The shoulder is a very compicated joint with multiple possible pathological issues including rotator cuff tears, labral tears, arthritis, impingement, AC joint arthritis, among other issues. Advancements in technology and surgical skills has allowed many of these ailments to be addressed using minimally invasive methods, i.e. shoulder arthroscopy. Shoulder arthroscopy is the use of small incisions approximately 5-10mm in length through which a camera is placed and other instruments can perform the surgery.
The most common pathology I personally encounter in my practice is shoulder impingement. This occurs when bone spurs at the tip of acromion dig into the rotator cuff tendons and cause tendonitis or partial tears. A burr is used through the arthroscopic portal to remove the bone spurs. If a complete tear occurs in the rotator cuff then sutures into the tendon and a plastic anchor has to be placed into the bone to repair the tendon. The rotator cuff is a group of four muscles that form a tendon that helps move the shoulder. As patients age and bone spurs form, this tendon can tear and retract. If untreated, the tear can grow in size and become irreparable, which can lead to shoulder arthritis.
Using arthroscopic methods, I am able to remove the bone spurs which can lead to rotator cuff tearing and repair the rotator cuff back to the bone with use of specialized anchors and sutures.
Rotator Cuff Anatomy
This cartoon shows the rotator cuff anatomy. There are four muscles that form a thick tendon that can tear on its insertion into the humerus bone. The rotator cuff helps elevate the arm and keep it elevated.
This cartoon shows how bone spurs can develop. As the arm is raised, the bone spurs can dig into the rotator cuff tendon and cause a tear.
Rotator Cuff Tear
This is what a rotator cuff tear would look like. If untreated the rotator cuff muscle can retract and atrophy and would then become irreparable.
Surgery is done through small incisions that can often heal without being visible. This is a significant improvement over older open methods.
Rotator Cuff repair
Using specialized anchors which go into the bone, a suture pulls the rotator cuff tendon down onto the bone so it can heal.
Bone Spur Removal
Using the camera and a high-speed burr, we are able to remove the offending bone spur which can lead to tears.
Post-operative rehab is key to having a good outcome with this type of surgery. Because it can take months for the tendon to heal to the bone, activity must be carefully monitored to the tendon does not re-tear.