Shoulder and elbow tendon repair
Shoulder and elbow tendon repair surgeries are procedures that repair one or more torn tendons. A tendon is a tough band of fibrous tissue that connects a muscle to a bone. A tendon can be partially torn or torn into two pieces as a result of wear and tear over time, or an acute trauma such as a fall. Shoulder and elbow tendon repair surgery reconnects complete or partial tendon tears, eliminates pain and restores movement, strength and function to the shoulder and elbow.
The shoulder joint is not held in place with bones, but rather an elaborate system of muscles, tendons and ligaments. There are eight tendons in the shoulder that attach muscles to your upper arm bone (humerus), clavicle (collarbone) and scapula (shoulder blade):
- Two tendons on the deltoid muscle – The deltoid muscle is the big muscle that gives your shoulder its rounded shape.
- Two tendons on the bicep muscle – The bicep muscle is your upper arm muscle.
- Four tendons attach four muscles to the rotator cuff of your shoulder, located at the head of your upper arm bone (humerus).
Advancements in surgical techniques have led to less invasive techniques such as arthroscopic surgery. Many types of shoulder tendon repair surgery on the rotator cuff can be performed on an outpatient basis. The three main types are:
- Open repair surgery – The first technique to repair torn muscles and tendons, open rotator cuff repair involves a surgical incision a few inches long. Your orthopaedic surgeon then detaches the shoulder (deltoid) muscle to access the torn tendon. During open repair surgery, your surgeon may also remove bone spurs from the underside of the acromion, the outer end of the shoulder blade (scapula) to which the collarbone is attached. This surgical method is often required if the tear is large or complex and involves additional reconstruction such as a tendon transfer.
- Shoulder arthroscopy repair surgery – Your surgeon inserts a thin camera (arthroscope) into a very small incision in your shoulder joint to see inside. The camera transmits pictures to a monitor screen, guiding the surgeon's miniature surgical instruments to perform the surgery.
- Mini-open repair – Your surgeon uses newer technology and instruments to perform this type of rotator cuff repair and assess and treat other damaged structures within the joint. A combination of arthroscopy and open surgery, mini-open repair surgery removes bone spurs arthroscopically without having to detach the deltoid muscle. Your surgeon then repairs the rotator cuff directly through a mini-open incision.
Tennis elbow is a painful condition of the elbow caused by overuse. It occurs when there is microscopic tearing of the tendons on the outside of the elbow joint. As the name suggests, tennis elbow has long been associated with racquet sports and other physical activities that overuse the arms. In our computer age, tennis elbow is happening more frequently to people who have never played racquet sports. The National Institutes of Health (NIH) reports that physicians increasingly are seeing tennis elbow caused by non-sports activities such as constant computer keyboard and mouse usage.
Orthopaedic surgeons use two types of surgery to treat tennis elbow:
- Open surgery – Your surgeon makes an incision over the elbow to access the tendon and make the repair. The tendon is first detached from the bone, repaired and then reattached. The procedure is usually performed as outpatient surgery.
- Arthroscopic surgery – During this minimally invasive procedure, your surgeon makes small incisions to access the tendon and uses tiny instruments to repair the tendon. Arthroscopic surgery is an outpatient surgery.
The biceps muscle in your upper arm is connected to your shoulder bone by two tendons known as the biceps long head tendon and short head tendon. On the other end, your biceps muscle is attached to your elbow bone by one tendon, the biceps distal tendon. That's why bicep tendon repair surgery can be called shoulder tendon surgery or elbow tendon surgery.
Several types of procedures are effective to repair torn or partially torn bicep tendons. Some orthopaedic surgeons prefer to operate through two incisions, while others operate through one incision. One approach is to attach the bicep tendon with stitches through holes drilled in the bone. Another approach uses metal implants called suture anchors to attach the tendon to the bone.