and to release the capsule from its attachment to the glenoid labrum
so that the muscle and tendon can be drawn out further laterally to the insertion. Without such releases the repair may be under undue tension and at risk for failure. After the releases have been performed and after any scar has been dissected from the humeroscapular motion interface, traction sutures are placed in the tendon edge. If good quality tendon can be brought close to its normal insertion site with the arm in adduction, a robust repair can be carried out.
The ideal reattachment technique has the following properties:
(1) yields a smooth upper surface which can articulate congruously with the intact undersurface of the coracoacromal arch
The ideal reattachment technique has the following properties:
(1) yields a smooth upper surface which can articulate congruously with the intact undersurface of the coracoacromal arch
and avoids knots or tendon edges on the upper aspect of the repaired cuff where they could rub under the coracoacromial arch
(2) excludes joint fluid from the repair site and accommodates some slippage in the sutures and knots without separation of tendon from bone
(3) creates a secure isometric junction between the tendon and bone spreading the load among numerous sutures
(4) can accommodate weakened bone at the greater tuberosity
(5) can be accomplished without sacrificing acromion, the acromioclavicular joint, or the deltoid origin
If there is insufficient quantity and quality of tendon to reach the tuberosity with the arm at the side, consideration can be given to moving the insertion site up to 1 cm medially on the humeral articular surface. If a robust repair cannot be performed, the priority shifts from repair to achieving the smoothest possible upper aspect of the proximal humerus for articulating with the undersurface of the coracoacromial arch. Often the head is translated superiorly because of the loss of the spacer effect of the superior cuff tendon and secondary erosion of the superior glenoid lip
This situation may call for smoothing of the upper aspect of the residual cuff as well as recession of the tuberosities if they are prominent so that the surface presented by the proximal humerus to the coracoacromial arch is smooth – we refer to this as a “smooth and move,” the goal of which is to convert the upper aspect of the proximal humerus into a smooth convexity that articulates congruously with the concave undersurface of the coracoacromial arch. Because the procedure is performed through a deltoid-on approach, no postoperative restrictions are placed so that the patient can move the joint actively immediately after surgery. We have found that when the cuff will not reach to a reasonable insertion site, abducting the shoulder so that repair can be achieved
and then ‘protecting’ the arm in abduction
tends to lead to cuff insertion failure when the arm is brought down to the patient's side.
and then ‘protecting’ the arm in abduction
tends to lead to cuff insertion failure when the arm is brought down to the patient's side.
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How you can support research in shoulder surgery Click on this link.
Here are some videos that are of shoulder interest
Shoulder arthritis - what you need to know (see this link).
How to x-ray the shoulder (see this link).
The ream and run procedure (see this link).
The total shoulder arthroplasty (see this link).
The cuff tear arthropathy arthroplasty (see this link).
The reverse total shoulder arthroplasty (see this link).
The smooth and move procedure for irreparable rotator cuff tears (see this link).
Shoulder rehabilitation exercises (see this link).