Rotator Cuff Therapy Exercises

Arthroscopic Rotator Cuff Repair

An arthroscopic rotator cuff repair is a modern method of torn rotator cuff surgery.

Rather than using a scalpel to open the shoulder a surgeon can use an arthroscope to see inside the joint.

An arthroscope is a type of endoscope and in effect is a small camera.

It is fitted with a very bright light that is inserted directly into the joint.



Arthsoscope< - - - Arthsoscope

Basics of an arthroscopic rotator cuff repair

Aneasthetic

As with any surgery an arthroscopic repair requires an anaesthetic to be given.

The choice will often depend on the either your own or your surgeons personal preference.

There are two options a general anaesthetic, knocking you out completely or a regional “nerve block” affecting just the shoulder area.

There are several advantages and disadvantages to each type of anesthesia for shoulder surgery.

For example A rotator cuff repair may require a general anaesthetic.

This is simply because the procedure can require the patient to lie on their side. This can be uncomfortable and people can get restless.

It is safer then to have the patient asleep and not twitching and moving. Regional anaesthetic means that you do not have to go to sleep. A lot of people find that general anesthesia can make them feel nauseated and sick.

The pain relief achieved from a regional anesthetic can be designed to last for up to 24 hours. This is a great help in controlling pain during the first day after surgery.

Preparation

Once in the operating room you have to be prepped for an arthroscopic rotator cuff repair. As with any surgery for torn rotator cuff that involves a number of things

  1. You will be positioned correctly. Possibly in a beach chair position or more regularly now lying on your side.
  2. Your arm / shoulder will then be cleaned using special surgical soaps.
  3. Finally you will have a sterile surgical drapes placed over the surrounding area to form a barrier to the rest of your body.

You are now prepped and ready to go!

Just a note about the surgical soaps; some of the surgical soaps used today are hard to wash off. They are designed to create a film that sticks to the skin very well.

It can take a few days for the soap residue to wash off completely. Please don’t be concerned as the surgical soap will not stain the skin permanently.

The procedure

An arthroscopic rotator cuff repair is performed through portals. These are small incisions in the skin each around ½ an inch long.

The surgeon will make these incisions over the arrears of the joint to which the surgeon requires access. Small plastic tubes known as cannulas are then inserted into the portals to allow easy access into the joint for the surgical instruments.

Arthroscopic Rotator Cuff RepairThe arthroscope, shown above, is the inserted through one portal and the surgical instruments through another.

The arthroscope is fitted with a bright light and a camera. This allows the surgeon to view the whole procedure on a large video screen.

There are a variety of surgical instruments used depending upon exactly what procedure/s is / are required.

They have all been specifically designed to be used in an arthroscopic rotator cuff repair.

The types of procedures the surgeon will carry out may include some or all of the following and more

  1. Remove inflamed tissue
  2. Remove bursa
  3. Repair tears in tendons
  4. Attach sutures to bones
  5. Remove pieces of bone

Immediately following a rotator cuff repair

Once the surgeon has completed the rotator cuff repair all of the cameras and instruments are removed. The cannulas are then removed and the portals closed either with sutures or staples.

A sterile dressing will then be applied to protect the wound. Finally the affected arm will be placed in a sling to immobilize it.

Then it is on to a hospital bed and you are wheeled away to spend some time in a recovery area. From there you will likely be moved to a hospital ward or day care centre from where you will be discharged.

The majority of patients undergoing an arthroscopic rotator cuff repair are discharged home the same day.

Advantages of an arthroscopic rotator cuff repair

An arthroscopic rotator cuff repair is a minimally invasive procedure. That is there is no need to open up the whole joint. For example in the case of a rotator cuff repair that means the large deltoid muscle can be left in place.

This means there is less trauma or damage to the connecting tissues and therefore a speedier recovery.

The essential rotator cuff repair rehab program that must follow any torn rotator cuff surgery can be started almost immediately. This will speed recovery times and help prevent scarring.

Is it for everyone?

No, is the very simple answer. As with most things in the medical world not everyone agrees. Some surgeons are not as experienced in using an arthroscope and some simple prefer the open or mini open approach.

The argument seems to be that direct sight of the rotator cuff leads to a better repair.

If it is for you and your surgeon then you may find a full arthroscopic rotator cuff repair beneficial.



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