The rotator cuff is a group of 4 tendons (the supraspinatus, infraspinatus, subscapularis and teres minor) that surround the top of the arm bone (humerus) where it meets the cup of the shoulder joint (glenoid) and help to stabilize the shoulder joint as well as abducting and rotating the arm. When these ligaments are damaged, arthroscopic rotator cuff repair can help restore function and eliminate pain.
Damage to the rotator cuff can occur as the result of a traumatic event in young patients or simply due to degeneration of the tendon tissue in older patients. When the rotator cuff is torn, a variety of treatment options may be considered based on the type, location and extent of the tear. These options may be non-operative, typically a several week course of physical therapy aimed at reducing pain and inflammation while restoring full range of motion and strengthening both the rotator cuff and muscles surrounding the shoulder blade. Other tears may require surgical intervention in the form of an arthroscopic rotator cuff repair. This involves inserting a camera as well as a series of small tools through portals in the shoulder.
During surgery, the doctor will first examine your shoulder joint to visualize the torn part of the rotator cuff before cleaning out the torn tissue and inserting anywhere from 1 to 4 composite, bio-absorbable anchors into the top of the humerus. These anchors are made of tricalcium phosphate (coral) and are gradually absorbed by the body over time, long after the tear has healed. Sutures attached to these anchors are then passed through the torn rotator cuff and used to secure it back in place. These operations will typically include a procedure known as a subacromial decompression, in which the surgeon will shave off the underside of the acromion (the pointy bone on the outside of your shoulder). This helps to free up extra space for the rotator cuff and essentially bathes the new repair in bone marrow- your body’s own stem cells.
Partial Rotator Cuff Repair
Rotator Cuff Repair
Rotator cuff repair with biceps tenodesis
Research and Patient Education
As a member of the MOON research group, Dr. Spencer is actively engaged in various research endeavors aimed at improving treatment for a variety of shoulder pathologies. Currently, Dr. Spencer is one of 12 physicians across the country actively enrolling patients in the Arthroscopic Rotator Cuff (ARC) Trial. This clinical trial, based out of Vanderbilt University in Nashville, is a national, multi-center endeavor examining the properties of atraumatic rotator cuff tears that determine which tears should be treated operatively or non-operatively. Enrolled patients are randomized to either operative treatment (rotator cuff repair surgery) or non-operative treatment in the form of a specialized physical therapy program designed by Dr. Spencer and the rest of the physicians involved in the study. Patients are then followed by Vanderbilt in the form of a daily physical therapy diary and 3, 6 and 12 month questionnaires. Patients have the ability to switch to the operative arm if they do not feel therapy has made a noticeable difference, and patients are compensated for every questionnaire they complete. For more information about the study, click here.
Platelet Rich Plasma (PRP) Injections
Currently, Dr. Spencer and his research assistant, Grayson Poff, are concluding a study examining the effectiveness of Platelet-Rich Plasma (PRP) injections for specific types of partial rotator cuff tears known as “intra-substance” tears. These tears are unique in the fact that they occur completely inside the tendon without disturbing the outside layer of tissue. This forms a sort of pocket into which PRP can be injected. While not covered by insurance, PRP injections can be very useful for specific pathologies, and our research has shown a 92% success rate for these tears. While the research in full has not yet been made available to the public, you can check out a summary here.