In patients with irreparable cuff tears or failed prior repairs that have preserved active elevation, the results of the 'smooth and move' can be excellent. This procedure enables immediate active use of the arm without the need to protect a tenuous repair. A full shoulder motion program can be started right away after surgery and progressed to gentle shoulder strengthening as rapidly as shoulder comfort permits.
Here is a followup note from a sixty year old rancher who had bilateral 'smooth and move' procedures without any attempt to repair his large supraspinatus or infraspinatus tendon defects. While some may have considered 'marginal convergence', a cuff graft, a tendon transfer, a superior capsular reconstruction or even a reverse total shoulder, none of these seemed appropriate for this active man who wanted to get back to roping cattle on his ranch.
From his operative note on the right side: "This rancher has pain and loss of function of his right shoulder. He has had a rotator cuff tear which was treated with a graft jacket. Unfortunately, this became infected and required debridement, leaving him with a stiff, painful shoulder.
There was extensive scar throughout the humeral scapular motion interface. The subscapularis was detached but was reconstructible. The supraspinatus was absent. The upper 2/3 of the infraspinatus was absent as well. There was minimal evidence of arthritis. The tuberosities were prominent. The undersurface of the coracoacromial arch was smooth.
Under satisfactory anesthesia, the shoulder was carefully prepped and draped in the usual manner. The shoulder was approached through a superior "deltoid on" approach. The abundant scar in the humeral scapular motion interface was debrided. The previous sutures and graft jacket were excised. The bursa was removed. The prominent tuberosities were resected using a rongeur and a burr. The subscapularis was identified, freed from scar and reattached anteriorly. The wound was thoroughly irrigated. A manipulation under anesthesia was performed to assure a full range."
Two years later he had a similar procedure performed on left side for a failed prior repair. His operative note states that there was "abundant scar in the humeroscapular motion interface. The supraspinatus was absent. The subscapularis was absent. The infraspinatus was absent in its upper 1/2. The biceps tendon was absent. The undersurface of the acromion was smooth.There was substantial scar and retained sutures. The deltoid was deficient in the area of the prior surgery.
Two years later he had a similar procedure performed on left side for a failed prior repair. His operative note states that there was "abundant scar in the humeroscapular motion interface. The supraspinatus was absent. The subscapularis was absent. The infraspinatus was absent in its upper 1/2. The biceps tendon was absent. The undersurface of the acromion was smooth.There was substantial scar and retained sutures. The deltoid was deficient in the area of the prior surgery.
The abundant scar in the humeroscapular
motion interface was lysed. The
prior sutures were removed. The prominences on the humeral tuberosity were
resected. The rough edges of the cuff were smoothed. The shoulder was gently
manipulated for a full range of motion.The weakened area of deltoid was reinforced by
imbrication of the weakened area
with six sutures of #2 Tevdek."
In a followup note he reported that both shoulders are dramatically improved and that he was back to roping and branding as shown in the photos below
