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The shoulder is made up of three bones: the upper arm bone (humerus), shoulder blade (scapula) and collarbone (clavicle). The shoulder is a ball-and-socket joint: the ball, or head, of the upper arm bone fits into a shallow socket (glenoid) in the shoulder blade.
The ball and socket joint is protected by articular cartilage, the smooth, white tissue that covers the ends of bones (humeral head) where they come together to form joints. The cartilage allows the bones to glide over each other with very little friction. The articular capsule is made up of fibrous tissue (ligaments) that completely encircles the joint and helps provide strength and support.
The Rotator Cuff
The rotator cuff is made up of four tendons: the Subscapularis, Supraspinatus, Infraspinatus and Teres minor. Working together, they hold the humerus bone in place while allowing it to move freely in a circular motion within the glenoid (socket).
Rotator Cuff Tears
A rotator cuff tear is an injury in which a tendon no longer fully attaches to the head of the humerus.
Any one of the four rotator cuff tendons can tear, however the most common tendon involved in rotator cuff tear is the supraspinatus tendon. This tendon is positioned between the humeral head and the top of the shoulder blade (acromion) which provides a roof above the ball and socket joint.
If a tear enlarges, it may extend either to the back (Infraspinatus) tendon or the front (Subscapularis) tendon. The biceps tendon also passes over the humeral head and also may be injured by the same factors that caused the rotator cuff tear.
Tears can either be partial thickness or full thickness, depending on whether the tear extends all the way through the tendon. Full thickness tears result from a partial thickness tear that was not repaired and has worn through.
Rotator cuff tears can be very painful and can affect movement. If a tear is not treated and corrected within six months of the injury, the muscle attached to one of the tendons loses strength and atrophies because it’s not working. The quality of the tissue declines and becomes much harder to repair.
With an aging population, the need for rotator cuff surgery has increased dramatically. But up to now, the only option for patients who were operable has been the reverse shoulder replacement. However, since 10 to 15% of patients require additional surgery within 10 years, this is not suggested for younger patients.
Superior Capsular Reconstruction
At CHI Health, we offer an innovative procedure, called Superior Capsular Reconstruction, for complete rotator cuff tears that many physicians say are irreparable.
Superior Capsular Reconstruction is new option for younger patients and those looking for a minimally-invasive procedure and older patients who don’t yet have shoulder arthritis resulting from irreparable rotator cuff tears.
Dr. Samuel Dubrow is the first orthopedic surgeon in Nebraska and Iowa to perform Superior Capsular Reconstruction and the only surgeon in the metro Omaha area performing a new minimally-invasive procedure for rotator cuff tears. He has also lectured and instructed other Orthopedic surgeons from across the country on this procedure, and has assisted other surgeons in learning the technique.
In the reconstruction, a piece of tissue is sewn into the top of the socket and into a portion of the rotator cuff. This keeps the natural mechanics of the shoulder and restores function while reducing pain. In one study, eight patients who were manual workers were able to return to their manual jobs after surgery.
Superior Capsule Reconstruction is performed arthroscopically so there are fewer complications and recovery is faster.
The CHI Health Shoulder Center
The CHI Health Shoulder Center is unique in that we provide a “one stop” center for your care. We are the only integrated physician practice in the region, a dedicated, multidisciplinary team that devotes a significant portion of our time to shoulder pain and injuries.
We are also the only team focused on shoulder care. You don’t have to travel all over town to see your orthopedic shoulder surgeon, orthopedic nurse or care coordinator, physical therapist, physical medicine and rehabilitation physician and musculoskeletal radiologist. Your care is coordinated in one place – and includes everything from assessment to outpatient, inpatient and rehabilitative care.
Our team assembles around you. We put all our knowledge and skills to work so you get the best care. We meet frequently, formally and informally, on a regular basis to review patient cases and data on how we’re performing as a team.
Some of the advantages we offer are: one phone number, same-day visits, a physician physiatrist and physical therapist who see you as a team and physical therapy that can begin on day one.
Everyone at the Shoulder Center works together as a team toward a common goal – your best possible outcome. This coordinated care means patient outcomes are even better, patients are more satisfied and lose less time from work, and costs are held down because there is no duplication, or waste of time and resources.
Call (402) 717-0820 to schedule an appointment to have your shoulder injury evaluated.