The Smooth and Move procedure is a simple surgical procedure for the management of symptomatic irreparable rotator cuff tears in shoulders with retained active elevation. For a link to an instructive video, click here.
The typical pathology in these cases is shown in the figure below.
Here is a case example of a 71 year old photographer with a failed prior cuff repair attempt. On examination he had symptomatic subacromial crepetance, weakness of flexion and external rotation, but retained active elevation.
Here is the preoperative radiograph showing evidence of cuff tear arthropathy.
The patient desired a conservative procedure with a short recovery rather than proceeding with arthroplasty.
At surgery he had no supraspinatus or infraspinatus. The debris shown below was removed from his humeroscapular motion interface
The typical pathology in these cases is shown in the figure below.
The surgical approach is through a deltoid splitting incision that preserves the deltoid origin, the acromion and the coracoacromial ligament.
The coracoacromial arch is preserved to avoid the complication of anterosuperior escape that is commonly encountered when acromioplasty is performed in the presence of a large cuff tear.
The surgery includes smoothing of the prominence of the greater tuberosity that is exposed in cuff tears along with resection of adhesions in the humeroscapular motion interface and a gentle manipulation under anesthesia to resolve the stiffness that is commonly associated with chronic cuff tears. Immediate active assisted and active motion are encouraged immediately after surgery. Because no repair or reconstruction has been performed, activities, including deltoid strengthening can be resumed as soon as they are comfortable.
Here is a case example of a 71 year old photographer with a failed prior cuff repair attempt. On examination he had symptomatic subacromial crepetance, weakness of flexion and external rotation, but retained active elevation.
Here is the preoperative radiograph showing evidence of cuff tear arthropathy.
At surgery he had no supraspinatus or infraspinatus. The debris shown below was removed from his humeroscapular motion interface
This video (used with permission of the patient) shows his function 6 weeks after surgery.
Eight weeks after surgery he was photographing north of the Arctic Circle. Here's one of his photos.
