The rotator cuff is a group of four muscles that run from the scapula (shoulder blade) and attach to the humeral head (top of upper arm bone) by their tendons. One of the muscles of the rotator cuff is the subscapularis. The subscapularis muscle runs from the underside of the scapula (shoulder blade) to the front of the humerus (arm bone) and is responsible for internal rotation of the arm. When the rotator cuff is injured, the tendon is typically torn off the humerus (upper arm bone), retracts and cannot heal back on its own. The subscapularis tendon also plays a role in stabilizing the biceps tendon. When the subscapularis tendon is torn, it allows the biceps tendon to dislocate, become unstable, shift, fret like a rope and cause pain. If left untreated, the biceps may rupture and result in a “Popeye-like” deformity.
Rotator cuff tears tend to progress and become larger and more symptomatic. Additionally, as time goes by the rotator cuff tendon retracts further and the rotator cuff muscle atrophies (shrinks and weakens) and degenerates (irreversibly turns to useless fat and scar tissue). This makes the repair technically more difficult (potentially not possible) and the rotator cuff becomes less likely to heal and function normally. The goal of surgery is to eliminate the shoulder pain and attempt to regain active motion and strength by reattaching the torn rotator cuff tendon back to the upper arm bone at the shoulder using sutures connected to anchors placed in the bone
Dr. Chudik approaches rotator cuff tears arthroscopically through small incisions (arthroscopic portals) and can repair the great majority of tears entirely arthroscopically. The surgery is generally performed as outpatient surgery (you go home the same day). Dr. Chudik uses the small incisions to look in the shoulder joint with a camera and special instruments are used to repair the rotator cuff and any other problems seen in the joint. Sometimes if the tendon is too far retracted or will not stretch to the correct insertion site arthroscopically, Dr Chudik may
need to make a larger, open incision to repair the tendon. The rotator cuff tendon is repaired back to the bone of the humerus with anchors into the bone and sutures into the tendon. The sutures and anchors hold the tendon in place until the tendon grows back to the bone gradually over four to six months.