Commonly, your shoulder is first evaluated with an arthroscope to look at the tear and determine if it can be fixed. An arthroscope is a small camera inserted into the shoulder through a small poke-hole. The camera is connected to a video monitor. The surgeon looks around the entire joint to evaluate the cartilage, tendons, and ligaments of your shoulder. After evaluating the shoulder joint, the surgeon places the camera in the space above the rotator cuff tendons, called the subacromial space. The surgeon can evaluate the area above the rotator cuff, clean out inflamed or damaged tissue, and remove a bone spur (subacromial spur). If a tear is going to be fixed, the surgeon may perform the surgery with a larger, open incision. Other surgeons use the arthroscope and 1-3 additional small poke-holes or smaller incisions to perform the surgery. The additional small incisions allow the surgeon to insert other instruments to repair damaged tissue. The goal is to attach the tendon back to the bone where it tore off. The tendon is attached with sutures. Small rivets (called suture anchors) are often used to help attach the tendon to the bone. The suture anchors can be made of metal or plastic, and do not need to be removed. At the end of the surgery, the incisions are closed, and a dressing is applied. If arthroscopy was performed, most surgeons take pictures of the procedure from the video monitor to show you what was found and what was done.
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