Shoulders

When is rotator cuff surgery necessary?

The rotator cuff is a tendon linking four muscles in your shoulder. These muscles cover the head of the upper arm bone, working together to lift and rotate the shoulder. The tendons at the ends of the rotator cuff muscles can become torn, causing pain, restricted arm movement, and necessitating rotator cuff surgery.

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Rotator cuff tears occur due to:

    • Shoulder trauma
    • Shoulder impingement associated with everyday wear and tear or sustained athletic activities (repeated overhead motions or forceful pulling motions)

For his research on rotator cuff surgery, Dr. Karas has received numerous grants and has been published in many peer-reviewed journals. With 25+ years of specialized expertise in orthopaedic sports medicine and full membership in the prestigious American Shoulder and Elbow Society (ASES), Dr. Karas has worked to provide you with many beneficial options for rotator cuff surgery that can restore your rotator cuff function and get you back to doing what you love.

Double Row Repair

    • Minimally invasive (as opposed to open surgery, in which the surgeon must split the muscle to make an incision)
    • An arthroscopic camera (about the size of a pencil) is inserted through an incision which allows Dr. Karas to view the torn tendon and perform the surgery with small tools
    • During double row repair for the rotator cuff, the torn tendon is attached back to its original site on the bone using a double row of sutures, as opposed to a single row
    • Sturdy construct and superior protection of the tendon and bone at the repair site
    • Double row repair for the rotator cuff restores original rotator cuff footprint (the exact size, shape and makeup of the rotator cuff)
    • Double row repair for the rotator cuff results in less tissue trauma, less post-op pain, and faster, more dependable rehabilitation than traditional surgery

Solutions for large and irreparable tears

In some cases, patients may experience a massive or irreparable rotator cuff tear. An irreparable rotator cuff tear refers to large rotator cuff tear in which the tendon has retracted far from the bone where it should be attached. An irreparable rotator cuff tear cannot be repaired by conventional techniques. Patients with an irreparable rotator cuff tear can present with a wide range of manifestations: from no symptoms or mild symptoms to those who are completely disabled and suffering extreme pain.

An irreparable rotator cuff tear most commonly occurs in:

    • Older patients, in which minor trauma brings on mild to severe symptoms
    • Younger and more active patients with a history of acute injury or previous rotator cuff problems

Fortunately, with over 25 years of specialized academic, clinical, and research experience on the subject, Dr. Karas can repair even irreparable rotator cuff tears.

Superior Capsular Reconstruction

    • Superior capsular reconstruction (SCR) is a cutting edge, minimally invasive surgical technique (as opposed to open surgery, in which the surgeon must split the muscle to make an incision)
    • An arthroscopic camera (about the size of a pencil) is inserted through an incision which allows Dr. Karas to view the torn tendon and perform the surgery with small tools
    • During superior capsular reconstruction, Dr. Karas uses a graft (living tissue from the patient’s own body or from a donor) between the head of the upper arm bone and the shoulder blade
    • Performed under general anesthesia combined with a nerve block, which also servers to manage post-op pain
    • Superior capsular reconstruction results in less tissue trauma, less post-op pain, and faster, more dependable rehabilitation than traditional surgery
    • Superior capsular reconstruction boasts a high success rate for even massive, irreparable rotator cuff tears

Rotator Cuff “Bridge” Technique for Irreparable Rotator Cuff Tear

    • The rotator cuff “bridge” technique is a minimally invasive surgery (as opposed to open surgery, in which the surgeon must split the muscle to make an incision)
    • An arthroscopic camera (about the size of a pencil) is inserted through an incision which allows Dr. Karas to view the torn tendon and perform the surgery with small tools
    • During rotator cuff “bridge” surgery, Dr. Karas utilizes a graft (living tissue from the patient’s own body or from a donor) trimmed to custom fit the individual tear size and shape, allowing for a tension-free repair, which increases the chances of tendon healing
    • The graft is combined with suture “bridges” to create a result that is strikingly anatomically similar to an undamaged shoulder
    • The rotator cuff “bridge” technique results in less tissue trauma, less post-op pain, and faster, more dependable rehabilitation than traditional surgery
    • The rotator cuff “bridge” technique restores a more secure rotator cuff footprint (the exact size, shape and makeup of the rotator cuff)
    • Potentially slows the progression of arthritis in the joint