With Orthopaedic Surgeon, Mr Soong Chua
As far as your upper body’s concerned, your rotator cuff could be the first thing to go. Rotator cuff tears are as debilitating as they are widespread: about 22% of the general population will tear a rotator cuff at some point in their life.
To find out more about the latest developments in rotator cuff tear surgeries, we spoke to Mr Soong Chua, orthopaedic surgeon with St Vincent’s Private Hospital. “Rotator cuff surgery can be pretty difficult to recover from, but we now have techniques that should help patients recover faster and get back to normal daily life faster,” says Mr Chua.
Your rotator cuff is composed of four muscles and tendons, serving as a stabiliser to your shoulder joint and allowing you to lift and rotate your arms. Rotator cuffs “tear” when the tendon that covers the top of your shoulder is damaged or torn, or in extreme cases, pulled away from the bone.
Treatment for rotator cuff tears
Minor rotator cuff tears are usually treated non-surgically through a combination of rest, physiotherapy, and in some cases, steroid injections.
For unusually large tears, chronic cases or injuries in younger patients, surgery is the preferred treatment. A traditional ‘open repair’ surgery involves a surgeon making an incision of around five centimetres over a patient’s shoulder. The surgeon detaches the shoulder (deltoid) muscle to get an unobstructed view of the tendon, and then manually removes bone spurs or transfers tendons for reconstruction.
Recovery is painful, and can take upwards of 6 months, with the patient undergoing physiotherapy to regain strength and range of motion.
But in the last 15 years, new and advanced techniques have seen arthroscopic (keyhole) surgery for rotator cuff repair become the operation of choice in theatres across the globe.
New methods: arthroscopic surgery
Arthroscopic rotator cuff repair involves inserting cameras and tools through tiny incisions in the skin and using the live stream view from the cameras to guide the instruments through the repair procedure.
“The basic technique is to place an anchor into the bone. The anchor has sutures attached to it, which we then pass through the tendon, and stitch back into the bone,” explains Mr Chua.
“Though full recovery of any rotator cuff repair surgery takes months, arthroscopic surgeries can significantly reduce patient pain post-surgery and make early recovery easier to manage,” says Mr Chua.
Three new developments within arthroscopic shoulder surgery
Within the field of arthroscopic shoulder surgeries, some exciting new developments are opening the doors for more effective repairs and better quality of life post-surgery.
The first is the use of tapes over traditional sutures or stitches for repairing tendons. The broader surface of the tape creates a larger pressure area which holds down tendons with more strength and stick, making repairs less vulnerable to re-tearing after an operation.
The second is further developments in the anchors used within the bone. “We’re testing new designs and materials to create the best hold and find the most effective way of incorporating anchor into bone,” says Mr Chua. For example, the medical world has optimised the quality and design to allow the use of biodegradable anchors, in place of traditional stainless-steel anchors.
Third, and perhaps most consequential, is a technique known as Superior Capsule Reconstruction (SCR). Emerging from Japan only a few years ago, the method was developed to treat major tears. Previously, tears of a certain size and position were difficult (and sometimes impossible) to repair completely, leading to reduced function and variable pain levels in patients, and eventually arthritis as a result of the rotator cuff deficiency. SCR involves taking a piece of tissue and placing it in the gap created by the torn tendon over the top of the joint. “While it’s too early to conclude the procedure’s effectiveness in fending off arthritis, early examples of SCR have been encouraging, particularly for restoring function and reducing pain,” says Mr Chua.
The risks of not treating rotator cuff tears
Pain and impaired function aside, the risks of leaving rotator cuff tears untreated include the potential for developing arthritis in the shoulder. These long-term side effects are why surgeons urge all rotator cuff injuries—particularly those in younger people—to be diagnosed and treated as soon as possible. And with the technology and techniques that we have today, the road to full recovery is looking smoother than ever.
Treating rotator cuff tears at St Vincent’s Private Hospital
With over 10,000 orthopaedic surgeries performed in 2018, the team at St Vincent’s Private Hospital Melbourne are second to none. Many of Victoria’s most experienced orthopaedic and shoulder surgeons consult on-site, and the hospital’s facilities and multidisciplinary team allow for patients to be treated end-to-end in-house, from ward, to theatre, to ongoing physiotherapy.
Mr Soong Chua
Mr Soong Chua is an orthopaedic surgeon who consults and operates with St Vincent’s Private Hospital Melbourne, in addition to other hospitals in Melbourne. Soong specialises in arthroscopic and reconstructive surgery of the shoulder, elbow and knee. Soong is passionate about advancing orthopaedic surgery, including through the use of 3D planning and advanced bone grafting techniques for shoulder replacement surgery, and robotic knee replacement surgery.
Mr Chua consults primarily at:
188 Gipps Street
East Melbourne VIC 3002
Phone: (03) 9928 6188
St Vincent’s Private Hospital Melbourne is a centre of excellence for orthopaedics, offering a wide range of orthopaedic procedures such as joint replacement surgeries – including hip, knee, foot, ankle, wrist, shoulder and elbow – and other orthopaedic interventions, including sports medicine and injuries, and tumour and reconstructive surgery. Its facilities in East Melbourne, Fitzroy, Kew and Werribee include on-site consulting rooms, pathology, radiology, sports medicine specialists, state-of-the-art surgical theatres, physiotherapy and other post-operative services.