The rotator cuff is a unique structure in the human body, which gives the shoulder its one-of-a-kind range of motion and function. Damage to the rotator cuff is quite common in athletes, and can result from a variety of reasons such as direct trauma or overuse. It can be surgically repaired; however, the procedure carries its own unique risks, which must be weighed by the patient before undergoing treatment.
Infection
Infection is a common complication of any surgical intervention, and rotator cuff repair is no exception. Infections can occur in the superficial skin where the incision is made and can extend to the deep tissues of the bone and muscle, which can be devastating, according to “DeLee and Drez’s Orthopaedic Sports Medicine." Usually it occurs due to a break in sterile technique. Treatment revolves around surgical removal of infected tissue and antibiotic use.
Loss of Anterior Deltoid Function
This is the worst common complication of rotator cuff repair, according to "Campbell’s Operative Orthopaedics." It can occur due to either damage to the axillary nerve, which supplies the anterior deltoid muscle, or the muscle detaching from the acromion, a bony structure from which it originates. Repair is often difficult and proper function never returns after this complication.
Hematoma
Hematoma is a term used to describe a collection of blood underneath the skin. It usually results from insufficient control of bleeding during the procedure, and patients receiving blood-thinning therapy are at particularly high risk. It usually is aspirated with a needle through the skin due to the propensity for these collections to become infected, according to DeLee.
Reflex Sympathetic Dystrophy
This is a pain syndrome that is characterized by burning pain, swelling, discoloration and sweating occurring in the affected extremity. It is due to irritation of nerves that results in abnormal impulses that affect blood vessels and skin in the area the affected nervous tissue supplies, according to Canale & Beaty. Steroid drugs and nerve blocks are often used to treat afflicted patients.
Fistula Formation
Fistula refers to the formation of a communication between the skin and the joint being operated on, in this case, the shoulder joint. As a result of the communication, fluid from the joint flows outside onto the external skin surface, as detailed in “DeLee and Drez’s Orthopaedic Sports Medicine." This often resolves with joint immobilization and is quite easily treated.
Traumatic Damage
Regardless of whether a surgeon uses an arthroscope, a camera inserted inside the joint, or opens the joint with a large incision, damage to structures in and around the joint can commonly occur. Usually the skin and experience of the surgeon are the defining variables, according to DeLee, and attention to proper surgical technique is the best way to prevent damage to structures that include nerves, blood vessels, bone, and muscle.
References
- “DeLee and Drez’s Orthopaedic Sports Medicine, 3rd edition”; Jesse C. DeLee MD, David Drez Jr. MD, Mark D. Miller MD; 2009
- “Campbell’s Operative Orthopaedics, 11th edition;” S. Terry Canale MD, James H. Beaty MD; 2007
