Rotator cuff tears do not typically heal completely without surgical intervention to properly stitch back the torn tendon onto the humerus, or the tendon’s natural attachment on the bone of the arm. Standard “open” shoulder surgery, however, can be an intense procedure requiring a large incision and an invasive operation involving bone anchors and sutures. An alternative to this, however, is arthroscopic surgery, a far more delicate and non-invasive procedure that produces the same essential results of restoring best possible functioning to the affected rotator cuff.
Arthroscopic rotator cuff repair, more popularly known as “keyhole” surgery, involves just two or three small punctures mere millimeters wide instead of a large incision. In performing the procedure, the surgeon first inserts a scope into a small puncture called the lateral portal and creates one to three more portals (anterior, superolateral and posterior, as necessary) in which to insert special instruments used to perform the procedure. One such instrument, known as a suture passer, is aligned over the tear’s long limb.
Thereafter, the surgeon ties the suture, thereby bringing together the two ends of the tendon. The surgeon repeats this step until the tear’s long limb is completely repaired. The surgeon then prepares the bone for suture anchors to be inserted, at which a long inserter then proceeds to anchor the sutures. Using special forceps, the sutures are passed first over the rotator cuff tendon and then through the tendon, at which they’re tied off in sequence. Depending on the size of the tear, several of these steps are then repeated as necessary. When the surgery is completed, the tear is fully attached to the bone.
Arthroscopic rotator cuff surgery offers several advantages over open shoulder surgery. For one, the procedure can usually be performed day-case, or without the need for an overnight hospital stay, so patients spend less time in the hospital overall. In addition, there is usually less pain following the procedure and, therefore, a quicker recovery time. There also tend to be fewer complications surrounding the surgical wound and no stitches to mind or take out later. After surgery, patients are usually seen by both the doctor himself and a physiotherapist to review exercises and other guidance for a smooth recovery.
If considering or undergoing arthroscopic rotator cuff surgery oneself, there are certain guidelines for ensuring best results. Patients should avoid eating or drinking anything following midnight of the night preceding the surgery. Following surgery, the plaster strips covering the small puncture wounds should be kept dry for up to a week or until healed completely, although waterproof plasters are available for when you take showers.
Arthroscopic surgery is a delicate procedure that not all shoulder surgeons are trained to do or possess the proper equipment to perform. There are, however, a small cadre of surgeons, like Seattle’s Dr. Daniel Grant Schwartz, who have studied this procedure extensively and now specialize in performing it par excellence. If your shoulder pain has lasted for six months or longer, if you’re experiencing a major loss of functioning and/or weakness in the area, if you’ve undergone a recent injury to the area or if you detect a rotator cuff tear longer than 3 cm, then arthroscopic rotator cuff surgery may be an option worth considering.