SUPERIOR CAPSULAR RECONSTRUCTION
Some patients have large rotator cuff tears that cannot be repaired with traditional techniques. Most of these individuals have had large rotator cuff tears for several months or even many years, and the tissue is no longer healthy. In patients with this type of condition and limited shoulder function, Dr. Welch may recommend a superior capsular reconstruction.
The rotator cuff is a unit of four tendons – the supraspinatus, infraspinatus, subscapularis, and teres minor – that work together with the ligaments (capsule) to stabilize the shoulder. The roof of the shoulder is composed of the supraspinatus tendon, part of the infraspinatus tendon, and part of the capsule. When these tendons and the capsule tear, the top of the humeral head (ball) migrates upwards. Once the humeral head migrates upwards, shoulder function is limited. Most patients with this condition have significant weakness, loss of motion, and pain. The superior capsular reconstruction (SCR) is designed to reconstruct the top of the rotator cuff and top of the capsule.
During a superior capsular reconstruction, Dr. Welch uses either a minimally-invasive, arthroscopic approach or an open incision to reconstruct the rotator cuff and capsular tissue on the top of the shoulder. During surgery, Dr. Welch uses suture anchors (medical screws with sutures) to attach a healthy graft (either a donor graft or an autograft) to the top of the socket. Dr. Welch then attaches the other end of the graft to the top of the proximal humerus (ball). By restoring the soft tissue “roof” of the shoulder joint, stability of the humeral head (ball) is restored. Once the humeral head is stable, an individual can re-gain function in his/her shoulder.
Following surgery, patients are placed in a sling with a pillow. The pillow positions the arm away from the chest and keeps tension off of the reconstructed tissue. Dr. Welch recommends intermittent icing and gentle range of motion following surgery. Dr. Welch recommends starting physical therapy 4-6 weeks after surgery. Physical therapy focuses on reducing swelling in the shoulder, restoring full range of motion, and eventually, restoring some strength to the shoulder. It is very important to follow the rehabilitation process carefully to achieve the best outcome.