Arthroscopic Rotator Cuff Repairs Presentation Designed For Patient Education Updated 2/11.
Transcript of Arthroscopic Rotator Cuff Repairs Presentation Designed For Patient Education Updated 2/11.
Arthroscopic Arthroscopic Rotator Cuff Rotator Cuff
RepairsRepairsPresentation Designed For Patient Presentation Designed For Patient
EducationEducation
Updated 2/11
University Orthopaedics & University Orthopaedics & Sports MedicineSports Medicine
OfficesOffices
Clifton (Medical Clifton (Medical Arts BuildingArts Building
WestchesterWestchester www.ucortho.comwww.ucortho.com 513-475-8690513-475-8690
University Orthopaedics & University Orthopaedics & Sports MedicineSports Medicine
SurgerySurgery
Holmes Hospital (Clifton)Holmes Hospital (Clifton) Outpatient Surgery CenterOutpatient Surgery Center
Mercy FairfieldMercy Fairfield MainMain Outpatient Surgery CenterOutpatient Surgery Center
Westchester Medical CenterWestchester Medical Center University Pointe Ambulatory Surgical University Pointe Ambulatory Surgical
Hospital (ASH)Hospital (ASH) University HospitalUniversity Hospital
AnatomyAnatomy What is the rotator What is the rotator
cuff?cuff? Supraspinatus Supraspinatus InfraspinatusInfraspinatus Teres MinorTeres Minor SubscapularisSubscapularis
What does the What does the rotator cuff do?rotator cuff do? Holds the humeral Holds the humeral
head (ball) in glenoid head (ball) in glenoid (cup)(cup)
Stabilizes the Stabilizes the shoulder jointshoulder joint
Rotator Cuff TearsRotator Cuff Tears
IncidenceIncidence How common is How common is
it? it? Very Very Rare in patients Rare in patients
younger than 40younger than 40 Incidence Incidence
steadily steadily increases with increases with ageage
Signs and symptomsSigns and symptoms PainPain
ShoulderShoulder Side of armSide of arm Often worse at nightOften worse at night Often worse with Often worse with
overhead activitiesoverhead activities WeaknessWeakness
Very large tearsVery large tears
What causes Rotator Cuff What causes Rotator Cuff Tears?Tears?
Sometimes they are simply Sometimes they are simply degenerativedegenerative
Patients who perform a lot of Patients who perform a lot of repetitive overhead activities may repetitive overhead activities may develop rotator cuff tearsdevelop rotator cuff tears
Traumatic-fall on the shoulder, or Traumatic-fall on the shoulder, or pull on the armpull on the arm
Incidence increases with ageIncidence increases with age
Natural History of RCTsNatural History of RCTs Usually begins in Usually begins in
anterior insertion of anterior insertion of supraspinatus tendonsupraspinatus tendon
Usually begins on Usually begins on articular surface as articular surface as partial tear and partial tear and progresses to full progresses to full thickness tearsthickness tears
Progresses from tendon Progresses from tendon to tendon enlarging like to tendon enlarging like a “hole in a sock”a “hole in a sock”
Once full thickness tear Once full thickness tear occurs it does not heal occurs it does not heal back to bone without back to bone without helphelp
Rotator Cuff Tear
Exposed cartilage on the humerus bone (ball)
↑→
““Footprint” of cuffFootprint” of cuff
Broad area of Broad area of greater tuberosity greater tuberosity (supraspinatus)(supraspinatus)
Other tendons are Other tendons are similarsimilar
From the articular From the articular margin to the margin to the “shoulder” of the “shoulder” of the greater tuberositygreater tuberosity
NOT just a linear NOT just a linear stripe!stripe!
Rotator Cuff Tears-Rotator Cuff Tears-DiagnosisDiagnosis
HistoryHistory
Physical ExamPhysical Exam
X-raysX-rays Often normalOften normal
MRIMRI Best test Best test
Rotator Cuff Tear ↓
Rotator Cuff Tears-Rotator Cuff Tears-TreatmentTreatment
Anti-inflammatory medications-decreasing Anti-inflammatory medications-decreasing inflammation causes decreased paininflammation causes decreased pain
Selective cortisone shots-steroids are very Selective cortisone shots-steroids are very potent anti-inflammatory medications and go potent anti-inflammatory medications and go directly to the source with little systemic directly to the source with little systemic absorptionabsorption
Physical Therapy-strengthening the remaining Physical Therapy-strengthening the remaining intact rotator cuff stabilizes the shoulder. intact rotator cuff stabilizes the shoulder. Treatment of choice for partial thickness tearsTreatment of choice for partial thickness tears
Surgery-most full thickness tears of Surgery-most full thickness tears of significant size should be surgically repaired. significant size should be surgically repaired. The fully torn cuff will not heal down to bone The fully torn cuff will not heal down to bone without help and will likely get bigger.without help and will likely get bigger.
SurgerySurgery
OpenOpen Make incisions and Make incisions and
move muscle out of move muscle out of the way in order to the way in order to expose the torn expose the torn tissuetissue
ArthroscopicArthroscopic Arthro=jointArthro=joint Scope=cameraScope=camera ““Look around joint Look around joint
with camera”with camera”
Arthroscopic Repair-Arthroscopic Repair-AdvantagesAdvantages
Less dissection = less Less dissection = less stiffnessstiffness
Preserves deltoid Preserves deltoid musclemuscle
Lower infection rateLower infection rate Better visualizationBetter visualization Ability to Ability to
evaluate/address other evaluate/address other pathologiespathologies ““Shopping Spree”Shopping Spree”
Less pain in early post-Less pain in early post-op periodop period
DECREASE RISK OF DECREASE RISK OF MAKING PATIENT MAKING PATIENT WORSEWORSE Torn biceps tendon that can be
addressed arthroscopically at the time of surgery
↑
Arthroscopic Repair-Arthroscopic Repair-AdvantagesAdvantages
Small tears easily Small tears easily repairedrepaired
Biggest advantage Biggest advantage is with larger tearsis with larger tears Can see betterCan see better Easier to mobilize Easier to mobilize
torn tissuetorn tissue Determining if it is Determining if it is
can be fixedcan be fixed Avoid big muscle Avoid big muscle
dissectiondissection
Arthroscopic Rotator Arthroscopic Rotator Cuff RepairCuff Repair
First performed in mid 90’sFirst performed in mid 90’s
Techniques and equipment continue Techniques and equipment continue to evolve such that it is an excellent to evolve such that it is an excellent optionoption
AnesthesiaAnesthesia Anesthesiologist Anesthesiologist
administers nerve block administers nerve block in pre-op holding area in pre-op holding area after giving some IV after giving some IV medicationsmedications Typically lasts about 18 Typically lasts about 18
hourshours General anesthesiaGeneral anesthesia
Patient then placed under Patient then placed under general anesthesiageneral anesthesia
Patient is positioned such Patient is positioned such that full access to the that full access to the shoulder can be obtainedshoulder can be obtained
Skin cleaned with Skin cleaned with sterilizing prepsterilizing prep
PortalsPortals Surgery done thru Surgery done thru
poke holes called poke holes called portalsportals
Typically 4-5 portals Typically 4-5 portals are utilizedare utilized
Cannulas are placed Cannulas are placed thru the portals for thru the portals for easier passage of easier passage of instruments and instruments and suturessutures
TechniqueTechnique
Complete inventory of the shoulder is Complete inventory of the shoulder is performed with the cameraperformed with the camera
Goal is to fix the rotator cuff to its Goal is to fix the rotator cuff to its anatomic positionanatomic position
Therefore, the pattern (personality) of Therefore, the pattern (personality) of the tear is evaluated the tear is evaluated
Next the cuff is fixed to bone with Next the cuff is fixed to bone with various techniques depending on the various techniques depending on the tear patterntear pattern
RepairRepair Sutures can be used to Sutures can be used to
close the tear side to close the tear side to side like a zipperside like a zipper
Finally, suture anchors Finally, suture anchors (screws with attached (screws with attached sutures are used to fix sutures are used to fix the cuff to bonethe cuff to bone Screw goes in boneScrew goes in bone Suture passed thru the Suture passed thru the
cuff and tied to bring cuff and tied to bring the tissue back to bonethe tissue back to bone
Address Associated Address Associated PathologyPathology
Sometimes other parts of Sometimes other parts of the shoulder also cause the shoulder also cause pain and can be addressed pain and can be addressed at the time if surgeryat the time if surgery Biceps tendonBiceps tendon
The tendon can simply be cut The tendon can simply be cut (tenotomy) or cut and sewn (tenotomy) or cut and sewn down to bone (tenodesis)down to bone (tenodesis)
End of the collarbone End of the collarbone (clavicle)(clavicle)
Take out end of collarbone Take out end of collarbone (distal clavicle resection)(distal clavicle resection)
Bone spurs on the shoulder Bone spurs on the shoulder blade bone (acromion)blade bone (acromion)
Smooth bone (subacromial Smooth bone (subacromial decompression)decompression)
Torn biceps tendon
↑
↑Smooth shoulder blade bone
SurgerySurgery
Most surgeries can be done with all Most surgeries can be done with all arthroscopic techniquesarthroscopic techniques
Sometimes incisions must be made to Sometimes incisions must be made to address pathology that cannot be address pathology that cannot be fixed with the camerafixed with the camera
This decision is often made at the time This decision is often made at the time of surgery after the shoulder is of surgery after the shoulder is evaluated with the cameraevaluated with the camera
Post opPost op Wake up in a slingWake up in a sling If pre-op block was successful then you If pre-op block was successful then you
should be pretty comfortable with a numb should be pretty comfortable with a numb armarm
Go home same dayGo home same day Start taking your pain medications as soon Start taking your pain medications as soon
as you get home prior to your block as you get home prior to your block wearing off. wearing off.
It can be very difficult to “catch up” if you It can be very difficult to “catch up” if you have no pain medication in your system have no pain medication in your system when your block wears off.when your block wears off.
Post-op-MedicationsPost-op-Medications
Pain medicationsPain medications Take these as neededTake these as needed Not well tolerated on an empty stomach Not well tolerated on an empty stomach
so make sure you eat something first so make sure you eat something first even if just crackerseven if just crackers
Nausea medicationsNausea medications Sometimes patients are nauseated after Sometimes patients are nauseated after
surgery from the anesthesiasurgery from the anesthesia Usually wears off in 24 hoursUsually wears off in 24 hours Can take medication if neededCan take medication if needed
Post opPost op Leave dressing intact for first 72 hours after surgery. Leave dressing intact for first 72 hours after surgery.
Reinforce if neededReinforce if needed May remove and shower at 72 hours post opMay remove and shower at 72 hours post op Do not scrub your woundsDo not scrub your wounds Simply wash your neck with soap and water and let the Simply wash your neck with soap and water and let the
soap and water run offsoap and water run off Do not soak your wounds until permitted to do so by Do not soak your wounds until permitted to do so by
your physician. NO BATH, SWIMMING OR HOT TUBS.your physician. NO BATH, SWIMMING OR HOT TUBS. If your wounds are dry, may leave open to the airIf your wounds are dry, may leave open to the air If oozing then put on a clean dry dressing and call your If oozing then put on a clean dry dressing and call your
doctordoctor Do not put any ointments on your wounds. This Do not put any ointments on your wounds. This
includes antibiotic ointments (Neosporin, Polysporin, includes antibiotic ointments (Neosporin, Polysporin, etc)etc)
It is easiest to wear a button shirtIt is easiest to wear a button shirt Wear your sling all the time except to showerWear your sling all the time except to shower
Post opPost op
Your first follow-up appointment Your first follow-up appointment should be 5-7 days post opshould be 5-7 days post op
Please make an appointment to go to Please make an appointment to go to physical therapy immediately after physical therapy immediately after your first post op appointment.your first post op appointment.
Post-Op RehabPost-Op Rehab Start passive range of Start passive range of
motion (the therapist motion (the therapist moves your shoulder moves your shoulder for you) at 1 weekfor you) at 1 week
Sling for 4-6 weeksSling for 4-6 weeks Start active range of Start active range of
motion (you move the motion (you move the shoulder yourself) shoulder yourself) when sling comes offwhen sling comes off
Start strengthening at Start strengthening at 8-12 weeks8-12 weeks
No sports, lifting for No sports, lifting for 4-6 months4-6 months
Frequently Asked Frequently Asked QuestionsQuestions
Will I have therapy post op?Will I have therapy post op? Yes. Initially 2-3 times per week then less often. Yes. Initially 2-3 times per week then less often.
Exercises must be done at home too! Exercises must be done at home too! How long do I have to wear the sling?How long do I have to wear the sling?
4-6 weeks. Longer when in an uncontrolled 4-6 weeks. Longer when in an uncontrolled environmentenvironment
When can I go back to work?When can I go back to work? This is highly variable depending on what you doThis is highly variable depending on what you do For desk jobs it could be as early as a couple For desk jobs it could be as early as a couple
daysdays Labor jobs with lifting, 4-6 monthsLabor jobs with lifting, 4-6 months
QuestionsQuestions
Any further questions should be Any further questions should be directed to your therapist or surgeondirected to your therapist or surgeon
Please call the office with questions Please call the office with questions or concernsor concerns
513-475-8690513-475-8690 www.ucortho.comwww.ucortho.com
Thank YouThank You