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This is doctor Brett Franklin with Sportsmed Orthopaedic Surgery and Spine Center
in Huntsville. A fifty seven year-old female with left shoulder pain for the
last several months.
She did not have any history of an injury.
She had the typical symptoms of a rotator cuff tear that include
pain in the shoulder,
pain at night while sleeping,
difficulty with overhead lifting activities, and weakness in the shoulder.
This video is of her left shoulder arthroscopic rotator cuff repair.
Here in this video you see the shoulder joint. We're inserting a needle
to create a cannula or portal to allow us to work inside the shoulder.
To the left is the humeral head or top of her arm bone. The bottom of the
screen is her shoulder joint or glenoid.
we're inserting a blue cannula as we call it to allow us to bring instruments
into the joint including the shaver here which we will use to debride some frayed
torn tissue around her labrum
in the front here
as well as a chance to look at her biceps tendon.
She had significant biceps pain and fraying
here so we are performing a biceps tenotomy
where we simply release
the biceps tendon
from its attachment in the shoulder joint.
Again we bring in the shaver
to debride some frayed tissue.
We are now looking at the under surface of her rotator cuff.
Now we are above the rotator cuff in a area called the subacromial
space and here you can see her rotator cuff tear.
This instrument is a radio frequency ablader we use to remove soft tissue
from the under surface of her
acromion or shoulder blade
to identify her bone spur
which you see now.
We are cleaning this up with a shaver.
Now we will focus on her rotator cuff tear you can see the tissue here
detached from the bone.
We use this gold tamp or punch to create a hole
in the top of her arm bone
which we will place an anchor into to secure
her rotator cuff back to the bone.
This is called a tap which we used to create
threads in the top of her arm bone or humeral head
where the rotator cuff attaches.
This allows for easier insertion of the anchor which we'll put in shortly.
Now that we've created a
hole we'll bring in our anchor which you see has
stitches in it
and we simply secure
this anchor which has stitches
threaded into it, into the bone.
These anchors can be made up several materials some of which are
absorbable.
Some surgeons prefer metal
this particular one is a nonabsorbable anchor.
You can see we've got nice secure purchase with our anchor and sutures.
Now we simply
use various techniques to
take the sutures out through a cannula
and we will pass these
sutures into her rotator cuff tissue
using a device.
T.his particular device has a needle which threads the suture
through the rotator cuff
and allows us to retrieve it
on the other side.
This particular anchor
has four separate sutures
through it and we'll repeat that process
a total of four times
bringing the suture through the rotator cuff
and retrieving it on the
other side of the tissue. You can see that we've passed two sutures
to the front
portion of the tear.
Now we will repeat the exact same process with the blue sutures
passing
them through the tissue.
Once they're passed we will use
what we call arthroscopic knot tying techniques where we simply
secure the sutures
through the tissue
and anchor the rotator cuff back to the bone.
We've tied the suture in the back.
We will repeat the same process
with the sutures on the front
and we simply cut the suture.
Now we have a nice secure repair of her rotator cuff and we have secured it
back to the bone
to allow the tissues to heal.
This procedure is usually done
as an outpatient surgery so she will go home the same day.
Recovery time for rotator cuff repairs can vary.
Patients are typically in a sling for four to six weeks.
They will be in a supervise physical therapy program for anywhere from two to
three months.
Depending on the type of work a patient does they could typically return to
work
within three to five days if they do light desk work or computer type work.
Any type of lifting
for pushing or pulling activities
will likely be closer to six to eight weeks.
I hope you have found this video helpful.
Again, this is Dr. Brett Franklin with SportsMED Orthopaedic Surgery and Spine
Center in Huntsville, Alabama presenting a rotator cuff repair.