The rotator cuff is a group of four muscles that surround the ball and socket. These muscles control much of your overhead function for daily activities. The most commonly injured of the four is called the ‘supraspinatus’. If it is torn, then it can cause trouble elevating the arm, and pushing things overhead. Sometimes it can be so severe that a person can experience ‘pseudoparalysis’, where the arm will not lift.
If the supraspinatus tendon (remember, then tendon is how the muscle attaches to the bone) is detached from the top of the ball, then we can typically re-attach it. The tendon can be reattached a few different ways, but the most common method these days is with a suture anchor. This is a small screw with stitches attached that can be screwed into the bone. The tendon is then laced up with the stitches and cinched down to bone. The screw can be made of metal or a non-metallic substance (plastic, calcium composite). The advantage of using non-metallic anchors is that future MRI scans show more detail in the event there is a new injury. As a general rule, the worse the tear, the more suture anchors may be needed to bring the tendon back to bone.
I perform these repairs through an arthroscopic approach. This entails 5mm incisions around the shoulder that allow access of a small camera to visualize the injuries. The other small incisions are then used to facilitate passage of various instruments to grasp and manipulate the tissue. This tends to cause less trauma to the muscles and skin which may help with rehab and cosmesis.
The bicep tendon can also be visualized in the shoulder joint and can also be addressed arthroscopically. If the bicep is too injured to repair in the joint, then the cameras are removed and an incision in the armpit can be used to find and repair the tendon in the upper arm where better quality tendon tissue can be found. I find that about 95% of the time the bicep can be repaired arthroscopically.
The procedure takes around one hour and people will go home about an hour or so after surgery. The brace is worn for one month for typical repairs, and can be removed for therapy exercises and waist level activities like computer work. The small incisions take about one week to heal enough to be submerged in water. The shoulder will improve for about one year after surgery, but basic daily activities can be done within the first 3 months after repairs for most people.