Minimally Invasive Shoulder Surgery
to the Journal
By Joseph A. Mannino, MD
are two common shoulder injuries that can be treated very effectively with
minimally invasive surgery. The surgical technique is called arthroscopy and is
performed through at least two small incisions, using miniaturized instruments
for cutting and repair.
rotator cuff is the group of muscles and tendons that cover the top of the arm
bone (humerus) and attach it to the shoulder blade, forming the joint. The
rotator cuff muscles give our arms a very wide range of motion and enable us to
rotate them nearly 180 degrees.
we age, our rotator cuff tendons can become thinner. While rotator cuff
injuries do occur in people of all ages, they are most prevalent among the
middle-aged and senior populations. The most common cause of rotator cuff tears
is falling. In trying to catch yourself and break the fall with an outstretched
arm, you can tear one or more of those tendons.
symptoms of a rotator cuff tear are pain and loss of function and strength.
People with rotator cuff tears have difficulty reaching over their heads and
they often have trouble sleeping at night due to shoulder pain. They may also
hear snaps, clicks, and pops inside the joint.
the shoulder is a ball-and-socket joint like the hip, the shoulder socket is
much more shallow. To provide additional stability the shoulder socket is
encircled by cartilage, which is called the labrum. When the ball portion of
the arm bone slides out of the socket and dislocates, the result can be a tear
in the labrum. This injury is most common among young athletes who are involved
in overhead throwing, such as baseball pitchers, quarterbacks, and basketball
players. We also see tennis players with this particular injury.
with a torn shoulder labrum typically experience a painful ache in the joint
and the sensation that something inside the joint is catching when they move
non-operative approaches to treatment do not alleviate symptoms, rotator cuff
tears and torn labrums can be successfully repaired with arthroscopic shoulder
surgery. This is ambulatory surgery that is performed at Cayuga Medical Center
and at Surgicare on the Convenient Care Campus in Ithaca.
the procedure, the surgeon usually makes two to four small incisions in the
shoulder. A tiny camera and light source are positioned inside the shoulder and
the image is projected on a video monitor. The surgeon makes the repairs while
watching the monitor, using specially designed surgical instruments. Depending
on the extent of the injury, arthroscopic shoulder surgery typically takes from
45 to 120 minutes and can be performed with regional anesthesia with the
patient comfortably sedated or with general anesthesia.
successful repair requires that the soft tissues heal back into the bone, which
takes several weeks. There is an important balance that must be maintained
between the healing process and rehabilitation of the shoulder joint, which is
why physical therapy is so important. Once the injury has healed, movement and
rehabilitation will enable you to regain motion in the joint. This is followed
by exercises to regain strength and endurance. The entire process can take two
to three months.
Mannino is board certified in orthopedics and is a member of the medical staff
at Cayuga Medical Center. He is in practice with Dr. Dirk Dugan at Orthopedic
Services of Cayuga Medical Associates, where he can be reached at (607)