Shoulder pain is often caused by problems with the rotator cuff, a group of four muscles surrounding the ball in the "ball and socket" shoulder joint. The four muscles that make up the rotator cuff are the supraspinatus, the infraspinatus, the teres minor and the subcapularis. Together they stabilize the shoulder and allow a full range of arm movement. There's a bursa, or sac of fluid, between the rotator cuff and the bone above it (the acromion) that keeps the movement free. When the rotator cuff is injured or torn, the bursa can become inflamed, which adds to the shoulder pain.
Sometimes the pain can be reduced or eliminated by physical therapy used in conjunction with anti-inflammatory medications. But sometimes if the rotator cuff is torn, it requires surgery. Rotator cuff surgery can sometimes be done arthroscopically but often requires an open surgery.
Instructions
Examine the Shoulder and Prepare for Surgery
1. Examine the shoulder externally to determine the patient's range of motion and degree of pain.
2. Check the shoulder arthroscopically if it looks like the rotator cuff is torn or impinged by bone of inflammation. Use a local anesthetic and make a very small incision to insert the tiny camera (arthroscope) to see what's causing the problem.
3. Look at the whole joint to see whether the problem is caused by ligaments, cartilage or tendons, or a combination of any of them.
4. Move the arthroscope to the space over the rotator cuff tendons to check for bone spurs and damaged or inflamed shoulder tissue.
5. Clean out any damaged tissue or a bone spur if you find one.
6. Determine if the rotator cuff needs to be surgically repaired.
7. Remove the camera, close the incision and dress the wound. Tell the patient what you've learned. If repair is needed, schedule an arthroscopic or open surgery for the repair.
Perform an Open Surgery to Repair the Torn Rotator Cuff
8. Anesthetize the patient. Although it's possible to perform this surgery with a local anesthetic, the duration of the surgery makes it easier on the patient if he's anesthetized. Keep the anesthetist in the operating room to monitor the patient during the surgery.
9. Cleanse the area over the shoulder thoroughly. Using a scalpel, make an incision about 3 inches long over the shoulder. Cut or detach the deltoid muscle to get to the rotator cuff.
10. Cut out any bone spurs or scar tissue around or on the rotator cuff muscles and tendons or the acromion. Remove the bursa if it's inflamed or abscessed. If you believe the muscle will need more room to move, shave off a portion of the acromion.
11. Make a small furrow in the bone where the rotator cuff should attach under normal conditions. Drill small holes in the furrow.
12. Use sutures to pull the tendon tightly into the furrow where it should heal, and tie off each stitch. This results in a smooth edge for the cuff, allowing it to move smoothly under the deltoid muscle and the acromion.
13. Repair or reattach the deltoid muscle.
14. Stitch the original incision closed. Apply a dressing.
Tags: rotator cuff, deltoid muscle, bone spurs, cuff bone, cuff torn, four muscles