Shoulder specialist at the Mercy Medical Center, Dr. Gregory Gasbarro talks about a new way to fix rotator cuff injuries.
Interview conducted by Ivanhoe Broadcast News in 2023.
So, your patient Randy told us that he was playing lacrosse when he fell on his shoulder and suddenly he’s got a massive injury.
Gasbarro: Yeah. So, Randy came to me and had a pretty normal shoulder and normal life before this big injury, playing lacrosse over one weekend. And he had immediate pain after the fall, a difficulty with overhead function, reaching for things, trying to get over his head to do activities in a difficult time doing his job on a horse farm with maintenance work.
He waited a long time. Something that shouldn’t wait, some things maybe not so bad. Where does this fall?
Gasbarro: Anytime you have an acute injury and you remember a distinct moment where you have new pain or new loss of motion, weakness in your arm or any other joint in your body, you should probably get it checked out. Things that creep up on you differently. Like if you wake up with pain one morning, it’s best sometimes if there’s no injury, wait it out a few days and sometimes those aches and pains can get better. But an injury is an indication to come in and see someone.
And he literally tore that thing. Did he share a tendon or ligament?
Gasbarro: So he tore what’s called the rotator cuff, which are a group of four muscles and tendons around the ball and socket joint of the shoulder. So they sit on the outside of the ball and they’re really important for not only motion of the ball and the socket, but also stability and centering the ball and socket.
And he had torn how many out of four?
Gasbarro: He tore three of his four rotator cuff tendons. So it’s like the sleeve of assured he almost went all the way around the sleeve.
When you saw him in surgery, I know you suggested the balloon spacers as an option, but what did you eventually settle on?
Gasbarro: So there’s lot of different techniques for really big rotator cuff tears. The quality of his tendon that was left after the rupture occurred wasn’t great. So I was a little bit worried about the structure of his remaining tenants, so I decided to do what’s called a biceps augmentation, which is to take the long head of the biceps, which is also a tendon in the shoulder and shift it to a new location where the normal rotator cuff attaches to and then repair the rotator cuff into that tendon to give it a little bit more structure and stout so it would hold up over time.
So, you literally just moved it over a little bit?
Gasbarro: Yeah, you release it from a little tunnel that it usually resides in. You cut it in one particular position based on judging where you are. You reattach one end of it lower on the arm and then you take the little stump that’s left and you shifted over, redirect it in a different position to help you with the surgery.
How long does the surgery take? And are you using microscopics?
Gasbarro: So arthroscopic surgery. So we put little stab holes around the shoulder, usually four or five. We put a camera in the joint. And we use tools going in and out to manipulate these different things to repair them. And as far as timing goes, if it’s a typical rotator cuff tear, it usually takes about 45 minutes to repair them. When you’re doing extra things with the biceps, you can add another, depending on the procedure, 15-30 minutes to really achieve what you’re trying to achieve.
And when you get in there, is the tool more like a needle tool or a scalpel?
Gasbarro: So, the incision is about the size of your pinky nail. It’s a little stab wound. And there’s different tools that we use. So we have things that can manipulate the tissue. They’re pretty small in size, usually between four and eight millimeters in width. So you can manipulate things. You have passers to go through tissue that are curved needles. So there’s a whole variety of arthroscopic tools that we have to be able to do different things in there.
Randy is an active guy. So, how long was the recovery period for him and then what about regaining full motion usage?
Gasbarro: So, for these big rotator cuff tears, when you tear two or three of the four tendons, keep you in a sling a little bit longer than I normally would for a smaller tear. So for him, he was in a sling for six weeks after the surgery and only removed it to move his elbow his wrist and his hands. So he kept the shoulder nice and still. And then after the six weeks, I sent him to physical therapy and he worked on range of motion. He started active motion where he started moving his own arm over a set around 10 weeks after surgery. And he didn’t start strengthening until 16 weeks after surgery. And that gives you four months of tendon bone healing that really needs to occur to make it solid enough to withstand forces across the joint so it doesn’t rip again.
So, someone like us, so a lazy person, the thought of that tendon even repairing itself is almost mystical. How do they go about doing that?
Gasbarro: Yeah. So you do certain things during the surgery, so you get rid of bad tendon and then you’re fixing what’s left of good tendon. So that’s one part of it and the other part of it is you prepare the bone with a little bleeding surface to accept the tendon. And the tendon likes to grow on to bone much more than it likes to grow to itself. So it creates scar tissue across that interface between the bone and a tendon, and it takes time for it to mature. There’s been lots of studies and animals, mice and rats, to show over time how those scar formations occur and how they mature over time. And the time points that I just mentioned to you are all based on clinical experience, research studies and animal studies.
What’s Randy’s prognosis?
Gasbarro: I think he’s going to do well. The last time I saw him, he was able to raise his arm up over his head. He’s back to doing maintenance work on the horse farm. So I think long term I think is a chance of hopefully getting to retirement and not needing anything in the future.
Can you explain why raising your arm up that hurts more than anything when you have a shoulder issue? What’s going on there?
Gasbarro: So, it hurts to raise your arm with any shoulder problem, especially the rotator cuff because you’ve lost the proper biomechanics of the joint so you can’t balance the ball on the socket in the center position, which means everything else around it as overworking, which causes inflammation, which ultimately leads to pain, and with movement, that pain can get worse.
END OF INTERVIEW
This information is intended for additional research purposes only. It is not to be used as a prescription or advice from Ivanhoe Broadcast News, Inc. or any medical professional interviewed. Ivanhoe Broadcast News, Inc. assumes no responsibility for the depth or accuracy of physician statements. Procedures or medicines apply to different people and medical factors; always consult your physician on medical matters.
If you would like more information, please contact:
Dan Collins
Sign up for a free weekly e-mail on Medical Breakthroughs called First to Know by clicking here
