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This website is under development - The information contained on this site is for guidance only and is not intended for self diagnosis or self treatment. This will not replace professional medical advice or consultation. Always seek the professional advice of a qualified health care provider like your doctor or specialist before embarking on  any treatment. If you have a problem please consult your doctor or specialist.
Arthroscopic stabilisation    Reverse Replacement    Arthroscopic Rotator Cuff Repair
Investigations
If impingement syndrome continues unabated, then logical outcome for a tendon that is  being rubbed so many times is to tear. The ultrasound scan will pick up the extent of the damage to the tendon and its retraction. Based on the history and the investigation findings, a decision is made to repair the tendon either using arthroscopic technique or by open technique.

Operation - Arthroscopic repair
The aim of the operation is to reattach the tendon back to the area in the humeral head from where it came off. There are number of steps in this process before a repair can be effected.  
The operation is usually performed as a day case procedure under general anesthetic. One may supplement this with a nerve block at neck or using local anaesthetic around the wound and inside the joint. To perform the operation, you will be turned to your ‘good-side’ such that the affected sided in on the top.  Gentle traction will be applied to the arm to help the pass various instruments needed to perform the operation.
The shoulder joint is visualized by introducing the telescope via a small stab incision in the back of the shoulder. Sterile saline is pumped into the shoulder under pressure to distend the joint. The quality of the tendon and the status of the long head of biceps are checked from inside the joint.
An extensive partial bursectomy is done to expose the tendon and the muscle unit. Using special graspers, the tendon is mobilised and assessed for suitability for reattachment to achieve a tension free repair.
The area where one is intending to re-attach the tendon is made fresh. This step is technically called re-creation of the foot-print of the tendon. This is a vital step as the tendon can heal into a bleeding bone. Through further stab incision, a metal or plastic anchor pre-loaded with sutures are placed at the most appropriate spot in the footprint.They are very much like the pegs you drive down the ground while erecting a tent. Using specialist instruments, suture is passed around the tendon-muscle complex and is tied down to the foot-print area firmly securing the tendon at the right place. Long head of biceps may have to be sacrificed especially if it is damaged.
The wound is closed with sutures and water resistant dressing is applied. This is covered with a further layer of pressure dressing. The arm is then placed in a sling. You will be given information regarding wound care and information regarding various exercises you need to do.
Rotator cuff repair surgery can be very painful during the post-operative phase and the painkillers will only subdue the pain and not fully abolish it. It can take a week or two for the pain to come under full control. The level of pain is usually proportional to the size of the tear and the amount of mobilisation that is needed to get the repair done. Physiotherapy will be arranged if required.  

Sequence showing a rotator cuff tear from both inside and outside the joint. Insertion of anchors, passing sutures using special devices is shown. The final two pictures on the left shows the view of the cuff repair as achieved - from both inside and outside the joint.