At times the rotator cuff tears may not be repairable or they may have been previously repaired and re-tore. When this occurs, in specific patients, it may be necessary to transfer a tendon from another part of the shoulder to the area of damaged tendon. Generally, one of two tendons are used depending on the tendons that are torn. For tears of the supraspinatus and infraspinatus, the latissimus dorsi tendon is used. For tears of the subscapularis the pectoralis major is used. This procedure is generally indicated in patients younger than the age of 55 that still place higher functional demands on the shoulder and have an irreparable tear causing significant symptoms and impairment.
The procedure is contraindicated if the patient has significant comorbildites causing increase risk of complications or failure of the procedure. There must be adequate muscle tendon to transfer and the shoulder cannot have any significant degenerative change.
Dr. Lenarz’s procedures can be done at the hospital or an outpatient surgical center. Through small incisions, Dr Lenarz transfers the necessary tendon to the location of damage.
After the surgery, the patient will wake in the recovery room in a sling. If a “nerve block” was performed by the anesthesia doctor before the operation, the arm will remain numb for 12-24 hours. This is usually done for post-operative pain control. Icing the shoulder should be done liberally. This can be through the use of ice in a bag, ice packs or a circulating ice water cooler. The dressing may be removed and the patient may shower the day following surgery. The patient is asked to NOT scrub the incisions but allow water to wash over them. Initially there will be a period of immobilization in a sling. After that period, range of motion of the shoulder will begin building up to a delayed period of strengthening.