Hayward,Orthopedic,Surgeon,Und health Hayward Orthopedic Surgeon on Understanding Rotator Cuff Sur

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Shoulder surgery may be the only feasible option for thosepatients who have sustained a rotatorcuff tear that fails to show progress after non-surgical efforts have beenexhausted. This may be denoted by increased weakness, loss of function, andlimited motion in the joint. Most surgeons consider a course of non-surgicaltreatments to be advisable. For those tears that are associated with extremeloss of strength, the result of acute trauma, and/or are larger than average(exceeding 3 centimeters in length) at the time of the primary evaluation,early surgery may be considered a viable option. The procedure for repairing atorn rotator involves reattaching the tendon back to the ball of the shoulderjoint (humeral head) from where it was separated. There are several methods fordoing this. Each approach has its own pluses and minuses; all have the same endresult in mind – encourage the tendon to adhere to the bone. Selecting theappropriate surgical technique is dependent upon a variety of factors. Theseinclude the familiarity and experience of Hayward area orthopedic surgeons withany given procedure, the extent of the injury, the patient’s healthy body type,and the condition of the tendon and bone. Regardless of which approach isselected, medical studies have shown similar degrees of pain relief, strengthprogression, and patient satisfaction.There are three most commonly performed techniques for rotatorcuff surgery:1.      Open2.      Mini-open3.      All-arthroscopicAny orthopedic surgeon’s ability to repair a torn rotator cuff andaccomplish a suitable result will vary by technique depending on their experiencewith each technique. Whereas a certain surgeon may achieve acceptable resultsusing only arthroscopy, another may do better with a mini-open method. Beforeorthopedic surgery, patients should discuss their available options with theirorthopedic surgeon.OpenThere is no arthroscopy involved with open repair other than possiblediagnostic arthroscopy then, an incision is made over the shoulder to detachthe deltoid muscle and gain visual access to the torn rotator cuff. It is alsocommon for the surgeon to perform an acromioplasty which is the extraction ofbone spurs from the bottom of the acromion. This incision is usually severalcentimeters in length. Originally, pen repair was the only technique availablefor surgically repairing a torn rotator cuff. As time progressed and technologyimproved, less invasive procedures were developed. Even though less invasivetechniques are typically more desirable to most patients, the open repair iseffective at restoring function, reducing pain, and providing lasting relieffrom symptoms.Mini-OpenAs the moniker would suggest, the mini-open repair is a smaller variation ofthe open technique. Incisions are usually 3 cm to 5 cm long. This approachintegrates arthroscopy to view the tear. Injury to other tissues in the jointcan also be assessed. There is no need to detach the deltoid muscle whenperforming arthroscopic acromioplasty. Upon completion of the arthroscopy, thesurgeon will continue on to the mini-open incision and repair the rotator cuff.This operation can be performed on an outpatient basis as are the other twoapproaches. The patient outcomes are comparable to those of open repair andhave proven to be long-lasting.All-ArthroscopicIn this approach, several small incisions called “portals” are made in theshoulder joint allowing an arthroscope to view and repair the rotator cuff.There is a steep learning curve for surgeons as the technique is not easilymastered. This procedure is also performed on an outpatient basis and resultsappear to be comparable to those for mini-open repair and open repair.ResultsFollowing the repair of a rotator cuff, 80% to 95% of patients attainacceptable results, such as satisfactory pain relief, restored joint function,and increased range of motion.There are some factors that may reduce the probability a desirableoutcome:- Poor quality of tissue- Extensive tears- Lack of full compliance with rehabilitation and restrictions- Patients older than 65 years of ageRotator cuff surgery has become less invasive with the passing oftime. As advances in techniques are made, surgeons will experience a learningcurve in its mastery. At one time, larger tears were deemed untreatable usingless invasive techniques but this is changing as surgeons become more adeptwith progressing technology. Be sure to contact my office for more specific informationregarding the limitations of physical activity after recovering fully fromrotator cuff surgery.Committed to getting you back in the game,Dr. K