Certain shoulder conditions may require surgery, especially if conservative treatment options have not 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 through an arthroscope using between two and 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 with arthroscopy. Often, multiple shoulder conditions can be addressed at one time with arthroscopic shoulder surgery.
Shoulder arthroscopy is generally an outpatient procedure, which means you typically arrive at the facility about an hour and a half before your actual surgery time and you do not have to stay overnight in the hospital.
Our staff will check you in 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.
The anesthesia staff will discuss your options for medications during surgery. A general anesthetic will often be 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 the 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 in the shoulder.
Once you are in the operating room and fast asleep, your shoulder is filled with saline to expand the joint, making it easier for your surgeon to move surgical instruments and see tissues.
To be able to see inside of your joint, your surgeon inserts an arthroscope, which is 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 the different areas in your shoulder.
While in your shoulder, your surgeon will usually fix any repairable damage they find, even if it was not expected. Even MRIs can miss damage in your shoulder, but during an arthroscopy, your surgeon can see exactly what is problematic. A Physician Assistant often helps your surgeon throughout surgery and understands everything that was done.
After surgery, your surgeon will discuss what was found and explain any limitations you will have in using your arm.
The degree of your injury and the amount of repair determines what type of sling you are 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 dressing from surgery and can shower.
It can be difficult to care for yourself after a shoulder arthroscopy, and you may find you need extra help. Your surgeon will detail any post-surgery restrictions.
One to two weeks after an arthroscopy, patients can expect to be seen by either their surgeon or a Physician Assistant. At that time, they will discuss what they found during your surgery, what was done, and your recovery process.
Sometimes you are able to begin moving your shoulder and returning to activities on your own, as you are 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 small circles for six weeks. After that time, 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; however, it can take up to a year before they no longer notice any shoulder pain.
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Impingement and Arthroscopic Decompression
This is similar to wearing a hole in a pair of jeans. If you keep kneeling and rubbing the knee of your jeans, the fabric will thin and eventually the fibers will break and create a hole. The rotator-cuff tendons can catch and rub on bone spurs, initially causing pain and weakness, and progressing to partial or even complete tendon tears.
During an arthroscopic decompression, your surgeon uses surgical instruments to remove bone spurs and scar tissue, creating more space for your rotator cuff to pass through. After a simple decompression, you will go home in a shoulder sling and are able to use your arm as tolerated. Your surgeon will detail any post-surgery restrictions.
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 a 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 shaped like a ball to fit neatly into a socket created by the shoulder blade; this is referred to as the glenohumeral joint. 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, which can limit your shoulder motion.
A damaged hard-cartilage flap can damage the remaining healthy tissue in your shoulder. If the defect is relatively small, it can sometimes be polished and smoothed out with gentle motion exercises. If the hard-cartilage damage is severe, surgical intervention may be required 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, one of the incisions is expanded to three to five centimeters to better visualize the tissues without the arthroscope.
In either case, 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 small fraying of your rotator cuff 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 allowed to return to daily activities as tolerated.
Your surgeon will detail your post-surgery restrictions. It can take anywhere from two weeks to two months before you return to daily activities following a rotator-cuff repair, and it can often take six months to a year until your shoulder feels completely normal again.
Labral Repairs and Capsular Shift
This condition can be treated with arthroscopy. 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 likely be placed in a shoulder immobilizer sling for six weeks after surgery. Your surgeon will detail your post-surgery restrictions.
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. Sometimes the pain is hard to control with oral anti-inflammatory medication, cortisone injections, or physical therapy; at that point, surgical intervention may be necessary.
If surgery is necessary, your surgeon can use the 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 only a slight bulge in the biceps muscle, or re-attached to a lower area of the upper arm bone (tenodesis). After this procedure, you are often placed in a simple shoulder sling and are allowed to 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
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. Arthritis can cause painful pinching of the soft tissue.
Oral anti-inflammatory medications or cortisone injections sometimes help the pain, but if they do not provide lasting relief, surgical intervention is considered.
Your surgeon uses an arthroscope to visualize the AC joint and clear away the 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. Your surgeon will detail your post-surgery restrictions.
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
A shoulder replacement (arthroplasty) is where 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. This means you may or may not spend a night in the hospital. The 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 will replace the ball of your upper arm bone with one made out of surgical metal and replace the damaged cartilage of the socket with a surgical plastic insert. This traditional shoulder replacement surgery relies on your rotator cuff to power your shoulder in the same manner that a healthy shoulder functions.
If you have a large rotator cuff tear that is irreparable, then a traditional total shoulder replacement is not an option for you. In this case, you may have the option of replacing just the ball of the upper arm bone with an oversized ball or a reverse total shoulder replacement. In a reverse total shoulder, your surgeon will replace the ball of the upper arm bone with a rectangular plastic insert and the socket with a metal ball. After this type of surgery your shoulder will depend on the deltoid muscles instead of the rotator cuff to power and position the arm. Both surgeries provide you with a substantial reduction in pain.
You can expect to attend physical therapy after surgery, sometimes even starting 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 they had prior to surgery. You will find that you are able to move your shoulder with greater ease and without pain, making everyday tasks enjoyable again.