Experimental surgery helps those with severe torn rotator cuffs

For years doctors could do very little for those with sever rotator cuff injuries but thanks to a new experimental procedure, that is all changing.

When the rotator cuff tears, it makes even the simplest arm movement painful and difficult and a severe shoulder injury almost ended 65-year-old James Barrow's golf game for good. A year and a half ago, Barrow could barely lift his right arm due to an accident that severed tendons in his shoulder.

"One of the physicians I saw early on told me there was nothing they could do," said Barrow. "Golf game...disappeared."

There were several surgical options to fix limited rotator cuff tears but in the worst of these injuries, there was not much doctors could do.

Then Dr. Spero Karas began developing a new procedure to help fix the massive tears. By using a surgically-placed cadaver tissue graft, Karas replaces and reattaches the defective tendon.

"We sew the graft into the patient's native rotator cuff and use that graft to bridge the defect over to the bone," said Karas, who serves as the Atlanta Falcon's head team physician and is an associate professor of orthopaedics at Emory Healthcare Sports Medicine. "Then we reattach the graft to the bone."

Although the procedure does not carry Food and Drug Administration (FDA) approval at the moment, early studies are showing that this experimental graft-to-bone technique is a safe and effective repair.

Grafts themselves are currently FDA approved to add strength to traditional rotator cuff repairs.

Research Summary:
Rotator Repair
BACKGROUND: The rotator cuff is made up of the muscles and tendons in your shoulder. These muscles and tendons connect your upper arm bone with your shoulder blade. They also help hold the ball of the upper arm bone firmly in the shoulder socket. Any type of irritation or damage to your rotator cuff muscles or tendons is considered a rotator cuff injury. According to Emory HealthCare, it is estimated that up to 50 percent of adults over age 50 have some degree of rotator cuff tearing. Common causes may include falling; lifting; and repetitive arm activities such as throwing a baseball or placing items on overhead shelves. About 50 percent of the time, a rotator cuff injury will heal with self-care measures or exercise therapy.
(SOURCE: The Mayo Clinic)

STANDARD TREATMENTS: Physical therapy is a common treatment for rotator cuff injuries. Other treatments may include steroid injections or surgery. If a patient has a large tear, doctors may remove a bone spur or calcium deposits during surgery. The surgery may be performed as an open repair (through a 2 1/2 - to 4- inch incision) or as a mini-open repair (through a 1 1/4- to 2-inch incision). Arthritis may occur over time in patients with rotator cuff tears. In severe cases, doctors may suggest partial shoulder replacement or total shoulder replacement. A unique treatment option now available involves the use of a reverse ball-and-socket prosthesis. This reverse shoulder prosthesis is most appropriate for people who have very difficult shoulder problems.
(SOURCE: The Mayo Clinic)

A NEW OPTION: Spero Karas, M.D., associate professor of orthopaedics at Emory University and head team physician for the Atlanta Falcons, has developed a new procedure to fix massive rotator cuff tears. He uses a surgically-placed cadaver tissue graft to replace and reattach the defective tendon. This new graft-to-bone repair is not FDA-approved. However, grafts are currently FDA-approved to add strength to traditional rotator cuff repairs. Early studies show it is safe and effective. This technique only works for certain types of rotator cuff tears.
(SOURCE: Emory HealthCare)

For more information, please contact:
Emory HealthConnection
Atlanta, Ga.
(404) 778-7777 or (800) 75-EMORY


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