ROTATOR CUFF TEAR
Rotator cuff tears typically cause pain when one reaches overhead. The pain generally starts at the outside of the shoulder and radiates down the outside of the upper arm toward the elbow.
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PHYSICIAN: DR. PAGNANI, DR. JONES
ROTATOR CUFF TEARS
Rotator cuff tears typically cause pain when one reaches overhead. They also cause pain at night. The pain generally starts at the outside of the shoulder and radiates down the outside of the upper arm toward the elbow. If you have this type of pain and it does not go away after 3-4 weeks, it is probably a good idea to have a specialist look at your shoulder. In some cases, tears may be prevented by early treatment.
If you are experiencing pain in your shoulder, see our Questions and Answers section below and call our office at (615) 329-2520 for a consultation.
PROCEDURES: FULLY TORN ROTATOR CUFF
Introduction
Symptoms include pain, weakness, and loss of motion.
Rotator Cuff Tears
The underside of the acromion bone rubs the rotator cuff tendons causing pain and weakness. More space will be created for the rotator cuff by removing part of the acromion and the torn rotator cuff tear will be reattached to the humeral head.
Incisions
Small incisions (portals) are made around the joint. The scope and surgical instruments will go into these incisions.
Visualization
The scope is inserted into the back of the shoulder joint. Saline solution flows through a tube (cannula) and into the bursa sac to expand the joint and to improve visualization. The image is sent to a video monitor where the surgeon can see inside the joint.
Bursa Sac Bone Spur Removal
A specialized shaving instrument is used to remove the inflamed and irritated bursa sac. The shaver or a surgical burr is then used to remove bone from the underside of the acromion. More space is created for the rotator cuff tendons.
Cleaning Up the Rotator Cuff
The edge of the torn rotator cuff is smoothed out and damaged tissue is removed, leaving a healthier part of the cuff that will be reattached to the humeral head.
Rotator Cuff Reattachment
The rotator cuff is pulled back to its normal position for reattachment. Sutures attached to screw-like devices (“suture anchors”) are usually used to reattach the rotator cuff to the bone of the humeral head. The anchors are screwed into the bone, leaving the sutures for repair. The sutures are passed through the torn tendon and knots are tied through the portals to attach the tendons to the bone.
End of Procedure
After the rotator cuff is reattached to the humeral head, the surgical instruments are removed and the procedure is completed.
PROCEDURES: PARTIALLY TORN ROTATOR CUFF
Introduction
This condition is caused when the rotator cuff tendons rub the underside of the acromion bone. Chronic rubbing can lead to a weakening and even tearing of the rotator cuff. Symptoms include pain, weakness and loss of motion.
Rotator Cuff Pain
The underside of the acromion bone rubs the rotator cuff tendons causing pain and weakness. More space will be created for the rotator cuff by removing part of the acromion.
Incisions
Small incisions (portals) are made around the joint. The scope and surgical instruments will go into these incisions.
Visualization
The scope is inserted into the back of the shoulder joint. Saline solution flows through a tube (cannula) and into the bursa sac to expand the joint and to improve visualization. The image is sent to a video monitor where the surgeon can see inside the joint.
Bursa Sac Bone Spur Removal
A specialized surgical instrument is used to remove the inflamed and irritated bursa sac. A surgical shaver or burr is then used to remove bone from the underside of the acromion. More space is created for the rotator cuff tendons.
Shaving Frayed Rotator Cuff Edges
If less than 50% of the rotator cuff tendon is torn, the shaver is used to remove the frayed edges of the rotator cuff. If more than 50% is torn, a repair is usually performed.
End of Procedure
After more space has been created for the rotator cuff and the frayed edges have been trimmed, the procedure is completed.
PROCEDURES: BONE SPUR REMOVAL (SUBACROMIAL DECOMPRESSION)
Introduction
Impingement syndrome and associated rotator cuff tears are commonly encountered shoulder problems. This condition is caused when the rotator cuff tendons rub on a bone spur on the unnderside of the acromion bone. Chronic rubbing can lead to a weakening and even tearing of the rotator cuff.
Rotator Cuff Pain
The underside of the acromion bone rubs the rotator cuff tendons causing pain and weakness. More space will be created for the rotator cuff by removing part of the acromion.
Incisions
Small incisions (portals) are made around the joint. The scope and surgical instruments will go into these incisions.
Visualization
The scope is inserted into the back of the shoulder joint. Saline solution flows through a tube (cannula) and into the bursa sac to expand the joint and to improve visualization. The image is sent to a video monitor where the surgeon can see inside the joint.
Bursa Sac and Coracoacromial Ligament Removal
A specialized surgical instrument is used to remove the inflamed and irritated bursa sac. This instrument is about the size of a pen and shaves away the inflamed tissue and removes tiny pieces through a suction attachment.
REMOVING BONE
A similar instrument is then used to remove bone from the underside of the acromion. More space is created for the rotator cuff tendons. The acromion is flattened so that the bone no longer rubs on the rotator cuff.
End of Procedure
After more space has been created between the acromion and the rotator cuff, the surgical instruments are removed and the procedure is completed.
QUESTIONS AND ANSWERS
1. How do I know if I might have a tear?
Rotator cuff tears typically cause pain when one reaches overhead. They also cause pain at night. The pain generally starts at the outside of the shoulder and radiates down the outside of the upper arm toward the elbow. If you have this type of pain and it does not go away after 3-4 weeks, it is probably a good idea to have a specialist look at your shoulder. In some cases, tears may be prevented by early treatment.
2. What might have caused the tear?
Most people have a bone spur under their shoulder blade that rubs a hole in the rotator cuff over time. Only a small percentage of patients tear their rotator cuffs in sudden injuries. Usually the spurs wear the rotator cuff down over a long period of time. Some people are born with these spurs, and the spurs get bigger as one gets older. If you have one of these spurs, you are at risk for tearing your rotator cuff. The spurs can usually be detected with properly positioned X-rays. Early removal of the spurs before the rotator cuff is torn can prevent the need for a much more involved procedure later.
3. How long does the procedure last?
The operation to fix a torn rotator cuff generally takes between 60 and 90 minutes in our hands. If there is not a tear, removal of the bone spur takes only 30 minutes.
4. Will I have to go under general anesthesia?
Not necessarily. The Nashville Knee & Shoulder Center is one of a select number of centers where rotator cuff surgery can be performed without general anesthesia. Instead, patients normally receive a nerve block combined with a “twilight” anesthesia to relax the patient. Avoiding general anesthesia markedly reduces the risks of surgery.
5. Will I have to stay in the hospital overnight?
No. Rotator cuff surgery is now performed on an outpatient basis.
6. What will the aftercare be?
You may remove your bandage 48 hours after surgery. After the initial bandage has been removed, you may shower. If the rotator cuff has been repaired, you will be in the sling for one month. If the spurs are removed before the rotator cuff is torn, you will only have to wear the sling for a couple of days.
7. How long will I be in physical therapy?
If the rotator cuff had to be repaired, you will attend physical therapy on a regular basis for 2-4 months after surgery. Therapy will begin 2-4 days after surgery. In cases where a repair is not necessary, patients can usually be instructed to perform their exercises at home without the need for formal physical therapy.
8. How long will I be out of work?
You can expect to be out of work for at least 2 weeks after surgery to repair the rotator cuff. If your work requires heavy lifting, you may be unable to perform your usual job for several months. In cases where the spurs are removed before the rotator cuff is torn, you can expect to return to work after one week and will be able to return to heavy lifting between 8 and 16 weeks after surgery.
9. How long until I can resume normal activities?
After a rotator cuff repair, most patients can resume normal activities (except for heavy lifting and overhead work) at about 6 weeks after surgery. Three weeks generally suffice in patients who do not have a tear.
10. How long before I can throw or play sports?
Generally, six months are required before athletes can return to sports after a rotator cuff repair. After bone spur removal, 8 to 16 weeks are needed to return to sports.
11. Are there any additional resources I can reference?
Yes! Please see the American Academy of Orthopaedic Surgeons information on Rotator Cuff Tears:
https://orthoinfo.aaos.org/en/diseases--conditions/rotator-cuff-tears/
PROCEDURES: AC JOINT RESECTION (ARTHRITIC COLLARBONE)
Introduction
Arthritis at the end of the collarbone (“AC arthritis”) is a common shoulder problem. This condition occurs when the cartilage cushion between the end of the collarbone and the acromion bone is damaged. The loss of cartilage causes the 2 bones to grind on each other, producing pain on the top of the shoulder. Chronic rubbing from bone spurs arising from the arthritis can also lead to weakening and even tearing of the shoulder tendons. Symptoms include pain, weakness and loss of motion.
Incisions
Small incisions (portals) are made around the joint. The scope and surgical instruments will go into these incisions.
Visualization
The scope is inserted into the back of the shoulder. Saline solution flows through a tube (cannula) and into the bursa sac to expand the joint and to improve visualization. The image is sent to a video monitor where the surgeon can see inside the joint.
Bone Spur Removal
A specialized surgical instrument is used to remove the inflamed and irritated bursa sac. A surgical shaver or burr is used to remove bone and bone spurs from the underside of the acromion and clavicle. More space is created for the rotator cuff tendons.
Creating Space
About 3/8’s of an inch of bone is then removed from the end of the collarbone to create space between it and the end of the acromion. This space will eventually fill with scar tissue and the 2 bones will not rub on one another any longer.
End of Procedure
Following the procedure, patients should expect to be in a sling for 2-3 days. Physical therapy may be required if your shoulder gets stiff after surgery. Full recovery generally takes 4 months.