Jones Susan S. Jordan Douglas B. Kasow Keith A. Lamberson Yong S. Lee William J. Lichtenfeld Ryan W. Lirette Travis W. Littleton Richard R. Maguire J. Ryan Mahoney M. Jonathan Mathers Michael A. McHenry Wesley H. Miller Brian E. Morgan Daniel R. Orcutt Kevin U. Phillips Jake J. Schmidt Jeffrey P. Smith David A. Stokes Peter J. Symbas Shyam K. Most people feel better faster, but they are not technically healed faster after an arthroscopic repair.
All surgeries done to repair the rotator cuff, whether performed through open incisions or using the arthroscope, are designed to replace the rotator cuff to its original site, called the insertion.
The sutures placed to hold the cuff would fatigue over time and the repetition of normal shoulder motion if it were not for the fact that the body "heals" the cuff to the repaired position with relatively normal tendon. The rate of the healing process is not affected by the method used to repair the cuff, so the cuff will not "heal" more quickly if a less-invasive, arthroscopic procedure is performed. However, most patients feel better much sooner after an arthroscopic procedure because these procedures do not require the extra healing of the deltoid muscle and longer skin incisions.
Most of the recent studies show that in the hands of surgeons who are expert in all-arthroscopic rotator cuff repair, the results are comparable to open techniques. Interestingly, the studies of arthroscopic repairs show otherwise: the results do not appear to be significantly worse with larger tear sizes.
Studies have shown that "retear" rates may be higher with arthroscopic techniques, and the durability of these relatively new techniques will be better understood over time. The results of arthroscopic and open rotator cuff repair procedures are most effective when the patient follows a simple post-operative rehabilitation program.
Persons who suffer from pain, weakness and muscular imbalances in the shoulder may lose valuable time from work, become progressively disabled, or worse: do permanent or irreparable damage to the rotator cuff or develop premature arthritis.
It is impossible to predict whether a person who first presents with short-term pain and disability from a rotator cuff injury or tear will improve without surgery. Except in rare instances, an experienced physician or surgeon will first try to rehabilitate the shoulder with an intensive physical therapy program. If the function of the rotator cuff can be balanced, many people will avoid the need for surgery. In cases of an extremely long-standing rotator cuff tear with shoulder dysfunction, arthritis can occur in the shoulder joint.
This process is called rotator cuff arthropathy and can lead to severe disability and irreversible changes to the shoulder joint. Usually, if the process has gone unchecked for a long time, a rotator cuff repair is unlikely to be successful. Other surgical operations, involving replacement of the humeral head also called hemi-arthroplasty may be required to alleviate symptoms.
In the hands of a surgeon who is experienced with arthroscopic shoulder surgery, almost all of the following procedures can be performed alone or together to restore strength and eliminate pain in the shoulder joint or from the rotator cuff:. In the hands of an experienced surgeon, arthroscopic rotator cuff repair can be very effective in eliminating pain and restoring strength and function to the shoulder of a well-motivated patient.
The greatest benefits are often the ability to perform the usual activities of daily living, overhead activities, and sports without discomfort, and to sleep without a chronic ache in the shoulder.
As long as the shoulder is cared for properly and subsequent traumatic injuries are avoided, the benefits of repair should be permanent.
There are a few exceptions to this philosophy:. Adverse events following shoulder surgery are extremely rare , but they can not be completely eliminated. The risks of arthroscopic rotator cuff repair include but are not limited to the following:.
Infection, temporary or permanent injury to the nerves and blood vessels around the shoulder, permanent joint stiffness, recurrent tears of the rotator cuff, pain, allergic reactions to any implants or suture materials used to stabilize the joint, or the need for additional surgeries. The anesthesia used during the procedure also has some risks, that can be addressed by the anesthesiologist. The experienced and cautious surgical team uses special techniques to minimize all the above risks.
Many of the risks of surgical stabilization can be effectively managed if they are promptly identified and treated. Infections may require a wash-out of the joint, and rarely require removal of any implanted materials. Blood vessel or nerve injuries are rare, and most resolve spontaneously. Occasionally, such an injury may require surgical repair. Excessive stiffness of the joint is rare in the person who is cooperative with the postoperative rehabilitation program, and most of the stiffness will respond to exercises.
If a patient has questions or concerns about the "normal" course after surgery, the surgeon should be informed as soon as possible and be available to explain the expected course and outcome. Surgical rotator cuff repair is considered for healthy and motivated individuals in whom pain and weakness interfere with shoulder function and activity. Successful surgery depends upon a partnership between the patient and the experienced shoulder surgeon. Patients should optimize their health to prepare for surgery.
Smoking should be stopped one month prior to surgery, and be avoided altogether for at least three months following surgery. Any heart, lung, kidney, bladder, tooth, or gum problems should be managed before the shoulder surgery. Any active infections will delay elective surgery to optimize the benefit and reduce the risk of shoulder joint infection.
The surgeon should be made aware of any health issues, including allergies and non-prescription and prescription medications being taken. Some medications will need to be held or stopped prior to surgery.
Before surgery, patients should consider the limitations, alternatives and risks to surgery. Patients must plan on being less active and functional for 12 to 16 weeks after the surgery.
Driving, shopping and performing overhead chores, lifting, and repetitive arm activities may be difficult or impossible during this time. Plans for the necessary assistance need to be made before surgery. For individuals who live alone or those without readily-available help, arrangements for home help should be made well in advance. Usually, the complete rehabilitation and restoration to normal function can take as long as 6 months. Rotator cuff surgery can be delayed until the time that suits the patient best.
In persons who have longstanding symptoms it is probably prudent to consider surgery before secondary atrophy and arthritic changes can develop. Rotator cuff repair, particularly when done through the arthroscope is a technically demanding procedure that must be performed by an experienced, specially trained shoulder surgeon in a medical center accustomed to performing complex arthroscopic shoulder procedures on a weekly basis.
Patients should inquire as to the specific training the surgeon has undergone to perform such procedures i. While surgeons who are capable of performing simple arthroscopic procedures are relatively easy to find, complex reconstructive surgeries in the shoulder like arthroscopic stabilization procedures and arthroscopic rotator cuff repairs demand a degree of highly-specialized training. Many capable surgeons will have completed a fellowship additional year or two of training specifically in arthroscopic techniques, shoulder surgery and sports medicine.
A qualified sports medicine surgeon should be comfortable with both open traditional and arthroscopic techniques, and tailor the appropriate treatment to the problem to be addressed. Fellowship-trained surgeons may be located through university schools of medicine, county medical societies, or state orthopedic societies. Arthroscopic rotator cuff repair is usually performed in a qualified ambulatory surgical center or major medical center that performs such procedures on a regular basis.
These centers have surgical teams, facilities, and equipment specially designed for this type of surgery. For those patients who require an overnight stay, the centers have nurses and therapists who are accustomed to assisting patients in their recovery from shoulder stabilization.
Rotator cuff repair, either arthroscopic or through a "mini-open" incision is a highly technical procedure; each step plays a critical role in the outcome. After the patient is comfortably positioned in a seated position and anesthetic has been administered, the shoulder is given a sterile wash and draped for surgery. The surgeon begins by examining the shoulder while the patient is asleep or the shoulder relaxed so he or she can assess the relative stability of the joint, the range of motion, and feel for any abnormal grinding or catching of the joint.
Next, one or two very small 1cm incisions, or "portals" are made, usually one in the front and one behind the shoulder joint. If the injury is a severe tear that results in constant pain, or it does not respond to more conservative treatment, it is unlikely symptoms will resolve without surgery.
Pain and weakness may increase if the tear or tears do not get surgically addressed. If you think you may need surgery, learn more about if you may need one. Shoulder arthroscopy is a technique that can diagnose and treat a variety of shoulder joint injuries.
This technique differs from traditional, open approaches to surgery. Instead of making a large incision, the surgeon will make several smaller incisions —usually about half an inch — to reach the injured tendon. Next, the surgeon will insert a thin camera, called the arthroscope, into one of the incisions to get an anatomic visual of the injury and surrounding tissue. The other incisions allow for the insertion of specialized surgical tools that assist the surgeon in removing scar tissue and bone spurs, both of which can contribute to the painful symptoms of a rotator cuff tear.
The surgeon will also use plastic screws and sutures to repair the torn tendon. A torn rotator cuff is just one of the conditions shoulder arthroscopy can treat. Other common indications include labrum tear , ligament tear and repair of frequent shoulder dislocations. The price of rotator cuff surgery will depend on several factors.
The price of the surgery will hinge on variables such as your insurance coverage, your annual deductible, your coinsurance and your out-of-pocket maximum. The cost of the surgery will include the surgeon, anesthesia, imaging, lab tests and the hospital. You could receive separate bills for each of these services. When talking to your insurance company, it can be helpful to reference specific codes related to shoulder arthroscopy.
Commonly used codes for arthroscopic rotator cuff repair include:. Any surgery comes with the risk of complications. While these are rare, it is essential you become an informed patient before deciding to undergo surgery.
The potential complications of shoulder arthroscopy include the following. In addition to these risks, shoulder arthroscopy requires the use of anesthesia. The risks, though slight, of anesthesia include blood clots, heart attack and stroke.
Surgery is a stressful experience for many people, but knowing what to expect can alleviate some of that worry. Here are the necessary steps to know. Pain management is one of patients' most significant concerns following surgery.
Anesthesia and a nerve block will help with pain the day of the surgery, but once you go home, you will be responsible for managing your pain. Your care team will help prepare you to return home to begin your recovery process. Here are some things you can do to stay comfortable after surgery. Recovery happens in a few different stages. The first step is managing your postoperative pain.
Although your arm will likely be immobilized in a sling for four to six weeks after the surgery , you can return to most of your normal activities within a few days of surgery. You will be able to drive and walk, but remember you will be doing these things with one arm. During your recovery period, you will work with your physical therapist to regain motion and strengthen the area.
The rotator cuff surgery recovery timeline can vary case by case, but a full recovery typically takes four to six months. The spur can cause inflammation and pain in your shoulder. Surgery for shoulder instability: If you have a torn labrum, the surgeon will repair it.
The labrum is the cartilage that lines the rim of the shoulder joint. Ligaments that attach to this area will also be repaired. The Bankart lesion is a tear on the labrum in the lower part of the shoulder joint.
A SLAP lesion involves the labrum and the ligament on the top part of the shoulder joint. Why the Procedure is Performed. Arthroscopy may be recommended for these shoulder problems: A torn or damaged cartilage ring labrum or ligaments Shoulder instability, in which the shoulder joint is loose and slides around too much or becomes dislocated slips out of the ball and socket joint A torn or damaged biceps tendon A torn rotator cuff A bone spur or inflammation around the rotator cuff Inflammation or damaged lining of the joint, often caused by an illness, such as rheumatoid arthritis Arthritis of the end of the clavicle collarbone Loose tissue that needs to be removed Shoulder impingement syndrome, to make more room for the shoulder to move around.
Risks of anesthesia and surgery in general are: Allergic reactions to medicines Breathing problems Bleeding, blood clots, infection Risks of shoulder arthroscopy are: Shoulder stiffness Failure of the surgery to relieve symptoms The repair fails to heal Weakness of the shoulder Blood vessel or nerve injury Damage to the cartilage of shoulder chondrolysis.
Before the Procedure. During the 2 weeks before your surgery: You may be asked to temporarily stop taking blood thinners. These include aspirin, ibuprofen Advil, Motrin , naproxen Naprosyn, Aleve , and other medicines.
Ask your provider which medicines you should still take on the day of your surgery. If you have diabetes, heart disease, or other medical conditions, your surgeon may ask you to see your doctor who treats you for these conditions. Tell your provider if you have been drinking a lot of alcohol, more than 1 or 2 drinks a day. If you smoke, try to stop. Ask your provider for help. Smoking can slow wound and bone healing. Tell your doctor about any cold, flu, fever, herpes breakout, or other illness you may have before your surgery.
On the day of surgery: Follow instructions about when to stop eating and drinking. Take any drugs you're asked to take with a small sip of water. Follow instructions on when to arrive at the hospital.
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