There are different treatment options for rotator cuff repair. Different conditions or injuries may need different treatments. Here are some of the treatment options for rotator cuff repair:
Arthroscopic surgery involves making small incisions and using a tiny camera (arthroscope) and specialised instruments to repair the torn rotator cuff tendon. This minimally invasive technique allows for visualisation and repair of the tear without the need for a large incision. It is suitable for most rotator cuff tears and offers advantages such as less pain, faster recovery, and reduced risk of complications.
In some cases, an open surgical approach may be preferred, especially for large or complex rotator cuff tears. This involves making a larger incision to directly access and repair the torn tendon. The need for open surgery is becoming less and less with the advancement of the surgical instruments, surgeon’s skills & experience.
A hybrid approach combines aspects of both arthroscopic and open surgery. It involves an arthroscopic inspection followed by a smaller open incision to repair the tendon.
In situations where the rotator cuff tear is extensive or irreparable, a tendon transfer procedure may be considered. This involves transferring a nearby tendon, such as the latissimus dorsi tendon or the pectoralis major tendon, to reconstruct the rotator cuff and restore shoulder function.
In cases of massive rotator cuff tears, where the tendon is severely damaged or retracted, a patch or graft may be used to reinforce the repair and improve the chances of healing.
Superior Capsular Reconstruction
SCR is a treatment option for certain cases of irreparable rotator cuff tears. It involves reconstructing the superior capsule of the shoulder using a graft to provide stability and support to the shoulder joint. This procedure is typically performed arthroscopically.
During SCR, a graft, often sourced from a tissue bank (skin), is used to bridge the gap between the humeral head and the glenoid, effectively reconstructing the superior capsule. The graft is secured to the bone using anchors or other fixation devices.
Superior capsular reconstruction aims to restore shoulder stability, improve range of motion, and alleviate pain in cases where the rotator cuff tear is deemed irreparable due to significant tendon retraction or poor tissue quality. It can be a viable option for patients who are not suitable candidates for other repair techniques or who have experienced failed previous repairs.
Reverse Shoulder Arthroplasty
Reverse shoulder arthroplasty is a surgical procedure used to address irreparable rotator cuff tendon tears, specifically when the tear is accompanied by severe arthritis of the shoulder joint. In this procedure, the normal anatomy of the shoulder joint is reversed, meaning that the ball-and-socket relationship is switched.
During a reverse shoulder arthroplasty, the surgeon replaces the damaged ball-shaped head of the humerus (upper arm bone) with a socket-shaped prosthetic component, and the glenoid (the shoulder socket) is fitted with a metal ball component. This reversal of the joint’s anatomy allows the deltoid muscle, instead of the torn rotator cuff tendons, to take over the function of lifting and moving the arm.
The main goal of reverse shoulder arthroplasty is to provide pain relief and restore functional shoulder movement for individuals who have a non-functional or irreparable rotator cuff tendon tear. This procedure is typically considered when other conservative treatments, such as physical therapy, corticosteroid injections, or conventional shoulder replacement, have failed to alleviate symptoms.
How to Know Which Treatment Options are the Best?
The choice of treatment depends on several factors, including the size and location of the tear, patient age and activity level, overall shoulder condition, and the surgeon’s expertise. The surgeon will evaluate these factors and discuss the most suitable treatment option for your specific case.
It is important to note that rehabilitation and physical therapy are often an integral part of the treatment plan after rotator cuff repair, regardless of whether surgery is performed or not. These programs aim to restore strength, flexibility, and function to the shoulder and promote optimal recovery.
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