New and More Reliable Procedure for Common Shoulder Injury

Emory University doctors are using a new technique to repair a rotator cuff injury allowing it to heal more dependably and resulting in less likelihood that the patient will experience a re-injury.

The rotator cuff is composed of a group of four muscles that surround the ball of the shoulder joint. Tendons work with the associated muscles and provide mobility, stability and strength. Those tendons can weaken with age, overuse or injury and become vulnerable to a tear. Although a tear does not always require surgery, for those individuals who develop very significant pain, weakness or functional impairment surgery may be necessary.

Approximately half of rotator cuff repairs are done with a traditional "open" technique, using an incision that extends through the shoulder muscles. More recently, shoulder surgeons have employed a fiber optic camera, or arthroscope, to perform rotator cuff repair. Arthroscopic repairs require more surgical skill but use only small incisions, making the recovery less painful and potentially shorter than open repair.

Dr. Spero Karas, assistant professor in the Department of Orthopaedics, Emory University School of Medicine, is using a new technique for rotator cuff repair called the "double-row" arthroscopic repair. This procedure secures the tendon to the bone at two sites rather than one.

"It is much stronger than a typical 'single-row' arthroscopic repair and does a better job restoring normal rotator cuff anatomy," says Dr. Karas, who is part of the Emory Sports Medicine Center. "Recent studies also reveal that the 'double-row' repair heals in a more stable fashion, which results in better long-term outcomes.

"The operation itself takes a little longer to perform, about five minutes," says Dr. Karas. "However, the technique results in a much more substantial repair because there is actually more tendon attached to the bone."

There are thousands of shoulder injuries in the U.S. each year, some more serious than others. Persons likely to have a shoulder injury are athletes of any age, but the most affected are in their teens and 20s. Adults over the age of 45 are also at risk because their tendons become more vulnerable with age.

"Shoulder injuries are commonly caused by lifting heavy objects overhead or repetitive motions, especially above the shoulder," says Dr. Karas. "Taking 15 minute breaks while performing these activities can help one avoid shoulder injuries."

Dr. Karas also suggests that a rotator cuff strengthening program be employed by those persons who engage in activities stressful to the shoulder such as overhead work, tennis, baseball and swimming.
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