“I am supposed to do an Ironman with the oldest grandson when he turns 18…I will be 72) Thank you goes to Dr. Rudzki for doing such an amazing surgical repair on my shoulder and getting me to the start line once again.”
Chief complaint / Injury history –
Linda, an avid triathlete, came to us for evaluation of a complex shoulder injury when she crashed her road bike. She went to the E.R. where her dislocated shoulder was reduced. She had had a prior rotator cuff repair in which the rotator cuff was repaired via an open surgical approach.
Workup / Imaging –
MRI revealed a recurrent acute full thickness tear of the supraspinatus (rotator cuff tendon on top) and high-grade partial to focal full-thickness tear of the subscapularis (rotator cuff tendon in front) with medial dislocation of the long head of the biceps tendon. Given her young age (<65) and high activity level, surgery was necessary. Surgery for revision arthroscopic rotator cuff repair and biceps tenodesis was scheduled.
Revision rotator cuff repairs are more complicated surgeries because the tendon quality, bone quality, healing potential, blood supply, scar tissue, and other factors may prevent a succesful outcome. Our approach is to analyze these individually for each patient and tailor an approach to optimize success using the best medical evidence and over 15 years of experience in clinical practice. Dr. Rudzki’s research focus in fellowship at the Hospital for Special Surgery was on blood supply to the rotator cuff.
For Linda’s surgery, we removed the loose suture material from her prior surgery and arthroscopically repaired the supraspinatus with a technique to optimize healing that enhances blood vessel recruitment and healing elements from the bone and a “double-row” repair of the tendon with multiple points of fixation. We then repaired the subscapularis tear in front and tenodesed (tacked down) her long head biceps tendon to address its instability and remove it as a pain generator for the future. Linda tolerated the surgery well and the regional anesthetic block allowed her to go home the same day in a sling with a cryotherapy ice machine cuff around the shoulder.
PT & Recovery –
Surgery sets the stage for a successful outcome but the true final result relies on the collaboration between patient, surgeon, and physical therapist. Healing of a rotator cuff repair (especially with a revision) is a biologic process that requires careful protection of the repair in a sling and a deliberate, controlled protocol to gradually restore motion and ultimately strength. Patients are followed closely and frequently in the office and given clear guidance to optimize healing rates and outcomes. With tremendous focus and discipline, Linda worked hard and consistently on her physical therapy and had a full recovery with return to triathlons and golf
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