Should you consider Orthopedic Shoulder Surgery?

 

Your shoulder joint is the most flexible joint in your body. It allows you to place and rotate your arm in many positions in front, above, to the side, and behind your body. This flexibility also makes your shoulder susceptible to instability and injury.

Depending on the nature of the problem, nonsurgical methods of treatment often are recommended before surgery. However, in some instances, delaying the surgical repair of a shoulder can increase the likelihood that the problem will be more difficult to treat later. If you are experiencing pain in your shoulder, you should contact one of the orthopedic specialists at Dallas Orthopedic Institute, because early, correct diagnosis and treatment of shoulder problems can make a significant difference in the long run.

Types of Surgical Procedures

Arthroscopy

Arthroscopy allows the orthopedic surgeon to insert a pencil-thin device with a small lens and lighting system into tiny incisions to look inside the joint. The images inside the joint are relayed to a TV monitor, allowing the doctor to make a diagnosis. Other surgical instruments can be inserted to make repairs, based on what is with the arthroscope. Arthroscopy often can be done on an outpatient basis.

 

What conditions can be treated with arthroscopic shoulder surgery?

Rotator Cuff Tears

Treatment of rotator cuff tears with shoulder arthroscopy is controversial. Some orthopedic surgeons treat all rotator cuff tears arthroscopically, some choose particular tears, and others treat them all open. There is no consensus which one is better. For more information, consult an orthopedic specialist and have them advise you on both the pros and cons to shoulder arthroscopy for rotator cuff tears.

Shoulder Instability - Labral Tears - Slap Lesions

Labral tears, such as Bankart lesions and SLAP tears, are commonly treated with arthroscopy. It is very important that patients who have arthroscopic surgery for these procedures follow their post-operative rehab protocol very closely. Patients are often tempted to do too much too soon!

Impingement Syndrome

Patients with impingement syndrome that is not cured with conservative treatments may consider a procedure called an arthroscopic subacromial decompression. This procedure removes the inflamed bursa and some bone from the irritated area around the rotator cuff tendons. By removing this tissue, more space is created for the tendons and the inflammation often subsides.

Biceps Tendonitis

The biceps tendon can become irritated and inflamed as an isolated problem or in association with problems such as impingement syndrome and rotator cuff tears. When the biceps tendon is damaged and causing pain, a procedure called a biceps tenodesis can be performed. This procedure usually causes no functional difference, but often relieves symptoms.

Frozen Shoulder

Frozen shoulder seldom requires operative treatment, and treatment for many months or years is often necessary before considering operative treatment. When frozen shoulder must be treated surgically, it is of utmost importance to begin aggressive physical therapy immediately following surgery. Without this, it is likely the problem will return.

AC Joint Arthritis

The AC joint, or acromioclavicular joint, is occasionally affected by arthritis. When arthritis of the AC joint is severe, the end of the clavicle (collarbone) can be removed. By removing the damaged joint, the symptoms of AC arthritis are often relieved.

Open Surgery

 

Open surgery may be necessary and, in some cases, may be associated with better results than arthroscopy. Open surgery often can be done through small incisions of just a few inches.

Recovery and rehabilitation is related to the type of surgery performed inside the shoulder, rather than whether there was an arthroscopic or open surgical procedure.

Possible Complications After Surgery

There are always some risks with any surgery, even arthroscopic procedures. These include possible infection, and damage to surrounding nerves and blood vessels. However, modern surgical techniques and close monitoring have significantly minimized the occurrence of these problems.

After surgery, some pain, tenderness, and stiffness are normal. You should be alert for certain signs and symptoms that may suggest the development of complications.

• Fever after the second day following surgery
• Increasing pain or swelling
• Redness, warmth, or tenderness which may suggest a wound infection
• Unusual bleeding (some surgical wound drainage is normal and, in fact, desirable)
• Numbness or tingling of the arm or hand

Shoulder Replacement Surgery

 

If non-operative treatments fail, shoulder replacement surgery may be needed. Shoulder replacements are usually done to relieve pain.

 

There are several different types of shoulder replacements. The usual total shoulder replacement involves replacing the arthritic joint surfaces with a highly polished metal ball attached to a stem, and a plastic socket.

The components come in various sizes. If the bone is of good quality, your surgeon may choose to use a non-cemented or press-fit humeral component. If the bone is soft, the humeral component may be implanted with bone cement. In most cases, an all-plastic glenoid component is implanted with bone cement. Implantation of a glenoid component is not advised if:

• The glenoid has good cartilage.
• The glenoid bone is severely deficient.
• The rotator cuff tendons are irreparably torn.

Patients with bone-on-bone osteoarthritis and intact rotator cuff tendons are generally good candidates for conventional total shoulder replacement.

Depending on the condition of the shoulder, your surgeon may replace only the ball. Sometimes, this decision is made in the operating room at the time of the surgery. Some surgeons replace the ball when it is severely fractured and the socket is normal.

 

Another type of shoulder replacement is called reverse total shoulder replacement. This surgery was developed in Europe in the 1980s. It was approved by the Food and Drug Administration (FDA) for use in the United States in 2004. Reverse total shoulder replacement is used for people who have (a) completely torn rotator cuff and (b) the effects of severe arthritis, cuff tear arthropathy, or (c) had previous shoulder replacement that failed.
 

For these individuals, a conventional total shoulder replacement can still leave them with pain. They may also be unable to lift their arm up past a 90-degree angle. Not being unable to lift one's arm away from the side can be severely debilitating. In reverse total shoulder replacement, the socket and metal ball are switched. That means a metal ball is attached to the shoulder bone and a plastic socket is attached to the upper arm bone. This allows the patient to use the deltoid muscle instead of the torn rotator cuff to lift the arm.

Shoulder replacement surgery is highly technical. It should be performed by a surgical team with experience in this procedure. Each case is individual. Your surgeon will evaluate your situation carefully before making any decisions. Do not hesitate to ask what type of implant will be used in your situation. Ask why that choice is right for you.

Before surgery, patients see their internist or family practice physician for a preoperative medical evaluation. Cardiac patients should see their cardiologist as well. Two weeks before surgery, you should stop taking the following medications that thin the blood and can lead to excessive bleeding during surgery:

Non-steroidal anti-inflammatory medications (aspirin and ibuprofen such as Motrin and Advil)
Most arthritis medications

The surgery is performed on an inpatient basis. Most patients are discharged from the hospital on the second or third day after the operation.

 

If you are suffering from shoulder or joint pain, please contact our office immediately to schedule an evaluation.

 

Dallas Orthopedics Institute
 9330 Poppy Drive
Dallas , TX 75218