Some shoulder conditions may require surgery, especially if conservative treatment options haven’t been successful. For example, a rotator-cuff tear often requires the torn tendons to be surgically reattached to the bone. Shoulder dislocations may also require surgery to repair the socket and prevent future dislocations.
Most shoulder surgeries can be done arthroscopically, using two to five small incisions through which your surgeon places surgical instruments to make repairs. This type of surgery causes less harm to healthy tissues and greatly reduces recovery time compared to traditional surgery.
Impingement, cartilage damage, rotator-cuff tears, labral tears, biceps tendonitis, arthritis, and more can be treated arthroscopically. Often, arthroscopic shoulder surgery can address multiple shoulder conditions at one time.
Before your surgery is scheduled you’ll meet with your orthopedic surgeon to talk over the procedure, its risks and benefits, and your questions or concerns.
Shoulder arthroscopy is generally an outpatient procedure, which means you typically arrive at the facility about 90 minutes before your surgery time and don’t have to stay overnight in the hospital.
Our staff will check you in, have you change into a surgical gown, and do a brief health check, listening to your heart and lungs and checking your blood pressure, pulse, and temperature before starting an IV to give you fluids and medications. We also prep the skin around the surgery site.
The anesthesia staff will come in and review your health history, past surgeries, and current medications, and discuss your anesthesia options.
A general anesthetic is often used in conjunction with a nerve block; the anesthetic puts you to sleep and the nerve block numbs your arm and shoulder during and after surgery.
The nerve block can last up to 24 hours after surgery, and helps manage initial discomfort caused by the surgery. Your surgery time can vary from one to three hours, depending on how much repair needs to be done.
A surgeon and a physician’s assistant (PA) will lead your surgical team in the operating room.
Once you’re fast asleep in the operating room, your shoulder is filled with saline to expand the joint, making it easier for your surgeon to move surgical instruments and see tissues.
To see inside your joint, your surgeon inserts an arthroscope – a tiny camera hooked up to a large computer screen. This magnifies your shoulder structures for the surgeon.
Once your surgeon can see in the joint, they insert surgical instruments through another incision to repair damaged tissues. Multiple incisions are often made to get to different areas in your shoulder.
While in your shoulder, your surgeon will usually fix any repairable damage, even unexpected damage. MRIs can miss damage, but during an arthroscopy, your surgeon can see most problems.
After surgery, your surgeon will explain what was found and any limitations you’ll have using your arm.
The degree of your injury and the amount of repair determines what type of sling you’re placed in after surgery. You may be placed in a simple shoulder sling and be allowed to move your shoulder as tolerated by pain. If a larger repair is needed, you will be placed in a shoulder immobilizer sling which supports your arm at your side.
Usually, your surgeon will ask you to just rest and recover for a few days after surgery. After that, you may take off the bulky surgical dressing and shower.
It can be difficult to care for yourself after a shoulder arthroscopy, and you may find you need extra help. Don’t be afraid to ask for help if you need it.
One to two weeks after an arthroscopy, patients can expect to meet with either their surgeon or a PA to discuss what they found during your surgery, what was done, and your recovery.
Sometimes you can begin moving your shoulder and returning to activities as soon as you’re able. Other times you may require physical therapy. If you are in an immobilizer shoulder sling, you are often unable to move your surgical arm other than in small circles for six weeks. After that, you typically begin physical therapy to regain motion of your shoulder, and eventually progress to strengthening exercises.
It takes most patients three to four months before they are back to their daily activities, and up to a year before they no longer notice shoulder pain.
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Impingement and Arthroscopic Decompression
The rotator cuff has only a small space to pass through near the top of the shoulder. Scar tissue or bone spurs can press down into that space and cause pinching, on impingement. If the pinching isn’t alleviated, it can lead to rotator-cuff tears.
It’s similar to wearing a hole in the knee of your jeans. If you keep rubbing the same spot, the fabric will thin and eventually the fibers will break and create a hole. Rotator-cuff tendons can catch and rub on bone spurs, leading first to pain and weakness and progressing to tendon tears.
Patients with shoulder impingement often cannot alleviate their pain without surgery. During an arthroscopic decompression, your surgeon uses surgical instruments to remove bone spurs and scar tissue, creating more space for your rotator cuff. After a simple decompression, you will go home in a shoulder sling and can use your arm as tolerated.
Initial recovery for a decompression is relatively short; however, the surface that the spur was removed from can be sore for a few months following surgery, as it takes time for your body to develop new hard covering on the bone. This procedure is typically very helpful, and the bone spurs rarely return.
Hard Cartilage Damage and Chondroplasty
The upper arm bone is ball-shaped to fit neatly into a socket created by the shoulder blade. These bony surfaces are covered by hard cartilage and should ideally be smooth. A defect or flap in the hard cartilage can cause your shoulder to have a painful catch or click, limiting your shoulder motion.
A damaged hard-cartilage flap can damage healthy tissue in your shoulder. If the defect is relatively small, it can sometimes be polished and smoothed out with gentle motion exercises. Severe hard-cartilage damage may require surgery to remove unstable tissue flaps.
Arthroscopic shoulder chondroplasty can smooth out damaged hard cartilage. With this procedure, a surgical instrument removes the fraying or flapped hard cartilage and smooths down the remaining tissue.
After chondroplasty, you are often placed in a shoulder sling and can move your shoulder as you feel up to it. Your surgeon will detail your post-surgery restrictions.
Rotator Cuff Tears and Debridement vs. Repair
Most rotator-cuff tears can be fixed with arthroscopic techniques or a mini-open procedure. In the mini-open procedure, an incision is expanded to three to five centimeters to better visualize the tissues without the arthroscope.
If your rotator cuff is completely torn and pulled away, your surgeon will use anchors placed into your bone to reattach the torn tendon. The anchors have sutures attached; similar to a strong thread, sutures let the surgeon sew the tendon tightly to the bone. The number of anchors and sutures depends on the severity and number of tendon tears.
Usually after a large rotator-cuff repair, your tendons need time to heal and you will be placed in an immobilizer shoulder sling for up to six weeks. This prevents you from putting too much tension on the repair before the tendon heals to the bone, which could cause a re-tear.
If you have only minor rotator-cuff fraying or your tendons are not completely torn, your surgeon may simply debride (clean up) the damaged area. In this case, you will likely be placed in a simple shoulder sling and can return to daily activities as tolerated.
It can take from two weeks to two months before you return to daily activities following a rotator-cuff repair, and six months to a year until your shoulder feels completely normal again.
Labral Repairs and Capsular Shift (Shoulder Dislocation)
When the ball comes out of the socket, the resulting shoulder dislocation can injure the labrum, causing pain, popping, and a feeling of instability. The labrum can fray or completely tear, causing a flap of tissue to catch within the shoulder joint.
This condition can be treated arthroscopically. Minor labrum fraying can be cleaned up and smoothed out. For a completely torn labrum, your surgeon will often use anchors made of a bone-like substance to sew your labrum down to the bone. Over time, your body turns the anchor into your own bone.
If you have dislocated your shoulder multiple times, you may have damaged the tissue surrounding the shoulder joint. In this case, your surgeon will tighten this tissue and restabilize your shoulder.
The number of anchors and type of sling you are in after surgery depend on the size and severity of your injury. For small labrum repairs, you will be placed in a simple shoulder sling after surgery and may lift light objects like a pencil, toothbrush, or fork. For larger repairs, you’ll likely be placed in a shoulder immobilizer sling for six weeks after surgery.
Bicipital Tendonitis and Tenodesis/Tenotomy
When the biceps’ long head becomes irritated and inflamed, the resulting tendonitis can be very painful or even tear the tendon at its attachment. If the pain is hard to control with oral anti-inflammatories, cortisone injections, or physical therapy, surgery may be necessary.
Your surgeon can use an arthroscope to release the long head of the biceps tendon from its attachment on the labrum. Since the short head of the biceps tendon is still attached to the shoulder blade, you will not lose strength or power in your arm. This can provide substantial relief for tendonitis patients.
The portion of the biceps tendon that was released can either be left unattached (tenotomy), causing a slight bulge in the biceps muscle, or re-attached to a lower area of the upper arm bone (tenodesis). After this procedure, you’re often placed in a simple shoulder sling and can lift light objects like a pencil, toothbrush, or fork. Your surgeon will detail your post-surgery restrictions.
Arthritis of the AC Joint and Distal Clavicle Resection (Shoulder Separation)
At the very top of your shoulder the collarbone joins the top of your shoulder blade, creating the acromioclavicular (AC) joint. When the shoulder blade is pulled away from the collarbone, the injury is called a separation. Over time, your AC joint can develop wear-and-tear damage or arthritis, causing painful pinching of the soft tissue.
Oral anti-inflammatories or cortisone injections sometimes help the pain, but if they don’t provide lasting relief, surgery is an option.
Your surgeon uses an arthroscope to visualize the AC joint and clear away soft tissues. Using a special bone-shaving tool, your surgeon removes about a half-inch off the end of the collarbone, providing more space within the AC joint and relieving pain.
If this is the only procedure you have, you can go home in a simple shoulder sling and use your arm as you are able.
The surface the bone was taken from can be sore for a few months following surgery, as it takes time for your body to develop a new hard covering on the bone. This procedure is typically very helpful, and the problem almost never returns.
Shoulder Arthritis and Total Shoulder Replacement
If the hard cartilage wears away, the bones can rub against each other, causing the pain and stiffness of osteoarthritis. If arthritis is limiting your everyday activities and you’re unable to manage your pain with medications, cortisone injections, or physical therapy, a shoulder replacement might be an option.
In a shoulder replacement (arthroplasty), the entire joint is replaced with metal and plastic. This procedure can be done in an inpatient or outpatient setting depending upon your health, medical history, and insurance, meaning you may or may not spend a night in the hospital.
Total shoulder replacement surgery involves separating the muscles in the front of your shoulder, the deltoid and pectoralis muscles, in order to access the shoulder in a nerve-free location. The rotator cuff is released to allow access to the shoulder joint.
Your surgeon replaces the ball of your upper arm bone with one made out of surgical metal and replaces the damaged socket cartilage with a surgical plastic insert.
This traditional shoulder replacement surgery relies on your rotator cuff to power your shoulder in the same manner as a healthy shoulder.
For large, irreparable rotator-cuff tears, you can replace just the ball of the upper arm bone with an oversized ball in a reverse total shoulder replacement. After this surgery, your shoulder will use the deltoid muscles instead of the rotator cuff to power and position the arm. Both surgeries provide substantial pain reduction.
You can expect to undergo physical therapy after surgery, sometimes as early as the next day. Although it can take up to a year, the majority of patients who undergo total shoulder replacement surgery feel much better than prior to surgery. You’ll find that you can move your shoulder more easily and without pain, making everyday tasks enjoyable again.