Posts Tagged ‘rotator cuff surgery’

Rotator Cuff Surgery

rotator cuffThe rotator cuff is a group of four tendons and their attached muscles that stabilize the shoulder and allow you to raise and rotate your arm. The shoulder is a ball-and-socket joint with three main bones: the upper arm bone (humerus), the collarbone (clavicle), and the shoulder blade (scapula). The rotator cuff helps keep the ball of the arm bone seated into the socket of the shoulder blade.

When the tendons and muscles of the rotator cuff are overly stretched or damaged, the shoulder may begin to hurt. Patients with a rotator cuff tear usually have a dull ache in their upper arm in the area of the deltoid muscle. Neck pain on the same side may develop over time, as well as dull headaches. Patients may experience weakness or “popping” in the shoulder. and have difficulty with over-head shoulder activities (tennis, swimming, getting dressed). Night pain is a common finding with rotator cuff injuries, and may result in the inability to sleep.

If you’ve torn your rotator cuff, your doctor may recommend surgery if your pain does not improve with nonsurgical methods. These include exercises using light weights and rubber bands, anti-inflammatory medications and massage to relieve discomfort. Continued pain and inability to perform the activities of daily living are the primary indications for surgery, and if you’re very active and use your arms for overhead work or sports, your doctor may also suggest surgery.

Surgery to repair a torn rotator cuff most typically involves sewing the torn edges of the tendon to their insertion on the top of the humerus, but partial tears may only require a trimming or smoothing procedure (debridement) to remove loose fragments of tendon, thickened bursa, and other debris from around the shoulder joint.

In open shoulder surgery, a surgeon makes an incision in the shoulder to open it and view the shoulder directly while repairing it. However, most tears can be fixed via arthroscopic surgery. Arthroscopic rotator cuff repair is a minimally invasive technique for repairing a damaged rotator cuff. Using a small fiberoptic camera, the surgeon repairs the rotator cuff through 2-3 small incisions (portals) in the shoulder. Arthroscopic techniques result in less pain and stiffness, thus leading to a faster initial recovery time. Because arthroscopic tools are thin, your surgeon can use very small incisions, rather than the larger incision needed for standard, open surgery.

Surgery for rotator cuff repair requires significant recovery time. The patient will most likely wear a sling for four to six weeks. It will take approximately 3 months for initial healing of the tendon, but patients may begin light activities, such as writing and typing, almost immediately after surgery. Light weightlifting and shoulder strengthening begins 10-12 weeks post-operatively. You may not have significant pain relief or an increase in motion for several months following rotator cuff surgery. The healing process, coupled with physical therapy takes an extended period of time, sometimes up to six to nine months for a full recovery.

About Dr. Karas

Spero Karas, MDSpero Karas, MD,  is the Director of the Orthopaedic Sports Medicine Fellowship Program and an Associate Professor of Orthopaedic Surgery at Emory University. Dr. Karas is an internationally recognized expert in his field, which includes sports medicine, surgery of the shoulder and knee, and arthroscopic surgery. He has been recognized as one of America’s “Top Orthopaedic Doctors” in Men’s Health Magazine April 2007 and “Top Sports Medicine Specialists for Women” in Women’s Health Magazine. Atlanta Magazine has named him “Atlanta’s Most Trusted Sports Medicine Specialist” for the past eight years.

Dr. Karas came to Emory in 2005, after serving as Chief of the Shoulder Service and team physician at the University of North Carolina in Chapel Hill. He currently serves as team physician for the Atlanta Falcons, as well as a consulting team physician for Emory University and Georgia Tech athletics. He cares for patients and athletes of all levels: professional, collegiate, scholastic, and recreational.

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Using -Skin- to Repair Your Rotator Cuff?

Dr. Spero KarasThe rotator cuff is the group of muscles and tendons that serve to stabilize the shoulder. The rotator cuff plays a key role in upper body mobility and ability when it comes to daily activities and athletic participation. Unfortunately, injuries to the rotator cuff, and specifically rotator cuff tears, are among the most common conditions affecting the shoulder.

Traditionally, surgeons have treated severe rotator cuff tears in one of three ways: simply removing dead and inflammatory tissue and bone spurs; transferring a tendon from another part of the body to the rotator cuff; or using freeze-dried human tissue or animal grafts to replace the missing tissue.

Unfortunately, in many cases, those rotator cuff tear treatments have been inadequate. Removing the inflammatory tissue and bone spurs certainly helps with the pain, but does nothing to improve motion. Transferring a tendon causes a lot of pain and trauma for patients who have to undergo surgery on two different sites on the body and, what is more, these extensive procedures may result in excessive complications.

As an alternative treatment for rotator cuff tears, I began using human skin grafts to perform a procedure called the “Bridge Technique.” In this procedure, the graft is surgically attached from the deficient tendon to the bone, forming a “bridge” over the empty space that once was a healthy tendon. Preliminary results in a study using human skin grafts to repair severe tears to the rotator cuff show that patients’ mobility is improved and pain is decreased.

In order to determine how the graft held up in 15 of my patients who were nearly a year or more out from having the procedure, I used Magnetic Resonance Imaging (MRI) and Ultrasound. In doing so, I found that in almost all of those patients, there was substantial healing of the graft and no complications related to the graft itself. Additionally, one year after the operation, patients had significant improvements in range of motion and a significant decrease in pain.

It’s very encouraging that in the evaluation of our early outcomes, nearly every one of our patients in this small series had favorable results, and their quality of life has improved. Using human tissue that has been properly processed for safety and durability has thus far provided a reliable option for patients who have had few alternatives for treatment.

Candidates for this procedure must be non-smokers with an irreparable rotator cuff tear, minimal arthritis, no joint dislocation and have less than 50% atrophy of their involved rotator cuff muscles.

I’ve included a video below that discusses the Bridge Technique and rotator cuff tear repair via skin grafts in more detail. Take a few minutes to check it out, and if you have questions for me, leave them in the comments below!

 

About Spero Karas, MD:

Dr. Karas joined the Emory Orthopaedic & Spine Center on February 1, 2005. Prior to that he served as chief of the Shoulder Service, team physician, and director of the Orthopaedic Sports Medicine Fellowship at the University of North Carolina at Chapel Hill Department of Orthopaedics. In addition to his role as director of the Orthopaedic Sports Medicine Fellowship Program at Emory, he serves as a consulting team physician for Georgia Tech and Emory University Athletics. Dr. Spero Karas is also an associate professor in the Department of Orthopaedics at Emory University School of Medicine and head team physician for the Atlanta Falcons.