The shoulder is a remarkably flexible joint that is supported by substantial
muscular strength in most directions, but over time inside and outside
of that joint is susceptible to wear, which often leads to persistent,
chronic pain.
Sauk Prairie Healthcare Orthopedic surgeons specialize in finding solutions to joint pain, including shoulder surgery.
Treatment options range from non-invasive solutions to arthroscopy and
in many cases total shoulder replacement or total reverse shoulder replacement.
Anatomy of the Shoulder
The shoulder is made up of three separate joints and layers of tissue holding
those bones in place.
The glenohumeral joint is what many think of as the shoulder: the meeting
of the ball at the top of the upper arm, or humerus, with the glenoid,
the socket of the scapula, widely known as the shoulder bone. The acromioclavicular
joint, or AC joint, connects the clavicle, or collar bone, and the scapula.
The scapulothoracic joint is not a true joint, but is made up of the shoulder
blade meeting the rib cage in a “sliding joint” over the back
of several the ribs.
The shoulder is powered and held together by several groups of muscles
and tissue. The outside part of the shoulder is made up of the large muscles
of the deltoid, trapezius, and pectoralis. The middle layer is made up
of the rotator cuff, which includes four small muscles surrounding the
glenohumeral joint, keeping the “ball” of the joint in place.
The inside layer of tissue is made up of ligaments between the humerus
and the glenoid to keep the joint from dislocating.
Rotator Cuff Tear
One of the most common surgical procedures in the United States is rotator
cuff repair. When the rotator cuff tendon connecting the shoulder to the
humerus is torn, by long-term wear or a sudden injury like a fall, it
is often necessary to surgically repair the tissue or even reattach it
to the bone.
A partial tendon tear can often be treated by non-invasive methods, such
as rest, icing and physical therapy. If shoulder pain and limited joint
mobility continue to be a problem after about six months and despite conservative
treatment, your Sports Medicine doctor may refer you to an Orthopedic surgeon.
If the cause of your shoulder pain is a partial tear of the rotator cuff
tendon, your Orthopedic surgeon may recommend an arthroscopic procedure
to repair the tissue. During arthroscopic rotator cuff surgery, the patient
will be given general anesthetic and “put to sleep” during
the surgery, or given a nerve blocker.
Small incisions are made on either side of the shoulder and an endoscope,
a small pencil-sized camera, is inserted in one side so the surgeon can
view the joint on an attached monitor. Tiny surgical tools are inserted
through the other incision, which the surgeon uses to trim and smooth
tissue, otherwise called debridement, remove bone spurs, and stitch the
tendon together at the site of the injury.
In the event of a complete tear, separating the tendon from the bone, anchors
are drilled into the top of the humerus bone and used to stitch the tendon
back into place.
If the injury requires a more complicated procedure, open surgery may be
necessary, though arthroscopic surgery is far more common. Arthroscopic
treatment allows for smaller incisions, less muscular damage and faster
healing time.
Although post-operative infection is rare in either case, infection is
even less likely following minimally invasive arthroscopic procedures.
The surgery can often be performed on an outpatient basis, with the patient
returning home the same day. Recovery includes several weeks of the shoulder
being immobilized with movement slowly reintroduced, first by passive
exercise, guided by a physical therapist, leading to active exercise,
building arm strength and control.
Recovery times and experiences vary from person to person, though progress
often depends greatly on a person’s consistency following through
with recommended physical therapy and at-home exercises.
Shoulder Arthritis
Shoulder arthritis is less common than arthritis in the hip or knee, but
the shoulder can be prone to several kinds of chronic joint pain.
Rheumatoid arthritis is an autoimmune disease, which causes the body’s
immune system to attack the synovium, or soft tissue that lines the joints.
This causes swelling, resulting in pain and stiffness in the joint.
Posttraumatic arthritis is a long-term condition caused by an acute injury
that damages the cartilage and other tissue around the joint, causing
an increase in friction and degradation of the tissue and then the bone.
Avascular necrosis is weakness and decay in the bone caused by a lack of
blood flow to the area. This can be caused by steroid use, alcoholism,
sickle cell disease, or a traumatic injury that interrupts blood vessels
in the area.
The most common form of shoulder arthritis is osteoarthritis, or degenerative
joint disease, known as wear-and-tear arthritis. Symptoms of osteoarthritis include:
Loss of strength
Loss of mobility
Crepitus, or a crackling sound with movement
Joint enlargement
Pain in the form of a deep ache at the back of the shoulder
When the AC joint is affected, pain on top of the shoulder radiating up
the side of the neck
Arthritis is a degenerative condition and cannot be reversed or cured,
but a range of options are available for treatment. Your Orthopedic surgeon
will often begin treatment recommending or finding out if you have already
tried non-invasive treatment, which can include change in activity, physical
therapy, and non-steroid anti-inflammatory medication such as ibuprofen.
Arthritis symptoms can be treated with minimally invasive arthroscopic
surgery, in which tiny tools are guided by a pencil-sized camera fed through
a tube, with images coming through to a monitor that the surgeon will
view during the procedure. During the operation the surgeon removes frayed
cartilage, bone spurs, and loose bone and tissue, which can get in the
way of smooth motion of the joint.
Late and end-stage arthritis is often treated through arthroplasty, or
shoulder replacement surgery, which can be performed in several variations such as the traditional
shoulder replacement, reverse arthroplasty, or hemi-arthroplasty.
Recurrent Shoulder Dislocation
When a young person is treated for a dislocated shoulder, the first priority
is getting the shoulder back into its socket, but this is often followed
by discussion of possible treatment to prevent
recurrent shoulder dislocation.
Shoulder dislocations are an unusual case in which a younger patient is
likely to be a more suitable candidate for joint repair surgery than an
older patient. The reason for this is that a younger person, like a teenage
athlete who has suffered a dislocated shoulder, is more likely to have
the injury repeated in the future, causing other chronic injuries, as
compared to someone who is in their 30s seeing a doctor for a shoulder
dislocation for the first time.
Studies have also shown a trend of earlier surgical intervention proving
to be more economical and more effective in the long run. While a common
approach to shoulder dislocation treatment in young people is to treat
the first instance as a stand-alone case and wait to see if a second dislocation
marks a need for further discussion, some Orthopedic surgeons have made
the case for pursuing surgical repair after the first dislocation.
Chronic shoulder instability is often accompanied by symptoms such as:
Feeling of looseness in the joint
A “dead arm” sensation
Among athletes, issues of not being able to throw objects as far, fast
or accurately as before their shoulder injury
A common shoulder repair is arthroscopic stabilization, or Bankart repair,
also called arthroscopic labral repair. In this procedure an Orthopedic
surgeon, using arthroscopic tools, installs about three or four anchors
in the bone, which are used to fix the damaged labral tissue in place,
supporting the shoulder joint.
If there is bone injury, soft tissue repair may not be enough to keep the
joint in place. Given the large surface area of the ball of the upper
arm compared to the cup of the shoulder joint, the arrangement is often
compared to a golf ball and a tee.
When there is damage to the edge of the tee, or the joint, the ball will
no longer reliably stay centered in place. During a Latarjet shoulder
stabilization procedure, the Orthopedic surgeon will cut a piece of shoulder
bone with muscle from the coracoid process, grafting it to the broken
part of the glenohumeral joint, and giving extra support by the movement
of muscle tissue.
Shoulder surgery is often preceded by physical therapy to prepare the shoulder
for repair, with therapy continuing after the procedure and initial recovery
period. Patients are usually able to return to full activity, but should
avoid contact sports for about six months.
Post-operative shoulder dislocation remains a possibility, but reduces
from a recurrent issue to only reappearing in approximately 10% to 15%
of patients.
After a full recovery over 90% of athletes are able to return to full activity,
though some are unable to return to the same level of play as before their injury.
In some cases of repeated shoulder dislocation involving chronic joint
injury, arthroplasty, or joint replacement surgery, may be appropriate.
Reverse shoulder replacement surgery is a technique that has been specifically
developed to treat those with a combination of joint damage and rotator
cuff injury.
Appropriate treatment of shoulder instability can vary greatly, as in the
case of some youth who are able to dislocate joints and pop them back
into place without any pain. Although many doctors would not recommend
they make a habit of that kind of “party trick,” it is often
evidence of naturally loose joints more than a serious condition, and
in some cases can be attributed to an athletic edge in certain sports
like swimming or gymnastics.
How Sauk Prairie Healthcare Treats Shoulder Injuries
The shoulder treatment experts at Sauk Prairie Healthcare can offer a range
of solutions for acute and chronic pain relief.
In the case of more significant joint injuries, your doctor might refer
you to an Orthopedic surgeon to discuss options in ligament repair or
reconstructive surgery. When chronic pain is returning despite conservative
treatment options, a surgeon may recommend arthroscopic treatment as a
long-term solution in the way of a minimally invasive surgical procedure.
Where other treatments are not appropriate or have been tried and exhausted,
partial or total joint replacement may be a solution for long-term pain
relief. If the rotator cuff has been so damaged that it cannot stabilize
a joint replacement, a reverse total joint replacement may be an option.
Orthopedic Surgery, OrthopedicsView Profile
