23412 Repair of ruptured musculotendinous cuff (eg, rotator cuff) open; chronic

Name of the Procedure:

Repair of Ruptured Musculotendinous Cuff (e.g., Rotator Cuff) - Open; Chronic

Summary

This surgical procedure involves repairing a chronic tear in the rotator cuff using an open surgical approach. The rotator cuff comprises muscles and tendons around the shoulder joint, providing stability and movement.

Purpose

The procedure addresses chronic tears in the rotator cuff, which can cause pain, weakness, and limited shoulder function. The goal is to alleviate these symptoms, restore shoulder strength, function, and prevent further damage.

Indications

• Persistent shoulder pain despite conservative treatments
• Significant weakness in the shoulder
• Limited range of motion
• Chronic rotator cuff tears confirmed by imaging studies
• Activities significantly compromised by shoulder dysfunction

Preparation

• Pre-operative fasting (usually from midnight before the procedure)
• Stop certain medications as advised by the surgeon (e.g., blood thinners)
• Pre-operative imaging like MRI or ultrasound
• Physical examination and medical history assessment

Procedure Description

1. The patient is taken to the operating room and placed under general anesthesia.
2. An incision is made over the shoulder to access the rotator cuff.
3. The surgeon identifies the torn tendon and cleans the area around the tear.
4. The torn edges of the tendon are repaired and reattached to the bone using sutures or anchors.
5. The incision is closed with sutures or staples.
6. A sterile dressing is applied, and the arm is placed in a sling.

Tools and Equipment Used:

• Surgical scalpel and scissors
• Sutures and specialized anchors
• Surgical retractors
• Sterile dressing materials

Duration

Typically, the procedure takes about 90 minutes to 2 hours.

Setting

The procedure is performed in a hospital or surgical center.

Personnel

• Orthopedic surgeon
• Anesthesiologist
• Surgical nurse
• Scrub technician

Risks and Complications

• Infection
• Bleeding
• Nerve damage
• Stiffness or limited range of motion
• Re-tear of the rotator cuff
• Anesthesia-related complications

Benefits

• Alleviation of chronic shoulder pain
• Improved shoulder strength and function
• Enhanced quality of life The benefits may be noticed within several weeks to months, depending on rehabilitation and recovery.

Recovery

• Post-operation, the patient will need to keep the arm in a sling for several weeks.
• Physical therapy typically starts a few weeks after surgery to gradually restore shoulder function.
• Full recovery can take several months, with specific restrictions on activities like lifting or overhead motions.

Alternatives

• Conservative treatments: Physical therapy, steroid injections, and anti-inflammatory medications
• Arthroscopic rotator cuff repair: A minimally invasive alternative with a faster recovery time
• Pros and Cons: Conservative treatments may not fully address severe tears, whereas arthroscopic surgery might not be suitable for large or complex tears.

Patient Experience

During the procedure, the patient is under general anesthesia and will not feel pain. Post-operative pain and discomfort can be managed with medications. Patients are encouraged to follow the rehabilitative plan closely to ensure optimal recovery.