Arthroscopic rotator cuff reconstruction is a minimally invasive surgery to repair torn tendons in the shoulder.
To repair torn tendons and restore movement and flexibility in the affected shoulder.
-Minimally invasive surgery compared to open surgery
-Limited to treating only certain types of shoulder problems.
Arthroscopic rotator cuff repair generally takes between one and two hours. It usually be performed under general anesthesia which means you will sleep through the surgery. An arthroscope is like a thin telescope with a light source used to magnify the structures inside the injured area of the shoulder allowing evaluation and treatment. After evaluating the shoulder joint using the arthroscopic camera, the surgeon can introduce surgical instruments via very few small incisions in the skin surrounding the shoulder to clean out damaged tissue, remove bone spurs, and reattach damaged tendons to the bones where they have torn off. Patients undergoing arthroscopic surgery can have varying diagnoses and pre-existing conditions. Surgeries vary widely and are patient specific.
Before surgery, physicians talk to patients about what to expect and provide pre-surgical instructions. These pre-surgical instructions may include the following: Two weeks prior to surgery, a patient may be asked to stop taking certain medications and/or supplements, especially those that make blood clotting difficult. Examples include ibuprofen, aspirin, and naproxen. Patients with certain medical conditions, such as heart disease or diabetes, may be asked to see the physician(s) treating these issues. Meeting with a physical therapist to discuss rehabilitation may or may not be suggested prior to surgery. Get as much rest as possible the night before surgery. Consider contacting someone to assist with daily activities after surgery, since arm movement will be limited.
Pain management: After surgery, you will feel pain. This is a natural part of the healing process. Your doctor and nurses will work to reduce your pain, which can help you recover from surgery faster. Medications are often prescribed for short-term pain relief after surgery. Many types of medicines are available to help manage pain, including opioids, non-steroidal anti-inflammatory drugs (NSAIDs), and local anesthetics. Your doctor may use a combination of these medications to improve pain relief, as well as minimize the need for opioids. Be aware that although opioids help relieve pain after surgery, they are a narcotic and can be addictive. Opioid dependency and overdose has become a critical public health issue. It is important to use opioids only as directed by your doctor. As soon as your pain begins to improve, stop taking opioids. Talk to your doctor if your pain has not begun to improve within a few weeks after your surgery. Rehabilitation: Immobilization. After surgery, therapy progresses in stages. At first, the repair needs to be protected while the tendon heals. To keep your arm from moving, you will most likely use a sling and avoid using your arm for the first 4 to 6 weeks. How long you require a sling depends upon the severity of your injury. Passive exercise: Passive exercise. Even though your tear has been repaired, the muscles around your arm remain weak. Once your surgeon decides it is safe for you to move your arm and shoulder, a therapist will help you with passive exercises to improve range of motion in your shoulder. With passive exercise, your therapist supports your arm and moves it in different positions. In most cases, passive exercise is begun within the first 4 to 6 weeks after surgery. Active exercise. After 4 to 6 weeks, you will progress to doing active exercises without the help of your therapist. Moving your muscles on your own will gradually increase your strength and improve your arm control. At 8 to 12 weeks, your therapist will start you on a strengthening exercise program. Expect a complete recovery to take several months. Most patients have a functional range of motion and adequate strength by 4 to 6 months after surgery. Although it is a slow process, your commitment to rehabilitation is key to a successful outcome.
Although rare, complications do occur during or following arthroscopy. They include the possibility of: Accidental damage to structures inside or near to the joint Nerve injury Excessive bleeding inside the joint which can cause swelling and pain Infection within the joint Reaction to anesthesia Risks can be reduced by following the surgeon's instructions before and after surgery.
Who is suitable for this procedure?
The best candidates for arthroscopic rotator cuff repair are healthy adults with no previous surgeries or scarring in the area being treated. The surgeon will make the final determination of each patient’s eligibility for the procedure after an examination and consultation with the patient.
Will I need to have an arm sling after surgery?
Yes. A particular type of sling is typically recommended (and provided in clinic prior to surgery) for protection for approximately 4-6 weeks after surgery. Dr. Hess recommends that you wear the sling at all times after surgery. You are encouraged to come out of the sling several times per day and move the elbow/hand/wrist to prevent them from becoming stiff. You may remove the sling to shower according to your post-op instruction sheet. • The sling is a good reminder for you to be careful with the shoulder after surgery. It is also a signal to those around you to be careful, so it is especially important to wear your sling at work/school and in crowds. • You will not be allowed to lift any significant weight (nothing more than 2-5 pounds) with the surgical arm for approximately 4-6 weeks after surgery. You may use the arm to perform some basic activities of daily living such as eating, hygiene and working at a computer.
What are the signs and symptoms of rotator cuff problems?
Sometimes, your rotator cuff tendons can become pinched by the surrounding bones or can tear. Issues like these can happen due to an injury such as falling on your arm. However, wear and tear over time can do a number on your shoulder as well, causing severe pain. Common symptoms of rotator cuff problems are: Weakness Loss of motion Stiffness Trouble raising your arm overhead Pain occurring mainly at night Cracking sensation when you move your shoulder You can treat many rotator cuff problems at home. Your doctor might suggest shoulder arthroscopy if you have a condition that’s painful and doesn’t respond to nonsurgical treatment. While you need to know how to prepare for shoulder surgery, you also need to know proper postoperative recovery tips. These rotator cuff surgery recovery tips could help make the healing process better, allowing you to start participating again in physical activities.
What is the difference between arthroscopic surgery and open surgery?
Open surgery is a procedure using larger incisions and enabling the surgeon to look directly into the joint. This approach might be better for certain procedures under certain circumstances. Arthroscopic surgery has some involves smaller incisions, less tissue damage, but these are usually not helpful if the overall procedure cannot be performed as well. Other surgeons feel that directly looking at the area of damage can allow for better and stronger repair of damaged structures. Depending on many factors, one surgery may be best for your particular situation. You need to discuss with your surgeon if a particular procedure can be done arthroscopically. There are debates among orthopedic surgeons about how to best perform different types of surgery. For example, many shoulder surgeons disagree about whether rotator cuff repairs can be performed as well arthroscopically as they can in open surgery. There are pros and cons to both, and these may vary based on the specific details of the injury.