17-Sep-07 10:00 AM CST

Relief for large rotator cuff tears with arthroscopic patch augmentation

Rotator cuff injuries can be very painful. Until recently, very large tears were often considered to be surgically irreparable. Two young surgeons in Houston are having success with a new technique that may significantly improve your chances for recovery.

"Doc' says it's my rotary cup!" Commonly misunderstood, the rotator cuff is a group of four muscles that surrounds the shoulder and functions to provide the strength and support to perform overhead activities. People with rotator cuff disorders often have pain or weakness when trying to throw a ball, fish, play golf or tennis, or do any kind of overhead work. They may have difficulty sleeping on their side because of pain at night or trouble reaching behind their back. The problem may start suddenly, after a fall, or reaching into the back seat of the car to get a heavy briefcase, or when trying to catch or lift a heavy object. Alternatively, it may come on gradually with repetitive overhead shoulder activities at work or play with no obvious injury. Rotator cuff disorders range from tendonitis to partial tears to full thickness tears, when the muscle is completely detached from the bone.

Conservative, non-surgical treatment of rotator cuff disorders may completely resolve your symptoms. Physical therapy can loosen up your shoulder and strengthen the muscles around it. A cortisone shot, placed just on top of the rotator cuff, may relieve the pain, at least temporarily, but sometimes permanently, and can be repeated if necessary.

If you continue to have symptoms or if you cannot get back to your normal activities pain free, your doctor may offer you a surgery known as "arthroscopic rotator cuff repair." This procedure uses specially designed instruments to sew the torn rotator cuff muscle back to the bone. This is all done through three or four ¼ inch incisions around the shoulder. Using a pencil sized digital camera inserted into your shoulder for the duration of the surgery, the doctor views the action on a high definition flat screen monitor.

Partial thickness tears and small full thickness tears can be easily sewn back to the bone using an arthroscopic technique by an orthopedic sports medicine surgeon.

These specialists have completed additional training to be proficient with these special instruments and techniques. Other people may have large or "massive" rotator cuff tears, when two, three, or all of the muscles tear off the bone. In the past, they may have been told their rotator cuff tears were too large to be repaired. Now, there is a new technique offering hope for people with large and "massive" rotator cuff tears.

In the April 2007 issue of Arthroscopy, Dr. Stephen Burkhart reported original research describing improvement in both function and pain for patients with very large rotator cuff tears who would have previously been told that their tears where irreparable. Using arthroscopic techniques similar to those described in the above study, Drs. Marc Labbé and Taylor Brown of the Bone and Joint Clinic of Houston are repairing large and "massive" rotator cuff tears. Additionally, they are involved in ongoing research to continue to improve the outcome for people with this terrible shoulder problem.

Using an arthroscopic technique developed and reported by Dr. Labbé in the October 2006 issue of Arthroscopy, these two orthopedic sports medicine surgeons are adding a "patch" to strengthen the repaired muscle. Just as your grandmother might have patched a hole on the knee of your jeans with a swatch of cloth, they add a patch over the rotator cuff, sewing it down over the repaired muscle and bone. In early studies, addition of this patch has been shown to increase the success rate for people with large and "massive" rotator cuff tears. The patch is skin obtained from organ donors which has been tested and specially processed for use as a graft. Select surgeons throughout North America are involved in a study using an open technique that involves a 2 to 3 inch long scar on the side of your shoulder to place the patch. This Houston team, as well as other surgeons in Los Angeles, Dallas, and Calgary, will perform the same operation with the arthroscopic technique This study will be ongoing for the next two years before final results are reported.