Shoulder dysfunction and impairment can result from tears in the rotator cuff (RC). Repair of the rotator cuff aims for pain elimination as well as improved function, increase the strength in the shoulder, and improve the motion range. Rotator cuff repair with a Phoenix shoulder surgeon can be either open, mini-open, or all-arthroscopic. Each type of method has its own advantages and disadvantages.
Early safe motion allows for optimal tendon healing and minimal stress applied to maintain the joint mobility. Rotator cuff repair still continues to develop in the field of orthopedics with new technologies ensuring optimal outcomes and patient satisfaction. The Phoenix orthopedic doctor, physical therapist, and patient need to work closely together.
Open Rotator Cuff Repair Technique
Open surgical technique was previously considered as the gold standard as it pertains to repairs of the rotator cuff. Shoulder surgeons in Phoenix such as Dr. Dewanjee at FXRX have managed to become more adept at decreasing patient morbidity, by further reducing the surgical trauma by the use of an all-arthroscopic approach.
Coordination of care and the effective communication by the surgeon and the physical therapist, in addition to a surgery-specific rotator cuff rehabilitation program, is essentially required for an optimal patient outcome and education.
To repair rotator cuff tears, a traditional open subacromial decompression and rotator cuff tendon reapproximation can be employed to restore function and decrease pain. Although there are some disadvantages associated with open rotator cuff repair.
Results in significant morbidity and postoperative detachment of the deltoid repair have been reported. A longer period of limited motion might be required by the open technique, which can result in greater stiffness.
Arthroscopic Technique for Rotator Cuff Repair
An ideal situation for an arthroscopic rotator cuff repair would be where a therapist who is well-educated with great communication skills, co-operates with the surgeon who is responsible for the treatment to help early mobilization of the shoulder, the safe re-establishment of scapulothoracic function, and also minimizes any risks of retear and stiffness.
Additionally, the surgical team and therapist should assist the patient to return to normal function. Patient age, size and chronicity of tear, fixation method, and surgical approach are the individual factors that can affect the treatment options to be employed. It is recommended that all arthroscopic rotator cuff repair patients should undergo an accelerated rehabilitation program.
The advantages of the completely arthroscopic cuff repair over the open and mini-open cuff repair techniques are many. The first of which is the reduction in scarring and adhesions by the decreased disruption of the soft tissues. Of all techniques, this arthroscopic rotator cuff repair is the most appealing cosmetically.
An advantage could be reduced postoperative pain, but this has been demonstrated only in a single nonrandomized study. Arthroscopic rotator cuff repair is likely to become more commonly performed as shoulder arthroscopic skills and instrumentation improve. It is at the moment, an effective and viable technique in the hands of surgeons with adequate skills.
The Mini-Open Technique
Recently, complete arthroscopic repairs of the rotator cuff have been developed and are being applied, as well as the already arthroscopically assisted mini-open repairs. Detachment of the deltoid is avoided in both these techniques. The glenohumeral joint can be additionally arthroscopically evaluated by the mini-open and arthroscopic approaches to rotator cuff repair.
Orthopedic surgeons in Phoenix AZ can place stitches in an open fashion, as they can get direct visualization of the cuff repair during the mini-open technique. Choice of bone anchors or osseous tunnels for fixation are also allowed by the mini-open techniques. In rare cases, tendon-absorbing stitches may be needed and these are made possible by the use of the mini-open technique.
If technical difficulties arise during the arthroscopic technique, then it is easy to convert into a mini-open repair. A few studies have shown arthroscopic cuff repair techniques as promising in relation to an alternative to mini-open or open repair.
These, however, have only been at the hands of Arizona sports medicine surgeons who had extensive experience in arthroscopy of the shoulder. The mini-open procedure in contrast requires only modest arthroscopic skills and documented history of success.
Research Shows Mini-Open Technique Successful for Full-Thickness RC Tears
A recent study was conducted to evaluate surgical repair of massive rotator cuff tears by use of a mini-open technique. Of the participants, 99 repairs of the massive rotator cuff tears were carried out in the same department between 1995 and 2006. According to data, 73 of surgeries involved men and 23 involved women, with a 55.7 average age. In 69 of the cases, surgery on the right side of the upper extremity was performed.
Radiological, clinical, and arthrographic basis was used in the examination of the patients in order to indicate surgical repair. Participants in this study had rotator cuff tears described as massive but repairable, and all were in the grades 3 and 4 range, based on the Bateman classification or the Gschwend classification systems. Rotator cuff re-attachment in these cases was done using several techniques, such as intraosseous sutures, Spiralok anchors, and Mitek anchors.
Researchers concluded that good outcomes can be achieved using the mini-open technique, even in the case of rotator cuff massive tears. The results are nevertheless worse than in small or medium tears. In this open procedure, the study preferred the use of the mini-open and deltoid splitting techniques, as it does not necessitate the detachment from the acromion of the deltoid. Anchors, which are loaded with 2 sutures, seemed more convenient for fixation. The double row suture and anchor technique, with the modified Mason-Allen suture, was used as well..
Conclusions
It is thus concluded that repair of massive rotator cuff tears by the mini-open technique, if indicated early, will give good results. However, there should be excellent surgical techniques used and good quality post operative care.
Rehabilitation should also be provided early on. The approach is fully recommended and the results obtained can be comparable with the results of those achieved by arthroscopy.
Dr. Sumit Dewanjee at FXRX is a first rate arthroscopic sports medicine surgeon in Phoenix and Scottsdale. For 5 years in a row, he has received the Patients Choice Award as a Top Orthopedic doctor in Phoenix. He excels at both open and arthroscopic rotator cuff repair.
Most insurance is accepted at the practice, call (480) 449-3979 today for a shoulder surgeon Phoenix AZ trusts!
References
Nordberg FB, Field LD, Savoie FH 3rd.
http://www.ncbi.nlm.nih.gov/pubmed /10652666
Ghodadra NS, Provencher MT, Verma NN, Wilk KE, Romeo AA.
http://www.ncbi.nlm.nih.gov/pubmed/ 19194025
Musil D, Sadovský P, Stehlík J.
http://www.ncbi.nlm.nih.gov/pubmed /17266840
