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- Welcome back to The Art of Medicine.
Let's talk now about the role of arthroscopic surgery
in repairing a torn rotator cuff tendon.
If we look at our right shoulder again,
shoulder blade,
socket and ball,
the arm,
the bone spurs that are in bone A,
and the bone spurs in bone C,
and finally, the rotator cuff tendon
that's inflamed and
torn, with some separation.
And the role of arthroscopic surgery,
which will include removing these bone spurs
and repairing the tendon.
So, first of all,
through the
arthroscope we bring a little bur in,
it looks like a little dremel.
That removes the spurs.
And then, we have to repair the tendon.
We repair the tendon by first,
advancing the torn piece
so that the ends
approximate.
Then putting some stitches in to hold them together.
And then using a device that we call
a bone anchor screw.
Now this is a very tiny screw that's literally
half the size of the tip of this pen.
But I'm gonna draw it big, so you'll understand it.
Here's the head of the screw.
Here is the shaft of the screw.
Here are the threads of the screw.
And on the head of the screw,
are attached these little sutures.
We bring this screw in through our TV camera
and place it into the bone.
We then take the stitches and we run them,
first through this part of the tendon,
then through this part of the tendon,
and then back onto the screw to reinforce it.
So again, what we have a torn
rotator
cuff
tendon
with our bone spurs and the torn tendon.
We then have a arthroscopic
repair,
where we've removed the bone spurs
on bone A and bone C
and then we've repaired the tendon,
first by advancing it so that the two ends meet,
then by placing an initial suture to hold the ends,
and then reinforcing it with what we call a anchor
screw.
Now, you might ask,
what happens if you don't repair it?
Can it heal?
Well, this will not heal,
because of a poor blood supply.
So in order to try to get it healed,
you have to sew it together.
Secondly, what if we decide to leave it like it is?
Well, there is a progression that occur
that can lead to the following
If this rotator cuff is no longer present,
eventually, here's your bone spur,
and bone spurs.
This is bone A, bone C.
The ball will ride upwards
in this manner,
coming out of the socket a little,
and pinching, the ball itself pinching
up against the bone spurs,
because the rotator cuff
is not there.
Here's one end of it here
and one end over here.
This will cause the ball to grind into that spur
and the ball will wear out, first here,
then it will develop some big spurs here.
And then eventually,
the socket will wear down.
So, the eventual result
of not repairing a tendon
can cause this severe arthritis
of the ball and socket joint
and the possibility of the need
for a shoulder replacement in the future.
- The surgical treatment of rotator cuff tears
has really drastically improved over
the last maybe 10 years with the advent
of arthroscopic cuff repair.
The arthroscope is a small camera that can be inserted
into the shoulder through tiny, little,
less than one centimeter incisions.
Now maybe 10, 15 years ago, the treatment for
a rotator cuff tear involved making a large incision
over the side or front of the shoulder here.
A very large incision and to get to the rotator cuff,
a surgeon would have to peal off the deltoid muscle
to get down to the cuff.
That has all changed now with the advent of the arthroscope.
Now the cuff can be repaired through tiny, little poke holes
through this small camera called an arthroscope.
And that really has cut down on the amount of pain
and the amount of stiffness post operatively.
Patients get back to their daily lives much, much quicker
than they did with an open cuff repair.
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