Arthroscopic rotator cuff repair.Information for patients.

Dr Geoffrey Smith

Anatomical images courtesy of www.biodigital.com

What is shoulder arthroscopy?

• Keyhole surgery of the shoulder joint.

• Many conditions are amenable to arthroscopic treatment

• Usually performed under general anaesthetic (asleep).

• An additional local anaesthetic nerve block may be used

• The patient is then carefully positioned on a special operating table

What happens?

• Several small (0.5cm) incisions are made• A camera and other instruments are inserted• The camera has an angled lens which can be rotated

around to give a view all around• We also change the camera position to get the best

possible view and angle for out working instruments• Visualisation is improved by running fluid into the

shoulder• We will quickly go over the anatomy of the shoulder

Bones

• The shoulder (glenohumeral joint) is a ball and socket joint.

• The ball is at the top of the arm bone (the humerus).

• The socket is the glenoid which is part of the shoulder blade (scapula).

Humerus Scapula

Soft tissue

• The glenohumeral joint is surrounded by a sleeve of tissue (the capsule).

• The capsule is thick in places & forms ligaments.

Capsule

Tendons

• Outside the capsule are the tendons of the rotator cuff.

• Tendons are where muscles attach to bone.

• Muscle pulling on bones through tendons produces movement at joints.

Rotator Cuff

• The rotator cuff is composed of 4 tendons

• Subscapularis (at the front)

• Supraspinatus and infraspinatus (at the top)

• Teres minor (at the back).

Subscapularis

Supraspinatus

Infraspinatus

Teres Minor

Subacromial space

• Above the rotator cuff is the acromion which is the bone you can feel on the top of your shoulder.

• The acromion is part of the shoulder blade (scapula).

• The subacromial space is between the undersurface of the acromion and the upper surface of the rotator cuff.

• The subdeltoid or subacromial bursa (a sac of fluid) occupies the subacromial space.

Acromion

Subacromial bursa

Glenohumeral joint

• We first put the camera into the glenohumeral joint from the back

• This is a right shoulder• Here we are inside the

capsule and below the rotator cuff tendons

Glenoid Humerus

Labrum

Undersurface of supraspinatus

LHB tendon

Rotator cuff tears

• In a tear the tendon usually pulls off the bone

Humerus

Rotator cufftendon

Tear

Rotator Cuff Tears

• The camera is switched to the side of the shoulder and is positioned in the subacromial space above the tendons

• The tear is usually more easily visualised from this view

Humerus

Rotator cuff

Tear

Repair

• Anchors with suture material are screwed into the humerus

• The suture is passed through the tendon

• And then back to another anchor which is placed in the bone

• This creates a very strong repair.

• The tendon is compressed against the bone helping healing rates

Anchorr

Repaired tendon

After Surgery

• You usually go home on the same day or the day after surgery

• A sling is worn for 6 weeks• Strengthening is allowed after 3 months• A return to full activities is expected after 4-6

months