Cover_Jan 05 (Page 2) - The Parklander Magazine

Options Are Available
For Rotator Cuff Tear
By Dr. Thomas Goldschmidt
Question: I have been told that
I have a rotator cuff tear and require
surgery. Are there any new procedures
which can minimize recovery time
after surgery and eliminate a large
surgical scar
Answer: There have been many
advances in surgical technique, providing
better cosmetic and operative outcomes for rotator cuff
surgery. I have asked Dr. Keith Kurland, ex-Chief of Staff at
Coral Springs Medical Center who specializes in orthopedic
and arthroscopic surgery, to address your concerns.
Rotator cuff injuries of the shoulder are common in all
age groups. They are typically associated with athletic injury
in the younger age group and degenerative disease in the
older age group. The spectrum of rotator cuff disease can
range from a mild tendonitis to a full blown tendon tear.
The rotator cuff consists of four tendons: the supraspinatus,
the infraspinatus, the teres minor and the subscapularis. The
supraspinatus tendon is the most commonly torn portion
of the rotator cuff.
Treatment initially can be conservative, especially in the
older, more sedentary patient. This may consist of injections,
physical therapy and anti-inflammatories. If this fails, and
the patient has pain at rest and at night with diminished
functional activities of daily living, he or she may be a good
candidate for surgery.
Open surgery is the traditional method of rotator cuff
repair. Newer techniques have evolved over the past several
years. A “mini-open” type procedure enjoys great success
amongst many surgeons. This is essentially an arthroscopic
technique to evaluate the rotator cuff and perform a procedure
that cleans any inflamed tissue, i.e. bursa, and impinging
ligaments and bone. Then the cuff is repaired through a
small incision placed on the outer aspect of the upper arm.
Even more recent is the technique of an “all arthroscopic
repair” of the rotator cuff. This is a procedure performed by
qualified orthopedic surgeons where a small telescopic type
video camera is inserted into the shoulder and the torn
rotator cuff is sutured or anchored back to or near its original
insertion. The whole procedure is done through three or four
small portals about the shoulder joint. There are a variety of
anchors and suturing devices that are essential in the repair
process. In order to secure the repair, the cuff is tied down
to the bone with a series of hitches and knots.
As any sailor will tell you, a proper knot may make the
difference between an adventure at sea and a disaster at sea.
The so-called “fisherman’s knot” is actually one of the varieties
used in rotator cuff repair. One of the latest innovations
has been the development of the “knotless anchor.” This is
a new technique where the rotator cuff is actually secured
to its anchor without any knots at all. The advantage of this
method is that there are no knots outside the surface of the
rotator cuff tissue to cause irritation or impingement when
the patient moves his or her shoulder after surgery.
Whether to perform the surgery open or arthroscopically
and whether to knot or go knotless is still best left to the
discretion and expertise of your orthopedic surgeon. P ●
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