The new procedure, approved by the Food and Drug Administration last year, is providing relief to those who are experiencing a large rotator cuff tear. The Stryker InSpace Subacromial Balloon Spacer is designed for patients whose rotator cuff tears cannot be repaired directly to the bone but are not ready for total shoulder replacement. This treatment is provided by Ryan J. Krupp, MD, an orthopedic surgeon and shoulder specialist, Executive Medical Director of Norton Orthopedic Institute and Norton Sports Health. Dr. Krupp was the first in the region to offer this service.
What is the rotator cuff?
The shoulder is the joint of the ball (head of humerus) and socket (glenoid fossa), and is the most mobile joint in the body. It relies on soft tissue structures around the shoulder for stability and movement, and the rotator cuff is the most important of these structures. The circumflex tendon plate connects the four muscles (supraspinatus, infraspinatus, subscapularis, teres minor) and the humerus to the scapularis to keep the shoulder in place and lift and rotate. It is composed of corresponding tendons that provide propulsion for movements such as. arm.
How can the rotator cuff be damaged?
Rotator cuff tears are especially common as we get older, and most tears occur in patients over the age of 40. When muscles are damaged, inflamed, or torn, the patient experiences pain, weakness, and loss of mobility. Such injuries often occur early in people who repeat the same overhead movement and are often seen in professions such as painters and carpenters. This is a common sport injury for “overhead” athletes such as pitchers and weight lifters who overuse the “pitching arm”. Rotator cuff damage can accumulate over time, but tears can also occur after traumatic events such as falls and accidents. Tears can be partial, with only part of the tendon damaged, or complete if the tendon is completely separated from the bone.
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“In the case of a large irreparable rotator cuff tear (MIRCT), the tendon is contracted or pulled back, so surgery does not have enough tissue to repair the bone directly,” Dr. Krupp said. Stated.
Rotator cuff damage and signs of treatment
Affected shoulder pain and tenderness are characteristic signs of rotator cuff injury. This includes resting and lying on the affected arm, especially overhead, behind the back, or pulling or lifting an object. Patients also usually experience shoulder weakness and loss of range of motion. If it is caused by trauma such as lifting or tilting an extended arm, it may cause sudden severe pain, a snapping sensation, and immediate debilitation. Symptoms can also gradually develop in more chronic situations, especially with repetitive activity overhead. Partial or minor rotator cuff tears can worsen over time, especially if not properly cared for.
Non-surgical treatment may relieve some pain and improve function. These treatments include rest and activity modification, intensive exercise and physiotherapy, nonsteroidal anti-inflammatory drugs (NSAIDs) or steroid injections. However, if you continue to have pain or functional deterioration, consult a shoulder specialist.
New treatment for MIRCT
Fortunately, many rotator cuff tears can be repaired directly to the bone, and especially with timely treatment, more normal anatomy and function can be restored.
“In the case of a large irreparable rotator cuff rupture (MIRCT), in these cases the deltoid muscles are used to move the shoulder and work on the injured rotator cuff as well as the deltoid muscles. Plasty has become the main treatment, “Dr. Krup said.
“Reverse total shoulder replacement is a good option for many patients, but we are always looking for additional treatments to offer to our patients, especially if they have less arthritis and are not ready for shoulder replacement.”
The InSpace Balloon Implant was designed with this patient population in mind. This has the ability to supplement the remaining rotator cuff and surrounding soft tissue structures, enabling arthroscopic treatment of MIRCT in patients with minimal or no arthritis. This device is a biodegradable balloon that is inserted between the acromion (called the acromion) and the head of the humerus and filled with saline. Balloons create space between the bone and the surrounding tissue, allowing for smoother movement and reducing friction and pain.
“It also allows the head of the humerus to return to a more normal position, allowing the rest of the rotating tissue to adapt and work to stabilize and move the shoulder,” said Dr. Krupp.
Implants do not last forever and are absorbed in about 3 months and completely in 6-12 months.
According to Dr. Krupp, “The theory is that when the implant is absorbed, it replaces the scar tissue that acts as a buffer between the head of the humerus and the acromion, while allowing the patient to rehabilitate the remaining rotator cuff tissue and other muscles. It’s about doing it. Around the shoulder. “
The potential benefits of this procedure over alternative treatments for MIRCT are:
- Shortening surgery time
- Minimally invasive approach
- Quick return to activity
- Shorter and less complex rehabilitation protocol
