several centimeters long) is often required if the tear is large or complex. The surgeon makes the incision over the shoulder and detaches the shoulder muscle (deltoid) to better see and gain access to the torn tendon.
During an open repair, the surgeon typically removes bone spurs from the underside of the acromion (this procedure is called an acromioplasty). An open repair may be a good option if the tear is large or complex or if additional reconstruction, such as a tendon transfer, is indicated.
All-Arthroscopic Repair
During arthroscopy, your surgeon inserts a small camera, called an arthroscope, into your shoulder joint. The camera displays pictures on a television screen, and your surgeon uses these images to guide miniature surgical instruments. Since the arthroscope and surgical instruments are thin, your surgeon can use very small incisions (cuts), rather than the larger incision needed for standard, open surgery. All-arthroscopic repair is usually an outpatient procedure and is the least invasive method to repair a torn rotator cuff.
Mini-Open Repair
The mini-open repair uses newer technology and instruments to perform a repair through a small incision. The incision is typically 3 to 5 cm long. This technique uses arthroscopy to assess and treat damage to other structures within the joint. Bone spurs, for example, are often removed arthroscopically. Once the arthroscopic portion of the procedure is completed, the surgeon repairs the rotator cuff through the mini-open incision. During the tendon repair, the surgeon views the shoulder structures directly, rather than through a video monitor.
If you think you may be a candidate for rotator cuff repair, call Dr. Bill Hefley at (800) 336-2412 to request an appointment, or request an appointment online.
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