In an arthroscopic rotator cuff repair, the surgeon makes several small incisions and inserts a long thin camera called an arthroscope into the shoulder joint in order to visualize the anatomy. Instruments are also inserted through these small incisions to repair the torn tendon back down to the humerus.
Most rotator cuff surgery is currently done arthroscopically, and most people do not need to stay in the hospital overnight after this type of operation. Open tendon repair requires a larger incision and some surgeons may recommend this operation for larger, more severe tears. During open surgery, the surgeon may also need to detach a part of the deltoid muscle on the front of the shoulder to be able to see more clearly. Open surgery is a good option when other issues with the shoulder need attending to at the same time.
Recovery time is longer than for arthroscopic rotator cuff repair and patients may require an overnight stay in the hospital. After rotator cuff surgery, it is not uncommon to feel tired for a few days. Some swelling and pain around the incision site is also common.
They are also advised not to lift any weight for up to 12 weeks. Recovery usually involves three phases , and it can take up to a year before a person is able to do things such as play contact sports.
In the first phase of recovery, a person generally wears a sling most of the time. However, the duration of its use varies from surgeon to surgeon. Use of the operated shoulder is mostly not permitted, other than during prescribed physical therapy exercises. People can often resume some light activities, but they should ease into them on the advice of their surgeon, physiotherapist, or both.
Twelve weeks after surgery, most people can increase activities that will help them regain strength in their shoulder and allow them to utilize their full range of motion.
It is always best to follow all advice from the surgeon and physiotherapist to ensure the best possible outcome.
If a person tries to push themself and move too quickly, this can be detrimental to the recovery process. Common side effects associated with anesthesia generally only last for a few days and may include:.
Another complication that can arise from any kind of surgery is an infection around the incision site. In rare cases of very large and chronic tears, the tendon may be too badly damaged and cannot be repaired at the time of surgery. Even in these uncommon instances, pain may improve post-operatively, but strength of the shoulder will not.
Occasionally, a surgically repaired rotator cuff may tear again, requiring a second operation to refix the tendon. Though health providers may recommend conservative treatment before carrying out surgery, rotator cuff repair may be the best option for those patients who have a more severe rotator cuff injury. You may have to wear a sling for 4 to 6 weeks after surgery. Pain is usually managed with medicines. Physical therapy can help you regain the motion and strength of your shoulder.
The length of therapy will depend on the repair that was done. Follow instructions for any shoulder exercises you are told to do. Surgery to repair a torn rotator cuff is often successful in relieving pain in the shoulder. The procedure may not always return strength to the shoulder.
Rotator cuff repair can require a long recovery period, especially if the tear was large. When you can return to work or play sports depends on the surgery that was done.
Expect several months to resume your regular activities. Some rotator cuff tears may not fully heal. Stiffness, weakness, and chronic pain may still be present. Surgery - rotator cuff; Surgery - shoulder - rotator cuff; Rotator cuff repair - open; Rotator cuff repair - mini-open; Rotator cuff repair - laparoscopic. The rotator cuff.
Rockwood and Matsen's The Shoulder. Philadelphia, PA: Elsevier; chap Rotator cuff and impingement lesions. Phillips BB. Arthroscopy of the upper extremity. Campbell's Operative Orthopaedics. Updated by: C. Editorial team. Rotator cuff repair. Three common techniques are used to repair a rotator cuff tear: During open repair, a surgical incision is made and a large muscle the deltoid is gently moved out the way to do the surgery. Open repair is done for large or more complex tears. During arthroscopy, the arthroscope is inserted through small incision.
The scope is connected to a video monitor. This allows the surgeon to view the inside of the shoulder. One to three additional small incisions are made to allow other instruments to be inserted. During mini-open repair, any damaged tissue or bone spurs are removed or repaired using an arthroscope. Then during the open part of the surgery, a 2- to 3-inch 5 to 7.
To repair the rotator cuff: The tendons are re-attached to the bone. 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. Through these small portals, hollow instruments called "canulas" are placed that irrigate the inside of the shoulder joint with sterile saline and "inflate" the joint with clear fluid. The canulas allow the placement of an arthroscopic camera and specially designed instruments within the shoulder joint.
The surgeon maneuvers the camera around the joint while he or she watches a video monitor of what the camera "sees". A highly-skilled surgeon can evaluate all of the important structures within the joint, test their stability and integrity, and look for signs of ligament injuries, cartilage wear or arthritis , and bony injuries that can be caused by or lead to shoulder instability or dislocation. Most often, the surgeon will take photographs of the interior of the joint to help to explain to the patient what was found, and how it was corrected.
This portion of the surgery is called a "diagnostic arthroscopy" and is absolutely necessary to assure the success of any surgical procedure in the shoulder even if an MRI had been obtained prior to the procedure. This is because the arthroscopic examination of the joint is still the "gold standard", or best way to understand ALL of the factors that could be present and may need to be addressed to treat the problem.
Once the surgeon understands what structures within the joint are injured or torn, he or she will choose the best possible surgical approach to treat the problem.
A highly-skilled surgeon who is comfortable with the anatomy of the joint and who has exceptional skills with specially-designed arthroscopic instruments and implants can usually address the problem without the need for large incisions.
For the most common type of rotator cuff tears, the tendon of the rotator cuff muscle called the supraspinatus will have torn and pulled back slightly from its normal attachment at the greater tuberosity atop the humerus. These "anchors" can be made of metal or absorbable compounds. They are screwed or pressed into the bone of the attachment site and the attached sutures are used to tie the edge of the rotator cuff in place.
As tears become larger, they deform and the tendon tissue "shrinks". Thus, larger tears need to be refashioned, repaired side-to-side, or "zipped" closed using a technique called margin convergence.
This technique is analogous to zippering shut an open tent flap. These are metallic or absorbable plastic devices that secure sutures to the bony attachment. The sutures are then sewn through the torn edge of the cuff to complete the repair. Occasionally, the site where the end of the collar bone clavicle meets the roof over the shoulder is found to be arthritic.
If there are bone spurs below the clavicle, these can be removed using the arthroscope and special instruments as well. At the conclusion of the procedure, any incisions are closed using absorbable or removable sutures. Absorbable "suture anchors" or implants are gradually absorbed and the sutures attached are incorporated into the healing tissues. When metallic anchors are used a matter of surgeon preference , these are buried in the bone, and do not affect the integrity of the bone or the shoulder joint.
Further surgery is NOT normally required to remove the suture anchors after healing. Arthroscopic and traditional open shoulder stabilization procedures may be performed under a general anesthetic or under a regional block that makes the shoulder and arm numb during and for several hours after the procedure.
The patient may wish to discuss their preferences with the anesthesiologist prior to surgery. Patients usually spend 1 or 2 hours in the recovery room.
Patients who undergo arthroscopic procedures almost always are comfortable enough to be discharged home. Recovery of comfort and function following shoulder procedures continues over a few months. Initially, the shoulder must be protected from overuse or stressing the repair while the shoulder heals using a sling and a very strict rehabilitation program.
Ironically, many patients who undergo arthroscopic procedures feel very comfortable long before the healing has taken place, probably because the approach spares the patient from large incisions and dissection through the muscle tissues.
Immediately postoperatively, the patient is given strong medications such as morphine or Demerol to help with the discomfort of swelling and the work of the surgery. Most patients are discharged to home the day of surgery with a prescription for oral pain medications such as hydrocodone or Tylenol with codeine and an anti-inflammatory medication. Immediately postoperatively, pain medications are given through an intravenous IV line.
Patients who require a hospital stay are placed on patient controlled anesthesia PCA to allow them to administer their own medication as it is needed. Oral pain medications are rarely required after the first two to three weeks following the procedure. Pain medications are very powerful and effective.
Their proper use lies in the balancing of their pain-relieving effect and their other, less desirable effects. Good pain control is an important part of appropriate postoperative management. Other pain medications taken through the IV or orally can cause drowsiness, slowness of breathing, difficulties in emptying the bladder or bowel, nausea, vomiting, itching, or allergic reactions.
Patients who have been on pain medications for a long time prior to surgery may find that the usual doses of pain medication are less effective. For some patients, balancing the benefits and side effects of medications is challenging. Patients should notify their surgeon if they have had previous difficulties with pain medications or pain control.
Most patients will not require a hospital stay after an arthroscopic rotator cuff repair procedure. Generally, a person must spend an hour or two in the recovery room until the anesthetic medication has worn off. The instructions for the care of their shoulder, bathing, use of medications, and potential problems are explained to the patient and their family prior to discharge. Because fluid is used to expand the shoulder joint during arthroscopic procedures, the shoulder is frequently swollen for a few days following surgery.
Also, the incisions will "weep" fluid for a couple of days postoperatively, and the dressing can become damp. These exercises will be explained prior to discharge. Some patients find that finding a comfortable position to sleep can be difficult for the first few days. Some tricks to help sleeping are to:. For the first 3 or 4 weeks, a home program of rest and limited self-therapy is usually recommended. Then, as healing has progressed, the arm is removed from the sling and a formal rehabilitation program is started with the physical therapist, on an outpatient basis.
Some early motion is important after rotator cuff repair, but unrestricted motion can endanger the success of the procedure. For the first 3 or 4 weeks, the patient is scheduled to see a physical therapist once or twice per week to monitor the progress of healing and to reiterate the proper exercises.
After a few weeks, the sling is removed, and a more comprehensive rehabilitation program is started. During this period, the therapist works closely with the patient to re-establish a normal range of motion.
The therapist and patient work together, but the patient is expected to do "homework" on a daily basis so that constant improvement is achieved. Once a normal range of motion is re-established, shoulder strengthening is started. It takes about weeks before the shoulder is completely rehabilitated for the normal activities of daily living, and about months before contact athletics, throwing, and overhead sports can be re-started. A good therapist can work with the patient on "sports-specific" training to re-train the muscles and shoulder for golf, tennis, throwing, and swimming.
The results of physical therapy are optimized by a competent therapist or certified athletic trainer , familiar with the procedure and the usual expectations, and a compliant patient , who is responsible to do home exercises and is motivated to improve. Most surgeons have a standard "protocol" that they can give to a physical therapist to let them know how to rehabilitate the shoulder. It is important for a patient to find a therapist with flexible hours and in a convenient location because the therapy will become part of a routine for 3 to 4 months.
The surgeon can recommend a therapist or therapy group with whom he or she is used to working and who is familiar with the procedure. Therapy is generally done on an outpatient basis, with 2 or 3 visits per week so that the therapist can check the progress and review or modify the program as needed to suit the individual. Patients are almost always satisfied with the range of motion, comfort and function that they achieve as the rehabilitation program progresses.
The sense of pain with overhead motions is usually present for several weeks following the surgery and is normal in the course of healing. Occasionally, persons will have slight decreases in their overall overhead mobility. These minimal decreases usually do not affect the ability to perform overhead activities or prohibit a return to athletics at the same or a higher level. If the exercises remain or become painful, difficult, or uncomfortable, the patient should contact the therapist and surgeon promptly.
There are very few risks to appropriate postoperative therapy. If the therapist and surgeon are not in communication about what exactly what was done and what the short and long term expectations are following this procedure, the therapist can be too aggressive or alternatively too timid about the rehabilitation.
This can result in failure of the procedure re-tear of the cuff or excessive shoulder stiffness. It is uncommon for these problems to occur. Every patient is slightly different.
0コメント