CN204815353U - Treatment rotator cuff injury's biological gasket - Google Patents

Treatment rotator cuff injury's biological gasket Download PDF

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Publication number
CN204815353U
CN204815353U CN201520546298.6U CN201520546298U CN204815353U CN 204815353 U CN204815353 U CN 204815353U CN 201520546298 U CN201520546298 U CN 201520546298U CN 204815353 U CN204815353 U CN 204815353U
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mesh bag
rotator cuff
gelinite
biological
treatment
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Expired - Fee Related
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CN201520546298.6U
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Chinese (zh)
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陈洁
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Individual
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Individual
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Abstract

The utility model discloses a treatment rotator cuff injury's biological gasket, it includes pocket and gelinite, the gelinite includes gel materials, the side of pocket forms the micropore, the inside of pocket is formed with the holding chamber, under the user state, gel materials is in holding intracavity absorption moisture inflation struts the pocket. The application method of shown biological gasket is earlier to the pocket will in sending into the shoulder sleeve again the gelinite pours into into inside the pocket. The utility model discloses a biological gasket has good restoration treatment rotator cuff injury's effect, has good biocompatibility, can provide holding power between suitable shoulder sleeve, and still the long -term slowly -releasing function of dosing is realized to the portable medicine, alleviate fast painful, shorten recovery time, the medicine can mix with gel materials and pours into the gel formation body in the pocket into, reaching the inflation and supporting the purpose, has again and slowly releases the medicine function, is particularly useful for satisfying the interior long -term continuously demand of using medicine of shoulder sleeve.

Description

A kind of biological pad for the treatment of rotator cuff injury
Technical field
This utility model relates to the technical field of the Design for Medical Device for the treatment of rotator cuff injury, particularly relates to a kind of biological pad for the treatment of rotator cuff injury.
Background technology
Strenuous exercise repeatedly can cause fragile soft tissue worn and torn or tear damage usually, takes on the example that sleeve tendon or laceration of ligament and articular capsule rupture are exactly this kind of damage.
Shoulder sleeve is named again and rotates sleeve, it is the one group of tendon complex surrounded around head of humerus, the front of head of humerus is tendon of subscapularis muscle, top is tendon of supraspinatus muscle, rear is tendon of infraspinatus muscle and roundlet tendon, be attached to the edge of greater tubercles of humerus and anatomical neck of humerus, its inner face is closely connected with joint capsule, outside is subdeltoid capsule, the motion of these tendons causes shoulder joint medial rotation, revolves outer and upper act activity, but the more important thing is, head of humerus is stable on Scapula glenoid by these tendons, plays an important role to the stable of maintenance shoulder joint and shoulder mobility.
4 pieces of muscle that shoulder is tucked inside the sleeve and teres major and triangular muscle constitute 6 pieces of muscle that human body is connected humerus and scapula jointly.The damage of these tendons or muscle can cause pain and shoulder function obstacle.Subacromial bursa is the natural hydrops of one of human body, and it allows tendon or ligament to move under acromion and processus coracoideus, and as buffering therebetween or motion lubricant to prevent these tendon injuries.
In the Patent document number CN101854886B of rectification-limited space company, provide a kind of prosthetic appliance being applicable to alleviating or eliminating rotator cuff damage, being introduced in acromion and processus coracoideus and shoulder tucks inside the sleeve between tendon, with prevent to the Continuous Damage of these body parts or allow relatively by overslaugh or head movement freely.
Affect the key influence factor of this operation:
1, sealing the smooth smoothness of graft, good airproof performance and stable, is the key affecting successful surgery.
2, prevent the excessive expansion of graft, cause Subacromial Space to reduce pressure increase simultaneously, patient can be made to produce pain and discomfort to the pressure that head of humerus causes.
3, carry out in prosthese expansion process at the certain pressure of maintenance, should guarantee in protection sheath without kink.
In described disclosed above-mentioned document, prosthese used is biocompatible material, by filling liquid in prosthese and sealing, makes prosthese have certain bearing capacity, recovers Subacromial Space.The sealing of prosthese used, by pulling pipe to carry out to stiffening ring, due to both mutual relative slidings, stopper embeds in the tube chamber of stiffening ring, continue to pull and make stiffening ring touch counter-force ring, continue to pull pipe to cause a part for stopper to rupture, this part of stopper self embeds in the tube chamber of stiffening ring, thus sealing prosthese.
The shortcoming of this structure is adopted to be:
1) complex structure, sealing property is bad, poor stability;
2) structural requirement of stiffening ring and counter-force ring, limits selecting of material;
3) this push-pull structure, easily causes kink (kink) phenomenon of the protection sheath in operation process;
4) excessive expansion of graft may be caused, after the pressure that head of humerus is caused, produce pain and discomfort;
5) owing to selecting unlike material, the degradation time of each material is asynchronous, especially stiffening ring part, may impact recovery effects at a specified future date;
6) because prosthese has bearing capacity, its material is relatively hard, and patient can be caused in upper limb active procedure uncomfortable;
7) because liquid full in prosthese is in sealing state (37 DEG C, be greater than 2 months) for a long time, liquid has rotten risk, and when prosthese (degraded) breaks, liquid pours out, and causes harmful effect to affected part;
8) Using prosthesis posterior joint is in daily routines state, and when degraded crack occurs prosthese, the activity extruding of head of humerus can make crack expand rapidly, in prosthese, full liquid pours out, the weight capacity of prosthese completely loses, and Subacromial Space reduces rapidly, may cause disease relapse;
Because the Using prosthesis initial stage is in complete closed state, medicine is carried on its surface or/and the ability recovering auxiliary material is very limited, and curative effect is not obvious and treatment cycle is long.
Therefore, the applicant is devoted to develop a kind of biological pad for the treatment of rotator cuff injury, realizes the effect can with good repairing and treating rotator cuff injury, can also be convenient for carrying medicine and realize long-term sustained release administration functions, simultaneously easy to use, damages little to patient.
Utility model content
The purpose of this utility model, proposes a kind of biological pad for the treatment of rotator cuff injury exactly, realizes the effect can with good repairing and treating rotator cuff injury, can also be convenient for carrying medicine and realize long-term sustained release administration functions, simultaneously easy to use, damages little to patient.
This utility model is for solving the problems of the technologies described above, provide a kind of biological pad for the treatment of rotator cuff injury, it comprises mesh bag and gelinite, described gelinite comprises the gel rubber material that fluid-absorbing expands, the side of described mesh bag is formed with some micropores, and the inside of described mesh bag is formed with the containing cavity for accommodating described gelinite.
In a state of use, described gel rubber material absorb in described containing cavity moisture expand strut described mesh bag.
This utility model forms support by gel rubber material imbibition to mesh bag, realize mesh bag self-expanding in a state of use, this self-expanding can according to suffered ambient pressure, compliance ground is against the geometry of irregular tissue wall, be conducive to shoulder tuck inside the sleeve inside form larger support contact surface, not only there is good, suitable biomechanical property, the isolation of appropriateness can be formed, micropore not easily blocks, the metabolism circulation of inside and outside material can not be affected, form inside and outside mass exchange and metabolism, prevent material from going bad and harmful substance accumulation.
And owing to there is good biomechanical property after gel rubber material imbibition, can to tuck inside the sleeve inner space automatic adaptation with shoulder, device can not be caused to form excessive isolation, also can not cause excess pressure to shoulder sleeve inwall, effectively avoid after expanding and produce pain and sense of discomfort.
Preferably, described gel rubber material is gel sponge material or injecting fluid gel rubber material.
Preferably, described gel rubber material is mixed by gel sponge material and injecting fluid gel rubber material.
Preferably, described gel rubber material select in the material as follows with biocompatible or biological degradability one or more: polycaprolactone (PCL), PGA (PGA), poly(hydrobutyl ester) (PHB), plastic starch material, animal derived cellular matrix, gelatin, chitosan, platelet rich plasma, polyether-ether-ketone (PEEK), poly-methyl acid methyl ester, alginate, Silica hydrogel, zein, temperature-sensitive hydrogel, polyurethane, de-cellular cartilage material, polylactic acid (PLA), PPDO (PPDO), lactic acid/co-glycolic acid (PLGA), methylcellulose.
Preferably, described mesh bag is combined by lateral plate more than two panels or two panels or integrally formed, and the edge of described lateral plate is interconnected and fixed, and innerly forms the containing cavity being used for accommodating described gelinite, described lateral plate offers respectively multiple described micropore.
Mesh bag of the present utility model is further designed to two sides combination or many lateral plates combine or integrally formed inside has the pad form of containing cavity, easy to make and be more convenient to the implantation of mesh bag.
Preferably, described mesh bag internal preset has sponge material layer.
Preferably, described mesh bag is made up of degradable high polymer material.
Preferably, described degradable high polymer material comprises one or more in following material: polycaprolactone, PGA, poly(hydrobutyl ester), plastic starch material, polyether-ether-ketone, zein, polylactic acid, PPDO, lactic acid/co-glycolic acid, collagen protein and methylcellulose.
This utility model adopts degradable high polymer material to make mesh bag further, mainly utilizes the feature of degradable material, and degraded timeliness is synchronous, avoids occurring that bulk/hard material is dissociated.
Preferably, curative drug can also be comprised in described gelinite.
This utility model effectively can carry curative drug, realize 360 degree of comprehensive administrations and play sterilization thoroughly, simultaneously because mesh bag can expand so its micropore is not easily blocked, what the medicine be convenient in gelinite continued by the micropore on mesh bag spreads to mesh bag surrounding, realizes long-term sustained release administration functions.
Preferably, described medicine is one or both or three kinds in analgesic, antibiotic medicine and biological preparation.
This utility model also proposes a kind of using method for the treatment of the biological pad of rotator cuff injury, and described biological pad is the biological pad of above-mentioned treatment rotator cuff injury, and implantation process comprises the steps:
Step 1, described mesh bag is sent in shoulder sleeve;
Step 2, described gelinite to be injected described mesh bag inner.
The method for implantation of the biological pad that the utility model proposes is different from the overall method for implantation of conventional device, but ingenious be divided into mesh bag and gelinite two parts by biological pad are implanted respectively, the final biological pad forming assembled state in patient body, and play effectiveness, implantation process is more convenient, and it is little to have wound, simple to operate, be implanted to power higher, the advantage that biocompatibility is good.
Preferably, described step 1 be specially described mesh bag carried out folding after through conduit Arthroscopic auxiliary under send to in shoulder sleeve, then withdraw from described conduit, described mesh bag launch to recover its folding before state.
Preferably, described step 2 is specially and modulates described gelinite in advance, by external pressure devices, described gelinite is injected the sponge material layer of described mesh bag internal preset, it (can be the moisture in body that described gelinite absorbs water gradually in shoulder sleeve fluid environment, also can be injecting fluid) expanding struts mesh bag, and the medicine in described gelinite externally continues slow dispersal events by micropore on described mesh bag.
Preferably, method for implantation of the present utility model also comprises step 3: toward mesh bag internal injection liquid, make gelinite absorb described injecting fluid fast and realize self-expanding.
In sum, the biological pad of this utility model treatment rotator cuff injury includes following or several somes beneficial effects:
1, biological pad of the present utility model has the effect of good repairing and treating rotator cuff injury, has good biocompatibility, can provide support force between suitable shoulder sleeve.
2, biological pad of the present utility model can also be convenient for carrying medicine and realize long-term sustained release administration functions, fast pain relief, shorten recovery time.Medicine can carry out mixing injecting in mesh bag with gel rubber material and forms gelinite, namely reaches expanding support object, has again slow release function, is particularly useful for meeting the long-term SM demand in shoulder sleeve.
3, biological pad of the present utility model is without the need to sealing, reduces the non-controllable risks such as leakage, and easy to use, damages little to patient.
4, the micropore on biological pad of the present utility model not easily blocks, and can not affect the metabolism circulation of inside and outside material.
5, biological pad of the present utility model not easily bursts, and again runs into shock or weight causes gap under acromion to reduce after implantation, and mesh bag pressure increases, and what the open architecture of mesh bag can prevent hypertonia in mesh bag structure from causing breaks.
6, biological pad of the present utility model in use, and the biomechanical property have well, be suitable for, can form the isolation of appropriateness, and form inside and outside mass exchange and metabolism, prevents material from going bad and harmful substance accumulation.
7, the degradable biomaterial of biological pad employing of the present utility model, degradation process is different from prior art, progressively declines at degradation process Intermediate gasket isolation features, and human body adaptability increases.Degraded form is different from prior art, and inner gel rubber material soak time is shorter than mesh bag material, can keep the global shape of mesh bag.
8, biological pad of the present utility model is easy to reclaim, and all can reclaim at any time in dispose procedure and after release, reduces mental pressure.
9, biological pad mechanical property of the present utility model is suitable for joint motion, can not cause the excessive isolation of acromion and head of humerus, produces pain and uncomfortable phenomenon after avoiding the pressure caused head of humerus.
10, method for implantation of the present utility model achieves Wicresoft's implantation, damages little, simple to operate, is implanted to power high.
Accompanying drawing explanation
Below in conjunction with the drawings and specific embodiments, this utility model is described in further detail:
Fig. 1 is the cross section structure schematic diagram of the biological pad of specific embodiment treatment rotator cuff injury.
Fig. 2 is the perspective view of specific embodiment mesh bag.
Fig. 3 is the structural representation of a lateral plate of specific embodiment mesh bag.
Fig. 4 is the application schematic diagram of the biological pad of specific embodiment treatment rotator cuff injury.
Fig. 5 is mesh bag feed status structural representation and the profile of specific embodiment.
Fig. 6 is the injection schematic diagram of specific embodiment gelinite.
Drawing reference numeral illustrates:
Mesh bag 1, gelinite 2, micropore 3, lateral plate 4.
Detailed description of the invention
As shown in Figure 1, present embodiment discloses a kind of biological pad for the treatment of rotator cuff injury, it comprises mesh bag 1 and gelinite 2.
The gelinite 2 of the present embodiment comprises gel rubber material 1 and the curative drug of fluid-absorbing expansion.
Exemplary, the gel rubber material of the present embodiment selects injecting fluid gel rubber material, described choice of drug antibiotic medicine.
Described injecting fluid gel rubber material and described antibiotic medicine can be carried out mixing preparation gelinite by the present embodiment by a certain percentage in advance, described antibiotic medicine adopts the medicine of liquid form or powder morphology, both ratios and concrete consumption, can adjust by suitable carrying out as the case may be, also can add other adjuvants, to meet different treatment needs and expanding needs, and be directed to the situation without the need to medication, also only can inject gel rubber material, and not add medicine.
As shown in Figure 2, the side of the mesh bag 1 of the present embodiment is formed with some micropores 3, and the inside of mesh bag 1 is formed with the containing cavity for accommodating gelinite 2.
The present embodiment in a state of use, biological pad as shown in Figure 1: described gel rubber material absorb in described containing cavity moisture expand strut mesh bag 1, described agent permeates therethrough micropore 3 externally discharges.
It should be noted that, the biological pad of the present embodiment is under unused state, and mesh bag 1 and gelinite 2 can be prefabricated separately respectively, do not combine.Be likely by the instruction of different manufacturers according to the present embodiment, make mesh bag, gel rubber material and medicine respectively, then undertaken supportingly forming one group of biological pad completed by another producer, supply third party uses.
Exemplary, the mesh bag 1 of the present embodiment is specifically combined by two lateral plates 4 as shown in Figure 3, the edge of two lateral plates 4 mutually bonds as shown in Figure 2 and is connected and fixed, the inner described containing cavity formed for accommodating described gelinite, and be preset with sponge material layer (not shown) at the described containing cavity of mesh bag 1 inside, on two lateral plates 4, offer multiple micropore 3 respectively simultaneously.
Wherein, pore size and the quantity of micropore 3 adjust according to practical situation, the present embodiment selects the micropore 3 of suitable aperture and quantity to make gelinite 2 be unlikely to be extruded in mesh bag 1 under shoulder sleeve inner wall pressure, and simultaneously medicine wherein also can effectively be disengaged by micropore 3.
In different specific embodiment, the concrete form of mesh bag also can be arranged according to practical situation, the mesh bag etc. of cuboid or square is combined to form as adopted six lateral plates, so described mesh bag also can be combined by other many lateral plates or integrally formed, be interconnected and fixed by the edge of described lateral plate, the inner containing cavity formed for accommodating described gelinite, and multiple described micropore is offered respectively on each described lateral plate, repeat no more herein.
Exemplary, the mesh bag 1 of the present embodiment is made up of degradable high polymer material, described degradable high polymer material comprise in following material one or more: polycaprolactone (PCL), PGA (PGA), poly(hydrobutyl ester) (PHB), plastic starch material, polyether-ether-ketone (PEEK), zein, polylactic acid (PLA), PPDO (PDO), lactic acid/co-glycolic acid (PLGA), collagen protein and methylcellulose.
Exemplary, the present embodiment according to make need to select as follows by biological degradability or one or more in biocompatible material, make fluid-absorbing (moisture, body fluid or blood etc.) expanding forms the gel rubber material of gel state: polycaprolactone (PCL), PGA (PGA), poly(hydrobutyl ester) (PHB), plastic starch material, animal derived cellular matrix, gelatin, chitosan, platelet rich plasma, polyether-ether-ketone (PEEK), poly-methyl acid methyl ester, alginate, zein, de-cellular cartilage material, polylactic acid (PLA), PPDO (PDO) and lactic acid/co-glycolic acid (PLGA), collagen protein and/or methylcellulose.
The described gel rubber material of the present embodiment can shift to an earlier date mixing preparation with described medicine and make semigel shape, is injected in mesh bag as shown in Figure 6 by pressure apparatus, then absorbs moisture further by gel rubber material and become gel completely and realize expanding completely.
Of course, in other specific embodiments, gel rubber material selected by biological pad of the present utility model can also be gel sponge material etc. other meet medical water swellability gel rubber material, also can be the compound of gel sponge material and injecting fluid gel rubber material.Described medicine also can adopt the other drug such as analgesic or biological preparation according to practical situation, in the multi-medicaments such as analgesic, antibiotic medicine and biological preparation two or three also can be adopted to carry out used in combination, repeat no more herein.
As shown in Figure 4, the biological pad of the present embodiment fully expands through absorbing moisture after implanting, and can keep apart acromion and head of humerus and the friction alleviated between tissue.Biological pad under swelling state can be various shape, sizes, is applicable to the concrete needs of patient, is enough to that compensate deformity or that size is inadequate natural mucilage capsule, makes the combination of natural mucilage capsule and graft and the bursal shape of health or size suitable.The biological pad of the present embodiment is about as 2-10cm after expansion in shoulder sleeve, wide about 2-7cm, and height is about 0.5mm-20mm, and biological pad is rectangle before expanding, and is similar rectangular parallelepiped protrusion part or pincushion after expanding.
The biological pad of the present embodiment is particularly applicable in the treatment of shoulder sleeve inflammation, and its concrete method for implantation is also different from conventional overall method for implantation, and what the method for implantation of the biological pad of the present embodiment adopted is split implantation, and its implantation process comprises the steps:
Step 1, as shown in Figure 4 mesh bag 1 is sent into shoulder sleeve in;
Step 2, gelinite 2 to be injected mesh bag 1 as shown in Figure 6 inner;
Step 3, past mesh bag 1 internal injection liquid (as normal saline), make gelinite 2 absorb described injecting fluid fast and realize self-expanding.
Mesh bag 1 is first implanted by described step 1 by the present embodiment, because mesh bag 1 inside does not exist the support substances such as gelinite, so small volume, and convenient implantation; Injected the gelinite 2 of appropriate amount again by described step 2, in shoulder sleeve, complete the assembling of biological pad, neither affect result of use, Wicresoft can also be realized simultaneously and implant, reduce the loss that implantation process brings for patient, and improve the success rate implanted further; Step 3 provides sufficient liquid to gel rubber material, absorbs to expand to form gel state fast for it.
It should be noted that, in other specific embodiments, above-mentioned steps 3 is also omissible, can by the body fluid of shoulder sleeve inside for gel rubber material provides the required liquid that expands, and gel rubber material also can realize imbibition and form gel state.
Exemplary, in concrete practical operation, the concrete implantation process of method for implantation of the biological pad of the treatment rotator cuff injury of the present embodiment is as follows:
Concrete steps 1: mesh bag 1 is carried out as shown in Figure 5 folding after through conduit Arthroscopic auxiliary under send to in shoulder sleeve, then withdraw from described conduit, described mesh bag launch to recover its folding before state.
Concrete steps 2: modulate gelinite 2 in advance, by external pressure devices, gelinite 2 is injected the described sponge material layer of mesh bag 1 internal preset, it (can be the moisture in body that gelinite 2 absorbs water gradually in shoulder sleeve fluid environment, also can be injecting fluid) expanding mesh bag 1 to strut forms good support force, and the medicine in gelinite 2 externally continues slow dispersal events by micropore 3 on mesh bag 1.Whether implement above-mentioned steps 3 further, select according to practical situation.
Medical personnel adopt the biological pad of the present embodiment and operate according to the method for implantation of the present embodiment, biological pad can realize Wicresoft and implant, gelinite and sponge material layer and shoulder inside of tuck inside the sleeve realizes mixing, expand gradually under the effect of fluid environment certain hour in shoulder sleeve, strut mesh bag formation and there is the adaptive support of good biological (mesh bag can form various shape under the restriction of outside shoulder sleeve inwall), gel rubber material is effectively limited in mesh bag, the medicine that gelinite includes then realizes continuing slow release to surrounding shoulder sleeve inwall place through in mesh bag micropore.
With above-mentioned be only preferred implementation of the present utility model; it should be pointed out that for those skilled in the art, under the prerequisite not departing from this utility model principle; can also make some improvements and modifications, these improvements and modifications also should be considered as protection domain of the present utility model.

Claims (9)

1. treat the biological pad of rotator cuff injury for one kind, it is characterized in that, comprising: mesh bag and gelinite, described gelinite comprises the gel rubber material that fluid-absorbing expands, the side of described mesh bag is formed with some micropores, and the inside of described mesh bag is formed with the containing cavity for accommodating described gelinite;
In a state of use, described gel rubber material absorb in described containing cavity moisture expand strut described mesh bag.
2. the biological pad for the treatment of rotator cuff injury as claimed in claim 1, is characterized in that: described gel rubber material is gel sponge material or injecting fluid gel rubber material.
3. the biological pad for the treatment of rotator cuff injury as claimed in claim 1, is characterized in that: described gel rubber material is mixed by gel sponge material and injecting fluid gel rubber material.
4. the biological pad for the treatment of rotator cuff injury as claimed in claim 1, it is characterized in that: described mesh bag is combined by lateral plate more than two panels or two panels or integrally formed, the edge of described lateral plate is interconnected and fixed, the inner containing cavity formed for accommodating described gelinite, described lateral plate offers respectively multiple described micropore.
5. the biological pad for the treatment of rotator cuff injury as claimed in claim 1, is characterized in that: described mesh bag internal preset has sponge material layer.
6. the biological pad of the treatment rotator cuff injury as described in any one of claim 1-5, is characterized in that: described mesh bag is made up of degradable high polymer material.
7. the biological pad for the treatment of rotator cuff injury as claimed in claim 6, is characterized in that: described degradable high polymer material comprise in following material one or more: polycaprolactone, PGA, poly(hydrobutyl ester), plastic starch material, polyether-ether-ketone, zein, polylactic acid, PPDO, lactic acid/co-glycolic acid, collagen protein and methylcellulose.
8. the biological pad for the treatment of rotator cuff injury as claimed in claim 1, is characterized in that: also comprise curative drug in described gelinite.
9. the biological pad for the treatment of rotator cuff injury as claimed in claim 8, is characterized in that: described medicine is one or both or three kinds in analgesic, antibiotic medicine and biological preparation.
CN201520546298.6U 2015-07-24 2015-07-24 Treatment rotator cuff injury's biological gasket Expired - Fee Related CN204815353U (en)

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Cited By (3)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
CN104984468A (en) * 2015-07-24 2015-10-21 陈洁 Biological pad for treating damages to rotator cuff and use method thereof
CN107874883A (en) * 2017-12-19 2018-04-06 易娟 ICU patient is with jaw pad
WO2021129860A1 (en) * 2019-12-27 2021-07-01 上海微创医疗器械(集团)有限公司 Rotator cuff balloon

Cited By (4)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
CN104984468A (en) * 2015-07-24 2015-10-21 陈洁 Biological pad for treating damages to rotator cuff and use method thereof
CN107874883A (en) * 2017-12-19 2018-04-06 易娟 ICU patient is with jaw pad
CN107874883B (en) * 2017-12-19 2020-11-24 易娟 Jaw pad for ICU patient
WO2021129860A1 (en) * 2019-12-27 2021-07-01 上海微创医疗器械(集团)有限公司 Rotator cuff balloon

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