The shoulder is a unique joint that, as opposed to other joints in the body like the hip or the knee, can move in a vast arc of motion in nearly all directions. This motion comes at the cost of sprains and strains, as the ligaments and tendons are bearing the majority of forces that are imparted across the joint during activities like throwing a baseball, playing volleyball, or lifting a heavy object.
Shoulder Pain Treatment
Sprains and strains of your rotator cuff and supporting ligaments can result in pain, stiffness, and weakness in the shoulder, and can thereby prevent you from enjoying your favorite sport, activity, or even performing critical activities at work. It is important that any ongoing pain in your shoulder should be evaluated by a shoulder expert who can determine the exact nature of the injury or condition. Thereafter, the appropriate treatments can be prescribed to rehabilitate your ailing shoulder.
Do I Need Shoulder Surgery?
The first step toward solving your shoulder problem is an initial consultation where you will discuss your symptoms with Dr. DeNoble. He will perform a physical examination and, if necessary, X-rays or an MRI. Whenever possible, Dr. DeNoble prefers using non-invasive procedures such as physical therapy, injections, or medical treatments.
When therapy and other nonoperative modalities are not indicated or have not solved the problem, Dr. DeNoble may recommend surgery using the latest minimally invasive arthroscopic techniques. Arthroscopic shoulder surgery avoids traditional large incisions which take longer to heal and typically require disrupting normal muscle attachments to bone in order to access the problem deep in the shoulder.
What Can Shoulder Surgery Treat?
Common shoulder problems that Dr. DeNoble, can treat include:
Common Shoulder Surgeries
Although conservative treatments and rehabilitation are always the first choices for shoulder problems, at times shoulder surgery is necessary to either return function or to eliminate chronic pain. These are the four most common shoulder surgeries we perform at Advanced Orthopedics.
Rotator Cuff Repair
The rotator cuff is the tendon attachment of four small muscles to the top of the arm bone. These muscles and tendons help hold the ball of the bone in the socket. Professional baseball pitchers have made rotator cuff tears famous, but they are common, particularly as we age. They may be the result of an injury such as a fall or a sudden jerking movement. When the rotator cuff has a tear the upper end of the arm bone moves up and hits the roof of the shoulder. This causes impingement and makes it difficult to raise your arm above your head; it can even be hard to simply shake hands.
We use minimally invasive arthroscopic techniques when possible, entering through very small incisions. Small anchors with thread are placed in the bone and the tissue is tied back down to the bone.
The shoulder is a shallow joint, and this allows a greater degree of motion. It also makes the joint less stable. Soft tissue in the shoulder joint makes the socket “deeper” and helps prevent dislocation. If dislocation occurs, the labrum and lining of the shoulder joint is usually torn away from the bone. Once a dislocation has occurred, the shoulder may become looser and prone to further dislocation. At a certain point, the doctor may need to stabilize the joint.
This arthroscopic procedure involves the placement of small anchors into the bone of the shoulder socket. To begin with, we attach thread to these anchors and loop it around the lining of the shoulder joint and the labrum and tie it. This brings the tissue back to the bone, allowing it to heal.
Sometimes a patient has chronic shoulder pain but doesn’t have a torn rotator cuff. Physical therapy, cortisone injections, and pain medications haven’t proven effective. The joint needs to be “cleaned out.”
To do this, we enter arthroscopically through two or three small holes and remove any irritated and inflamed tissue, scar tissue, or bone spurs that may be impinging on healthy tissue.
Osteoarthritis can affect the shoulder. This is the “wear and tear” type of arthritis and over time can cause the protective cartilage in the shoulder to wear down to nothing. As this is occurring, the patient will have flaps of cartilage that catch and cause pain during movement. This can be cleaned out arthroscopically, but once the cartilage is basically gone the only solution is shoulder replacement.
Shoulder replacement can take different forms:
- Resurfacing Hemiarthroplasty: The cap of the ball joint is replaced with a prosthesis and the remaining bone is preserved.
- Stemmed Hemiarthroplasty: Only the ball part of the shoulder joint is replaced with a metal ball and stem.
- Total Shoulder Replacement: The entire ball and socket joint is replaced with metal and plastic, respectively.
- Reverse Total Shoulder Replacement: This method is used if the patient doesn’t have a functioning rotator cuff.
Shoulder Surgery Recovery
Presently, recovery from all shoulder surgeries will involve having your arm in a sling to limit movement for a period of time after your procedure. On the easy end is debridement, where patients are in a sling for two to four weeks. With stabilization, rotator cuff repairs, and replacement, patients will be in a sling for four to six weeks.
Full recovery depends on the type of surgery, the degree of damage, and the patient’s healing capacity. As with all shoulder procedures, physical therapy will be a part of your rehabilitation. With stabilization, most patients can return to full use of the shoulder in three to four months. With rotator cuff repair, typical recovery is four to six months, but the shoulder will continue to improve far longer than that. In replacements, the patient can resume most daily activities in three months, although certain sports. Heavier workouts will need to wait for up to six months.
"I fell and broke my shoulder. I was immediately impressed with how he put me at ease and explained the surgery he hoped to perform with diagrams etc as well as explaining contingencies. He was optimistic and positive in his approach, which instilled a feeling of peace and confidence in me..." Click here to read more patient testimonials.
Shoulder Surgery Risks
As a matter of fact, shoulder surgery is very successful, returning function and eliminating pain. Since the procedures use minimally invasive techniques, the risks of issues such as infection and unusual bleeding are relatively low. Otherwise, the risks with shoulder surgery are the same as with any other surgery.
Shoulder Surgery Alternatives
At Advanced Orthopedics & Hand Surgery, we view surgery as the last option. At first, treat shoulder injuries and chronic pain with physical therapy, cortisone injections, anti-inflammatory medications, and with a change in behaviors causing shoulder strain. But when these treatments don’t solve the problem, surgery is often the only remaining option if the patient wants to have full use of his or her shoulder again.