Innovative developments on the horizon for rotator cuff injuries
The rotator cuff, a network of tendons and muscles in the shoulder that enable shoulder movement, remains one of the more commonly-injured areas of the body, with 3 to 4 million Americans visiting physicians yearly for cuff-related issues. Injuries may occur due to repetitive use--usually in sports like tennis, football or baseball--and can also stem from bone spurs or the aging process. While minor injuries to the rotator cuff are typically treated with physical therapy or anti-inflammatory medications alone, tears of any significant degree require surgery. Though many patients avoid surgery due to a multitude of reasons (e.g. interference with active lifestyle; don't think its necessary), failing to have surgery performed in a prompt manner leads to an extremely high risk of re-tearing the cuff and further extending an already lengthy rehabilitation process.
When the time comes for surgery, the two main routes are open surgical repair and a minimally invasive procedure. Open surgical repairs are necessary for tears that are large or complex and require a large surgical incision performed while the patient is under general anesthesia. Minimally invasive procedures, or arthroscopy, are primarily used for smaller or partial thickness tears. Arthroscopy is performed with three small puncture wounds, each of which is used to insert a camera and other instruments, which allows surgeons to perform the surgery with the guidance of a TV screen. With both open repairs and arthroscopy, no guarantees are made that the cuff is invincible to future injury. This uncertainty, along with a recovery process that's both dreadfully long and painful for patients, has led researchers to investigate new surgical techniques.
One technique uses double rows of sutures instead of singles in repairing the rotator cuff region, while another uses various new materials to act as scaffolds that will serve as supports for the repaired cuff as tissues heal. Additional possibilities in surgery include the use of human-cadaver tissue to patch the surgical repair and reinforce the tendon, pig intestines for the use of regenerating tissue and using special clots by centrifuging a patient's blood before surgery to isolate platelets (cells in blood related to clots). Unfortunately, these emerging techniques still have a ways to go in terms of research and application before they're used commonly. While researches continue to pursue perfection, surgeons are instead shifting their energy towards stressing the importance of the rehabilitation process, which requires painstaking adherence to the regimen prescribed. Patients who fail to consistently follow their rehab plan put themselves in danger of re-tearing the cuff, and subsequently going through the entire process all over again.
-As reported in a January '08 article published in the health section of the Wall Street Journal Online
-By Greg Gargiulo
