Rotator Cuff Repair with Dr. Mesghali
‘Mini’ Shoulder Procedure Yields Mega Results
Homayoun Mesghali, MD, FAAOS, FACS
Homayoun Mesghali, MD, FAAOS, FACS, a member of Montgomery Orthopaedic Surgeons, Inc., is a pioneer in arthroscopic orthopedic surgery in the Dayton area. Dr. Mesghali, who is the director of joint replacement surgery at Good Samaritan Hospital, is certified by the American Board of Orthopaedic Surgery, and is a member of Arthroscopy Association of North America. He is also an associate clinical professor at Wright State University Boonshoft School of Medicine. Call (937) 832-4773 or visit www.montortho.net for more information.
What is a rotator cuff and what does it do?
The group of four tendons that stabilize the shoulder joint form what is known as the rotator cuff. Each tendon hooks up to a muscle that moves the shoulder in a specific direction with rotation of the arm. The rotator cuff provides the stability these shoulder muscles need. The shoulder joint must be mobile and strong so you can use your arm and hand.
How are rotator cuffs torn, and what are the symptoms of a tear?
A tear in the rotator cuff tear destroys the shoulders joint’s support, and can cause pain and loss of strength and interfere with motion. A tear can be caused by a single traumatic injury such as a lifting injury or fall, or it may happen with a bone fracture or dislocation. Most tears, however, are the result of overuse of the shoulder muscles and rotator cuff tendons over time. People who do repeated overhead motions – like baseball or tennis players and weight lifters – are at risk. Rotator cuff tears are most common in people over age 40.
Some symptoms of the rotator cuff tear are pain or weakness when lifting or rotating the arm, pain when lowering the arm from a raised position, a cracking sensation (called crepitus) when moving the shoulder.
How is a rotator cuff tear diagnosed?
If you have symptoms of the rotator cuff tear, we do a physical exam and take some X-rays. We measure your arm’s range of motion in several different directions, and do a strength test. In some cases, we may do an MRI or ultrasound of the shoulder as well.
How is a torn rotator cuff treated?
If your tear is small and the symptoms do not interfere with your usual activities, you might be able to control discomfort with medication. If you are an active person, or if the tear is large, surgery might be the best treatment.
In the past, we would make an incision over the outside of the shoulder and separate the muscle beneath the skin to expose the rotator cuff, and repair the tear. This procedure is called open rotator cuff repair. Now, we have a less-invasive approach called mini-open arthroscopic repair.
What are the advantages of a mini-open arthroscopic repair?
In the mini-open technique, we look at the rotator cuff with a small camera (arthroscope) inserted into the joint. The image is projected on a television screen. With the image as our guide, we use small instruments to remove any bone spurs and damaged tissue. In the traditional surgery, we have to cut through muscle tissue to see the area and accomplish this step. In the mini-open procedure, the camera shows us the area. We can gently part the muscle fibers to get the job done.
The next step is making the actual cuff repair. We do this through an incision about an inch to an inch-and-a-half long – approximately half the length of the incision used in the open procedure. The mini-open technique is less painful than traditional rotator cuff surgery, requires less rehabilitation and can be performed on an outpatient basis on people of all ages.