The rotator cuff is made up of strong bands of tissue called tendons, which attach the shoulder muscles to the upper arm bone, or humerus, enabling the arm to be lifted or twisted. A rotator cuff tear can result from a sudden injury, such as a fall, or from the gradual wear and tear of overuse; tears typically occur at the point where the tendon runs close to the shoulder blade. When the cuff is completely torn, it is unlikely to heal naturally, and shoulder surgery becomes necessary. Arthroscopic surgery, or keyhole surgery, is carried out through small cuts in the skin, using a slender viewing instrument and tiny surgical tools. When compared to traditional surgery, an arthroscopic rotator cuff repair has the advantages of less pain, a shorter hospital stay and a quicker recovery without stitches.
A torn rotator cuff may be caused by falling and landing with the arm outstretched, or by catching or lifting a heavy item. Sometimes, repetitive movements with the arms above the head can lead to a tear, while in other cases, a tendon rubs against the shoulder bone and gradually causes more and more damage. Symptoms of shoulder pain and weakness of the shoulder muscles typically occur. Lifting or twisting the arm usually is difficult and painful, and pain that travels down the arm is sometimes experienced at night, preventing sleep. A surgical procedure such as an arthroscopic rotator cuff repair may be necessary in order for a person to resume a normal life.
During an arthroscopic rotator cuff repair, small incisions measuring no more than 2 inches (about 5 cm) in length are made in the skin above the rotator cuff. A type of thin telescope is inserted through one incision, sending images to a viewing screen while the operation is performed. Metal tubes are inserted through other holes in the skin, known as portals, allowing miniature surgical tools access to the injured area. The surgeon is able to manipulate the instruments very precisely by watching their movements on screen. Stitches are inserted into the torn tendon before being attached to special screws or plugs, known as suture anchors, which are fixed into the bone of the upper arm.
An arthroscopic rotator cuff repair, in common with other types surgery using arthroscopy, is considered a minimally invasive surgical technique. This is because there is less disturbance and damage to the skin and underlying structures than in conventional surgery, in which a larger opening must be made in order to carry out the operation. Following arthroscopic rotator cuff repair, the patient experiences less pain and scarring, and may leave hospital the same day.
