The rotator cuff is the thick band of muscles and associated tendons that cover the top of the upper arm and hold in it place, providing support and stability to the shoulder joint. The rotator cuff also allows for a full range of motion while keeping the ball of the arm bone in the shoulder socket. These tendons can become partially or completely torn as a result of a rotator cuff tear or injury. A rotator cuff tear often occurs as a result of injury or overuse of the muscles over a long period of time. Rotator cuff tears typically involve pain when lifting or lowering the arm, muscle weakness and atrophy, and discomfort at rest, particularly if pressure is placed on the affected shoulder.
In most cases, surgery is recommended for tears that cause severe pain or that do not respond to more conservative treatments. Most rotator cuff repair procedures are performed through arthroscopy, which uses a few tiny incisions rather than one large incision. This technique offers patients minimal trauma, less scarring and less damage to the surrounding muscles and tissue. The smaller incisions also result in less pain in the shoulder joint after the surgery.
Arthroscopic Rotator Cuff Repair Procedure
The purpose of arthroscopic rotator cuff repair is to attach the tendon back to the arm, along with removing any loose fragments from the shoulder area. Arthroscopy is a minimally invasive surgical technique that involves making several small incisions and inserting a fiber-optic device (arthroscope) and tiny surgical instruments to diagnose or treat certain conditions. Connected to a camera that displays images of the internal structure of the shoulder on a computer screen, the arthroscope allows the surgeon to precisely identify, target and treat joint abnormalities.
During arthroscopic rotator cuff repair, the patient is sedated under general anesthesia, and several small incisions are made in the shoulder, into which a thin tube and tiny instruments are inserted. The surgeon repairs the tendon through visualization on a television monitor. During the surgery, rotator cuff tears are repaired and any bone spurs are removed. The rotator cuff muscle is stitched back to the bone, which helps the rotator cuff to heal in its proper location. Once the repair is complete, any incisions will be stitched closed and patients will be moved to a recovery room where they will be monitored post-operatively for a few hours.
Risks of Arthroscopic Rotator Cuff Repair
As with any surgery, there are certain risks involved with arthroscopic rotator cuff repair, which may include:
- Nerve damage
- Need for repeated surgery
These complications are rare and most people experience symptom relief with little to no complications after arthroscopic rotator cuff repair
Recovery from Arthroscopic Rotator Cuff Repair
After surgery, the arm is immobilized to promote proper healing. A sling may be recommended to keep the arm from moving for the first several weeks post-surgery. Physical therapy often begins shortly after surgery to help restore strength and movement and allow patients to gradually resume their regular activities. It is important for patients to commit to their physical therapy program in order to achieve the most effective surgical results.
Rotator cuff repair surgery is usually successful in relieving shoulder pain, although full strength cannot always be restored. It is important for patients to commit to their physical therapy program in order to achieve the most effective surgical results. After surgery, physical therapy may be necessary for up to 4 months and full recovery may take up to 6 months. Most patients experience effective pain relief, restoration of function and improved range of motion after their procedure.
Arthroscopic Bankart Repair
The socket of the shoulder, or glenoid, is covered with a layer of cartilage called the labrum that cushions and deepens the socket to help stabilize the joint. Traumatic injuries and repetitive overhead shoulder movements can tear the labrum, leading to pain, limited motion, instability and weakness in the joint. Symptoms of a labral injury may include shoulder pain and a popping or clicking sensation when the shoulder is moved, as well as rotator cuff weakness. One of the most common labral injuries is known as a Bankart lesion. This condition occurs when the labrum pulls off the front of the socket. This occurs most often when the shoulder dislocates. If a Bankart tear doesn’t heal properly, it can cause future dislocations, instability, weakness and pain.
Bankart lesions may be treated through conservative methods such as rest, immobilization and physical therapy, particularly in older patients. However, many cases require surgery to reattach the torn labrum to the socket of the shoulder. This procedure is often performed through arthroscopy which is especially effective in treating joint conditions such as Bankart repair.
The Arthroscopic Bankart Repair Procedure
Surgery to repair a Bankart lesion is often performed through arthroscopy. Arthroscopy is a minimally-invasive technique that uses tiny incisions to insert a probe-like camera, allowing the surgeon to fully examine the area before performing corrections. After making the incisions, the surgeon also inserts specialized instruments through the arthroscope to repair the damage to the shoulder at the exact location of the injury. Any tears in the muscle, tendon, or cartilage will be fixed and any damaged tissue is removed. After the procedure, the incisions are stitched closed.
Recovery from Arthroscopic Bankart Repair
After arthroscopic Bankart repair, patients will generally be required to keep their arm immobilized in a sling for approximately one month. In addition, patients will undergo physical therapy for about four months to strengthen the muscle tissue and improve the range of motion in the shoulder. Patients are often restricted from participation in contact sports for a six-month period after surgery, to allow the shoulder to fully heal.
Risks of Arthroscopic Bankart Repair
As with any surgical procedure, there are risks associated with arthroscopic Bankart repair that may include:
- Blood clots
- Shoulder stiffness
- Blood vessel or nerve injury
Shoulder weakness and stiffness may also occur as a result of this procedure.
Arthroscopic Bankart repair results in minimal pain and trauma and less scarring and damage to surrounding tissue than traditional open surgery. There is also a shorter recovery period and a shorter length of rehabilitation than with traditional open surgery. This is often a successful option for many patients, allowing them to return to regular activities with little to no incidence of recurring dislocation.