This website is under development - The information contained on this site is for guidance only and is not intended for self diagnosis or self treatment. This will not replace professional medical advice or consultation. Always seek the professional advice of a qualified health care provider like your doctor or specialist before embarking on any treatment. If you have a problem please consult your doctor or specialist.
Investigations
If the investigation shows that the tendon tear is large to massive (tear size greater than 4 cm) and when indicated, an open repair may be offered. If the examination and investigations suggest that the tear could be old and there is indication that the muscle could have lost its ability to contract, (as deducted by the amount of fat infiltration) then open repair is not offered. Sometimes in order to establish if the muscle is healthy or not (ie to assess the extent of fat-muscle ratio) a MRI scan of the shoulder may be undertaken.
Operation
The aim of the operation is to reattach the tendon back to the humeral head. As the tendon margin is likely to have retracted 4 cm or more, when the repair is effected, it can be under great deal of tension. Therefore, I undertake a number of sequential steps to decrease this tension.
The best I have known is to perform a very good release of the scar tissues tethering the tendon, followed a ‘double-row’ repair. This is achieved by using combination of small titanium anchor pegs (about 5 mm in width) and anchoring all the sutures to a large screw.
This technique was developed and popularised by Mr T D Bunker of Exeter and is called as ‘Capstan Screw Technique’. This is an excellent and an ingenious technique which allows a robust attachment of multiple sutures at one anchor point. It is almost like suspending a man on a parachute!
The operation is usually performed as a inpatient procedure (for pain control purpose) or occasionally as a day case procedure under general anesthetic with or without nerve blocks. Following acromioplasty, +/- excision of distal clavicle, and an extensive partial bursectomy the muscle tendon unit is exposed. Using tension free locking sutures to hold, the tendon is mobilised to its insertion. More often than
not, the long head of biceps will have to be sacrificed. Sometimes, I use that as a tendon graft to bridge any gap.
The area where one is intending to re-attach the tendon is made ‘fresh’ and this step is called re-creation of the foot-print. This is a vital step as the tendon can heal into a bleeding bone. Metal or plastic anchors pre-loaded with sutures are then placed at the most appropriate spot in the footprint. Sutures are then passed around the tendon-muscle complex and are tied down to the foot-print area firmly. This will secure the tendon at the right place. This is very much like the anchor peg used to secure a tent.
The wound is closed with dissolving sutures as ‘invisible darning’ and a water resistant dressing is applied. This is covered with a further layer of pressure dressing. The arm is then placed in an appropriate sling. You will be given information regarding wound care and information regarding various exercises.
Rotator cuff repair surgery can be very painful during the post-operative phase and the painkillers will only subdue the pain and not fully abolish it. It can take a week or two for the pain to come under full control. The level of pain is usually proportional to the size of the tear and the amount of mobilisation that is needed to get the repair done.
| Ultrasound scans |
| MRI scans |
| A S D + D C E |
| Impingment syndrome - Picture |