Dr. James Shaffer, Shoulder Surgeon
Dr. James Shaffer was recently interviewed on WEEU’s “Health Talk” program. Here is the third of four excerpts from the interview, full of helpful information relating to shoulder treatment and surgery.
Question: What if you have a patient who maybe has a rotator cuff tear and things aren’t getting better. How do you proceed from there?
Dr. Shaffer: Typically, before we consider surgery we’d have an MRI scan of the patient’s shoulder so we can show the rotator cuff in some detail. Usually a plain x-ray is obtained at some point but that doesn’t show the tendon directly, whereas the MRI would. I then have a good idea of the size of the tear, and idea of the quality of the muscle the rotator cuff is, how far the tendon may have pulled back away from its usual attachment. These are all important factors to consider.
From there, I’d have a thorough discussion with the patient about their goals, explain to them that it is a lengthy rehab process after surgery, and then when it comes to the surgery itself, most of these can be done arthroscopically. In my practice, I probably only do an open procedure for a rotator cuff once a year or so. The other vast majority, 99%, are done arthroscopically. What that means is it’s done with special, very small instruments through very small incisions, usually four incisions, each of which is no more than about one half inch around the shoulder. A special camera is inserted into the shoulder and then specialized instruments are used to clean out the shoulder and then visualize and see the rotator cuff. Then, it’s reattached to the bone where it’s torn away with things called suture anchors, which are basically little screws with a stitch attached, and the screw is put into the bone at the upper end of the arm bone on the top of the ball part of the shoulder joint and then that stitch is passed through the tendon to tie that tendon back down onto the bone. Usually small channels are placed into the bone to allow for some growth factors and some stem cells within the bone to then travel out of the area of the tendon and allow for better healing.
A patient can usually can home the same day of the surgery. They are usually in and out the same day, and the surgery itself takes about an hour and a half or a little more. In my practice, you’ll get a visit from a home health physical therapist, usually the day after surgery, to make sure you’re comfortable getting in and out of the sling, dressing, bathing, and then a few weeks later you’ll start outpatient physical therapy.
AJRC
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