Rotator Cuff- Set Up Is Critical

Rotator Cuff Surgery- set up is critical. Rotator cuff problems are common. In general orthopaedics, you will see a lot. They don’t all have to goto a shoulder surgeon as the technology has improved so much that the surgery has become a lot easier. Arthroscopic techniques are available but harder & slower; I prefer a mini incision technique. Here are my tips: • • • • •

Beach chair (barber chair) position Position drapes with pocket drape to hold the arm for you Use a small angled retractor (cerebellar retractor;My Kingdom for a good retractor!) Use fibre wire(FiberWire.Taper.Arthrex.AR-7200) for the repair and use Mitek bony anchors (my preference) I use a mini-incision( approx. 2cm), long., over lateral acromion, but do NOT detach deltoid from acromion, but split deltoid, and then rasp undersurface of acromion to create enough space for repaired rotator cuff to move in.

Arm rests in bag.

Instrument tray on other side of OR table within easy reach of surgeon

2 to 4 cm mini-incision

Large tear, needs FiberWire and bony anchors

other notes/miscell:

Deltoid (gap/puckering of skin)partially detached in heavy smoker( with soft bone), at fall 3 weeks after surgery( attacked by bird) Case 2:

Rotator cuff arthropathy. 71 yo,F. Ultra sound shows large tear- repairable. Would you repair the cuff or replace the joint? Case 3:

“Bald head”. Massive cuff tear. Mini incision technique. 60 yo,M.

Repaired via mini incision technique. Fiberwire. Bony anchors.

\ Major repair at 2 mths in 60 yo,F. Case 4:

Rotator cuff arthropathy. Good ROM and little pain. 80 yo,F.

Major repair at 2 mths Case 5:

Massive retracted tear. 70 yo,F. Mobilized and repaired with FiberWire and Mitek.