We have found that the human rotator cuff is considered to be one of the more commonly injured or damaged parts of the body, especially in the case of those who participate in sports where the athlete uses some type of shoulder motion (i.e. Baseball, Tennis, Swimming, Volleyball, etc.) and people over the age of 40. The cause of rotator cuff damage can occur in a variety of different ways and can be treated a handful of different ways. Because rotator cuff surgery is also one of the procedures that we specialize in here at the Orthopaedic Center of Arlington, we would like to help educate you on the causes of rotator cuff damage and the surgical process.
Anatomy of the Rotator Cuff
The rotator cuff is made up of four major muscles (subscapularis, supraspinatus, infraspinatus, and teres minor) as well as the tendons connecting the upper part of the arm bone (humerus) with your shoulder blade.
Causes of Rotator Cuff Damage
A rotator cuff injury is most commonly damage or tearing to the tendon connected to the subscapularis muscle, but it can also be damage to the muscle itself. Typically, whenever a patient is in need of rotator cuff surgery it is due to strain or a tear of a tendon or muscle. This damage is often caused by tendinitis which can be brought on by overuse or overload of the shoulder. Tendinitis left untreated can lead to degeneration and/or tearing. Acute tearing can also occur with a sudden injury like falling down or lifting something too heavy with a jerking motion. Acute tears have also occurred with other injuries to the shoulder, such as a broken collarbone or dislocated shoulder.
Surgical Process to Repair Rotator Cuff
When assessing the options to repair a rotator cuff tear, there are a couple of different options. Medical advancements have brought us to the point of surgical techniques that are much less invasive than previously known. Each process has different advantages and disadvantages.
The options that a patient has are determined by a few factors, including the experience and capabilities of the doctor, the extent of the tear, the physical anatomy of the person, and the quality of the tendon tissue or bone. If the patient has other shoulder problems like bone spurs or soft tissue damage the surgeon can typically take care of the problems all in one operation.
The three options that are most common when repairing a rotator cuff tear include the traditional open repair, arthroscopic repair, and mini-open repair.
Open repair falls into the most traditional type of surgical repair. The surgeon makes a sizeable incision and then has access to the damaged portion of the shoulder. This type of repair is most often used when the tear is large or complex. The surgeon makes the incision over the shoulder and then detaches the deltoid muscle to gain visual access to the torn tendon. As technologies have become more advanced this procedure is used less and less, and procedures that are less invasive have been pursued.
All-arthroscopic repair is the least invasive procedure, where the surgeon inserts a small camera into the shoulder joint. This camera is called an arthroscope and is the way in which the surgeon see while repairing the damaged portion of the shoulder. Because the arthroscope and surgical instruments are thin the incision can be much smaller, cutting down on recovery time.
The last type of repair is the mini-open repair procedure. This is the newest form of shoulder repair and it uses new technologies in order to fix the shoulder issue. Similar to the open repair, a surgeon can take care of addition problems while executing the procedure, but in this case, does not need to detach the deltoid muscle. This procedure uses the arthroscope to view the problematic area and then is viewed directly while being repaired instead of through a video screen.