Reconstruction of complete shoulder (rotator) cuff avulsion, chronic (includes acromioplasty)
CPT4 code
Name of the Procedure:
Reconstruction of Complete Shoulder (Rotator) Cuff Avulsion, Chronic (includes Acromioplasty) - Also known as Rotator Cuff Repair Surgery with Acromioplasty.
Summary
In this procedure, a surgeon repairs a torn rotator cuff—a group of muscles and tendons that stabilize the shoulder—and smoothens the acromion (a part of the shoulder blade) to prevent future injuries. This surgery addresses chronic tears that occur over time.
Purpose
This surgery aims to restore shoulder function, reduce pain, and improve strength and movement in patients with chronic rotator cuff tears that haven't responded to conservative treatments. The ultimate goal is to allow patients to return to their regular activities without shoulder pain.
Indications
- Chronic shoulder pain lasting for several months
- Limited shoulder movement and strength
- Inability to perform daily activities due to shoulder dysfunction
- Failed non-surgical treatments like physical therapy and medication
- MRI or ultrasound confirming a complete rotator cuff tear
Preparation
- Fasting for at least 8 hours prior to the surgery
- Adjusting or stopping certain medications as advised by the surgeon
- Preoperative imaging studies like X-rays, MRI, or ultrasound to assess the tear
- Pre-surgical physical evaluation and possibly blood tests
Procedure Description
- Anesthesia: The patient is given general anesthesia, along with a regional nerve block.
- Incisions: Small incisions are made around the shoulder.
- Arthroscopic Inspection: A tiny camera (arthroscope) is inserted to inspect the shoulder joint.
- Repair: Torn tendons are sutured back to their attachment on the bone using special surgical anchors.
- Acromioplasty: Bone spurs and a part of the acromion are shaved off to create more space for the repaired tendons.
- Closure: Incisions are closed with sutures or staples, and a bandage is applied.
Duration
The procedure typically takes 1.5 to 3 hours, depending on the complexity of the tear.
Setting
The surgery is performed in a hospital or an outpatient surgical center.
Personnel
- Orthopedic Surgeon
- Anesthesiologist
- Surgical Nurses
- Operating Room Technician
Risks and Complications
- Infection at the surgical site
- Bleeding or hematoma
- Nerve damage
- Stiffness or limited range of motion
- Incomplete healing or reinjury of the rotator cuff
- Adverse reactions to anesthesia
Benefits
- Reduced or eliminated shoulder pain
- Improved shoulder function and range of motion
- Increased strength in the shoulder
- Enhanced quality of life and ability to engage in daily activities
Recovery
- Immobilization of the shoulder in a sling for several weeks
- Pain management with medications
- Physical therapy to regain strength and mobility starting a few weeks after surgery
- Full recovery typically takes 4 to 6 months, with gradual return to physical activities
Alternatives
- Physical therapy and rehabilitation
- Corticosteroid injections
- Oral anti-inflammatory medications
- Less invasive procedures like arthroscopic debridement
- Pros of non-surgical options include avoiding surgical risks, though they might not fully address chronic pain or functional deficits.
Patient Experience
- Patients might feel soreness and pain post-surgery, managed with prescribed pain relievers.
- Some discomfort and limited mobility due to wearing a sling.
- Gradual improvement in movement and strength over the next few months with rehabilitation.
- Pain and discomfort usually subsides within a few weeks.