Chronic irreparable rotator cuff tear - Superior Capsular Reconstruction (SCR)
My rotator cuff is torn and cannot be repaired
The rotator cuff is a system of tendons surrounding the humeral head at the shoulder joint. They come from from shoulder blade muscles and cause motion of the joint when they contract. Those muscles are supraspinatus, infraspinatus, subscapularis and teres minor.
Whilst often a torn rotator cuff can be successfully repaired, sometimes degeneration has progressed too far to make repair possible.
Who gets a chronic irreparable rotator cuff tear?
The rotator cuff, especially the supraspinatus tendon, are subject to wear and tear and age related degeneration. In some patients more than in others. There are also anatomical variances that can support early degeneration of rotator cuff tendons. Some patients can recall an incident of shoulder injury that dates back many years. They somewhat recovered from the injury but are now finding themselves in increasing pain. The rotator cuff becomes irreparable if the tear is long standing which has caused muscle and tendon to waste away. During that process they become retracted and dysfunctional, making repair impossible.
What are the symptoms of chronic irreparable rotator cuff tear?
It is not uncommon that a torn supraspinatus tendon causes none or very little symptoms as the rotator cuff is a system of multiple tendons and deficits can be compensated for. In some cases however this system decompensates and chronic inflammation triggered by the tear can cause pain. Inability to raise the arm and early fatigue are the consequence of rotator cuff tear.
How is chronic irreparable rotator cuff tear diagnosed?
The clinical assessment will reveal limitation in range of motion next to reduction in strength. X-ray, ultrasound and MRI scan are important imaging studies. In particular MRI scan is able to image the size of the tear precisely and also the degree of tendon retraction and fatty atrophy of muscle tissue. Based on MRI scan findings the decision can be made if a rotator cuff tear is successfully repairable or alternative procedures should be chosen.
Treatment for chronic irreparable rotator cuff tear
Non operative management including physiotherapy and exercise physiology is often able to relieve pain and improve function. In the presence of a torn rotator cuff tendon a cortisone injection is not advisable. Firstly the pain relief will only be short lived and secondly cortisone decreases the success rate of healing in cases where surgical tendon repair is planned or has been performed.
Where non operative management fails to provide comfort and improved function, surgery is an option.
Surgery for chronic irreparable rotator cuff tear - Superior Capsular reconstruction
In select cases of patients under the age of 65 with a rotator cuff tear that is not amenable to surgical repair, Superior Capsular Reconstruction is an option. There are 4 tendons that form the rotator cuff: subscapularis tendon at the front, supraspinatus at the top and infraspinatus and teres minor tendons at the back.
Most often the supraspinatus tendon at the top is torn and sometimes severely retraced which also leads to wasting and fatty atrophy of the muscle itself.
These tendon tears are not repairable and chronic pain and dysfunction develops. Superior capsular reconstruction aims to close the gap at the to of the shoulder joint where the supraspinatus tendon used to be. It is a procedure than can be carried out via arthroscopy (keyhole surgery) and utilises a tissue patch (freeze dried human dermal allograft or patient harvested fascia lata) that is fixed at the top between glenoid upper rim and humeral head supraspinatus tendon footprint.
This patch keeps the joint concentric and avoids upward migration. It treats chronic pain reliably and often restores a remarkable function. This procedure is utilised in patient up the age of 65. Above that age reversed total shoulder replacement becomes a valid option.
Preparation for surgery for chronic irreparable rotator cuff tear - Superior Capsular reconstruction
Prior to the procedure, we will arrange for one preconditioning physiotherapy session where we fit a shoulder immobiliser, explain some simple exercises and give you an ice bladder with icing instructions. If required we will also arrange for a bulk billed pre admission clinic at the hospital. This is run by a specialist anaesthetist who will gather information and investigations that are required for safe anaesthesia.
Our reception staff will advise of costs, hospital and admission details.
Recovering from surgery for chronic irreparable rotator cuff tear - Superior Capsular reconstruction
The shoulder immobiliser will be fitted after the surgery and a continuous cooling cuff will be placed. Shoulder immobilisation will be required for six weeks after the procedure.
Physiotherapy will commence 48 to 72 hours after surgery and will focus on making you comfortable and keeping the shoulder mobile.
Once shoulder immobilisation has been ceased physiotherapy aims to increase range of motion and improve strength.
A gym based strength and resistance program supervised by an exercise physiologist will follow.
Full recovery to pre-injury mobility and strength will take several months.