The shoulder has a glenohumeral joint that allows you to perform complex and multiaxial movements with the shoulders. This is a ball and socket joint composed of the humeral head (ball) and the scapula’s glenoid cavity as the socket.
The shoulder joint is also considered a synovial joint since it has a fluid-filled cavity wherein the articulating surfaces of two bones meet each other. This allows the shoulders to reduce friction, move smoothly against each other, and maximize shoulder mobility.
Furthermore, the shoulder joint is surrounded by various soft tissue structures, such as the rotator cuff muscles, which keep the joint together to maintain stability. But no matter how tough they are, these structures can still sustain severe injuries that can compromise shoulder function.
Fortunately, some of the best shoulder specialist in Miami can now repair the once-dubbed “irreparable” rotator cuff injuries through superior capsular reconstruction.
What is superior capsular reconstruction?
There are four rotator cuff muscles that support the shoulder joint and ensure stability. Underneath these muscles is the joint capsule, which also surrounds, protects, and stabilizes the joint.
The rotator cuff can sustain severe tears or ruptures that compromise the joint capsule. Unfortunately, this kind of massive rupture cannot be easily repaired with traditional surgical methods. Patients with such conditions are then considered for a superior capsular reconstruction.
A superior capsular reconstruction is a surgical procedure performed to restore shoulder function and stability after a severe rotator cuff injury. It involves the anatomic reconstruction of the joint capsule as it becomes abnormally loose or shifts upward due to rotator cuff injuries. This type of surgery is intended to serve as an alternative for the following major surgical procedures:
- Reverse total shoulder arthroplasty
- Patch augmentation
- Interval slide
- Muscle transfer
- Tuberoplasty
- Debridement with or without biceps tenotomy
Unlike superior capsular reconstruction, the procedures mentioned above carry serious risks, plenty of issues, and a limited lifespan.
When is superior capsular reconstruction needed?
Orthopedic specialists often recommend superior capsular reconstruction to patients with chronic rotator cuff problems. This can be due to massive ruptures caused by a traumatic injury or gradual muscle degeneration. Such conditions often cause severe recurring pain, muscle weakness, and limited shoulder and arm mobility.
Initially, doctors will utilize non-surgical options to treat and manage your condition. This includes pain medications, immobilization, soft tissue release, and steroid injections. When these conservative techniques fail, then that’s when superior capsular reconstruction comes into the picture.
Superior capsular reconstruction is indicated in patients with the following criteria:
- Failed nonoperative treatment
- Massive irreparable rotator cuff tears that come with intolerable pain and shoulder dysfunction.
- Severe rotator cuff tears that do NOT have a bone deformity or a significantly degenerated glenohumeral joint.
- Severe superior migration of the humeral head.
- A functional deltoid muscle and intact or reparable subscapularis tendon.
- Little to no rotator cuff arthropathy.
Patients should have the above mentioned criteria to ensure a good prognosis and a successful superior capsular repair.
According to studies, this procedure often has a poor outcome for elderly patients with insufficient bone stock, multiple failed cuff repairs, and recurrent shoulder instability.
That’s why doctors perform a pre-operative evaluation first to see if a superior capsular reconstruction is the right course of treatment for you.
How is it performed?
Superior capsule reconstruction may be performed using arthroscopy or open surgery, depending on the severity of the patient’s condition. Here’s a rundown of what typically happens during a superior capsular repair:
- Once anesthesia is administered, the patient will be placed in a beach chair position wherein the arm comfortably rests at the side to access the shoulder joint easily.
- Next, small incisions are made that will serve as portals of entry for the arthroscope and other specialized instruments. For open surgery, a large incision will be made.
- The surgeon will evaluate the injury and repair some parts or perform specific techniques needed to prepare the area. This includes subscapularis/ infraspinatus repair biceps tenodesis, or greater tuberosity debridement.
- Next, the surgeon will drill two holes each into the top of the glenoid and humeral head, wherein suture anchors will be inserted.
- Tissue grafting is then performed. The type of tissue that will be used can either be from the fascia lata, extracellular matrix, or the long head of the biceps tendon. The tissue will be cut and prepared into the desired thickness and length.
- The suture anchor will be threaded into the tissue from both sides. The surgeon can also utilize a Scorpion suture-passing device once the tissue graft is properly positioned in the shoulder.
- The graft should be on top of the joint capsule, bridging the gap in its space. Once accurately positioned, the suture anchors are tied and secured on both ends.
- Once done, the incision is closed, and a bandage will be placed on top of the healing skin.
There are various modifications to this procedure depending on the patient’s condition and the technique used. But all of it aim for the same end result一enhanced active abduction and external rotation, as well as relieved pain and other symptoms.
What to expect after a superior capsule reconstruction?
Superior capsular repair is often performed on an outpatient basis. This means you can go home a few hours after the surgery once the anesthesia wears off. Post-operative care usually involves the following:
- Abduction wedge or sling for at least four weeks.
- Rehabilitation using passive motion or pendulum exercises and other progressive range of motion therapy.
- Medications to relieve post-surgical pain and inflammation and prevent infection.
- Proper wound care.
- Avoid certain activities, such as heavy lifting, driving, excessive working, and other activities that require shoulder movement. This is only for the first few weeks after the surgery.
Most people recover from superior capsular reconstruction after 8-12 weeks. But regular follow-ups with the doctor are required for at least two years.
After the surgery, the patient should be able to feel the benefits of the procedure, such as improved muscle strength, shoulder stability, and flexibility. Furthermore, the operation offers little to no complications, unlike other forms of invasive procedures.
Where can I find the best South Miami orthopedics facility?
South Florida International Orthopedics is home to the best board-certified doctors and surgeons specialising in treating various orthopedic conditions, such as severe rotator cuff injury.
We provide a comprehensive range of treatment options using state-of-the-art devices and advanced techniques. Some of the services we also offer include the following:
- Miami sports medicine
- Physical therapy
- Shoulder care
- Joint replacements
- Arthritis care
- Fracture
- Independent medical exam
- Workers’ compensation
- And more!
Contact our Miami office at (305) 233-0011 or Homestead office at (305) 247-1701 to inquire about our services or schedule an appointment for your initial checkup!
The material contained on this site is for informational purposes only and DOES NOT CONSTITUTE THE PROVIDING OF MEDICAL ADVICE, and is not intended to be a substitute for independent professional medical judgment, advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified healthcare providers with any questions or concerns you may have regarding your health.
