Ultra Sling ER Post-Op Care - Massive Rotator Cuff Tear

Surgical Procedure and Rehabilitation

Arthroscopic surgery was performed with the patient in a Beach-chair position (Tenet Tmax Beach Chair, Tenet Medical Engineering, Calgary, CN) following interscalene nerve blockade and administration of parenteral prophylactic antibiotics. An articulated hydraulic arm holder facilitated positioning of the arm for arthroscopy and arthroscopic rotator cuff repair (Spider Arm Holder, Tenet Medical Engineering, Calgary, CN). (Fig. 5).

Routine arthroscopic evaluation was performed in order to rule out comorbid pathology followed by a modified acromioplasty. Care was taken to preserve the coracoacromial ligament so as to prevent the risk of increased superior displacement of the humeral head by removal of this stabilizing barrier.

In all cases, a massive rotator cuff tear with marked medial and inferior retraction of the supraspinatus and infraspinatus respectively was identified (Fig. 6). Arthroscopic repair was performed by placing the arthroscope in a lateral portal so that the entire posterior extent of the tendon tear could be visualized. The tendon was then mobilized using a radiofrequency probe (VaprR, Mitek, Johnson and Johnson, Norwood, MA). The tendon tear was then repaired using a margin-convergence method as described by Burkhart along with direct reinsertion of the tendon in bone, or by partial reinsertion of the posterior component of the tendon tear if the supraspinatus was irreparable (Figs. 7A-C).9,10 After repair an intraarticular pain catheter was placed for postoperative pain control (PainbusterTM, DonJoy Orthopaedics, Carlsbad, CA).

All patients were then placed in a shoulder immobilizer with an external rotation pillow (UltraslingTM, DonJoy Orthopaedics, Carlsbad, CA) in order to protect the posterior component of the tendon repair.

Patients remained in the shoulder immobilizer with an external rotation pillow for six weeks and no therapy was performed during this time period. After six weeks active motion was permitted for daily living activities. Gentle assisted range of motion was performed and strengthening was delayed until four months after the surgical procedure.