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Spring 2008

Arthroscopic Procedure Used to Repair Rotator Cuff

Less-invasive surgery reattaches muscle and tendons that stabilize and help move the shoulder

An innovative arthroscopic procedure offers a minimally invasive approach to repairing damage to the rotator cuff, the group of four muscles and tendons that stabilize and help move the shoulder. The procedure allows surgeons to reach the site of the injury and reattach muscle and tendon to bone without cutting through the deltoid muscle, which surrounds the shoulder.

Arthroscopic procedure used to repair rotator cuffThe arthroscopic procedure, which is performed on an outpatient basis, “is just as effective and results in less post-operative pain and a shorter recovery time than the traditional ‘open’ surgery,” explains UCLA orthopaedic surgeon Seth C. Gamradt, M.D. Damage to the rotator cuff can be caused by traumatic injury (such as a fall), repetitive overhead activities (such as painting or pitching a ball) or the normal wear and tear of aging. Damage can range from inflammation to severe pain caused by a partial or complete tear of the muscle or tendon.

Symptoms of a rotator-cuff injury include shoulder pain during activity, night pain, weakness and difficulty with overhead activities. Conservative treatment with physical therapy, antiinflammatory medications and steroid injections can help to improve symptoms. But if these treatments fail, surgery may be recommended. X-rays and magnetic resonance imaging are used to confirm the diagnosis and document the location and size of the injury.

In the arthroscopic repair procedure, surgeons make three or four small incisions of less than a half-inch each through which a camera and instruments are inserted to make the repair. A series of suture anchors—small screws with sutures attached—is used to reattach muscle and tendon, fastening the rotator cuff back to the bone. After the tear is repaired, bone spurs (excess bone that can grow along edges of bones and can impinge against the tendons and cause pain), which are present in most rotatorcuff patients, are removed to normalize the space for the rotator cuff. In addition to the mechanical repair, Dr. Gamradt can use a biological material produced from platelet-rich plasma that is derived from the patient’s own blood and which contains growth factors to aid in healing. Also, newer materials that allow the anchors to be absorbed into the bone more quickly are being developed.

Patients can expect to wear a sling for about six weeks as the repair heals and undergo physical therapy to regain the fullest use of their shoulder.

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