Shoulder Repair Gains Reinforcement

An Excerpt from Health Reach Magazine, Spring/Summer 2004 Edition

By: Dr. Patrick St. Pierre

      Shoulder injuries are common among athletes such as tennis players and swimmers, but they can also result from everyday activities such as housecleaning  or carrying luggage. Symptoms of a damaged shoulder joint, or rotator cuff, include cronic pain --- particularly at night ---and an eventual inability to reach above shoulder level.

     The first line of treatment for a rotator cuff injury is  physical rehabilitation. Simple exercises to strengthen the surrounding muscle is often all that's needed to heal a torn tendon and anchor a loose joint in place. Surgery is prescribed only if rehabilitation is unsuccessful in alleviating pain and restoring range of motion, notes Patrick St. Pierre, MD, an orthopedic surgeon specializing in sports medicine. An Assistant Professor of Surgery at the Uniformed Services University of Health Sciences in Bethesda for the past ten years, Dr. St. Pierre joined the Virginia Hospital Center medical staff in February.

     For patients requiring surgery, new advances are making rotator cuff repair less invasive. While open surgery has traditionally been standard practice, a new technique described by Dr. St. Pierre allows the tendon to be repaired arthoscopically. In the "footprint cruciate technique," a tiny camera attached to a long, thin scope is inserted through an incision the size of a buttonhole, allowing the surgeon to visualize the inside of the joint. Instruments are then deployed the a series of equally small incisions, and surgical ligatures are sewn in a firm crisscross pattern, forcing the rotator cuff back into its natural spot, or footprint. This anchoring technique produces similar results to open surgery by snugly reinforcing the reattachment of tendon to bone.

     Rotator cuff repair --- whether open or arthroscopic --- is available on an outpatient basis. Recovery times for both types of surgery are the same: 12 to 18 weeks, including rehabilitation and strength training.  However, the patients in the U.S. and Germany suggest that the footprint cruciate technique may cause less pain and discomfort postoperatively because it involves minimal trauma to the muscles in the shoulder. Patients are usually able to completely resume normal lifestyle activities and sports following surgery.

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