Question:Sometimes the consumer craze goes too far. I don't mind picking my own doctor, but I want him or her to tell me what to do -- not give me choices and let me decide. I'm talking about having surgery to repair a rotator cuff tear. Please just tell me if I should have an open operation or go with the newer mini-open method.
Answer:When it comes to giving patients advice or direction today, doctors are in an equal dilemma. Many patients want to be considered consumers. Their attitude is: just give us the information and we will decide what's best.
Physicians are trying to honor and respect that whenever possible. If a surgeon feels comfortable offering either choice, it's likely that he or she is skilled and confident in performing either one. This is good since the surgeon's experience and technical abilities are important to the final outcome.
There are advantages and disadvantages to both procedures. The mini-open doesn't disrupt as much soft tissue as the open operation. In particular, the deltoid muscle along the upper arm isn't cut during the mini-open approach. But the surgeon has better visibility with an open incision.
If the tear is small, the mini-open method works well. The hospital stay is shorter, so there may be lower costs, too. With the mini-open incision, the surgeon can always switch over to a full incision if needed.
You can always ask your surgeon for more specific direction in this decision. He or she may be trying to give you as much choice as possible without knowing your needs and wants for information and independence.Nicholas G. Mohtadi, MD, FRCSC, et al. A Randomized Clinical Trial Comparing Open to Arthroscopic Acromioplasty with Mini-Open Rotator Cuff Repairs for Full-Thickness Rotator Cuff Tears. In The American Journal of Sports Medicine. June 2008. Vol. 36. No. 6. Pp. 1043-1051.
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