Shoulder Surgical Procedures
What Are Shoulder Surgical Procedures?
There are several surgeries commonly recommended by your orthopedic specialist.
When shoulder surgery is prescribed, the surgical procedures used by physicians are intended to provide more room for the rotator cuff tendons.
In this procedure, called subacromial decompression, the bone spurs that the tendon rubs against are simply removed, thereby creating more room for the tendon to glide normally.
This type of surgery is referred to as an acromioplasty. Simultaneously, the lubricating sack located between the rotator cuff and the underside of the acromion (bursa) that has been inflamed by the impingement process, is also removed.
Biceps tenodesis describes the surgical procedure that is usually performed for the treatment of biceps tendonitis of the shoulder. The biceps tendon passes through the shoulder joint and attaches to the labrum. When this attachment is torn, it is a so-called SLAP tear of the shoulder.
Individuals with biceps tendon problems may have developed a SLAP tear or irritation and inflammation of the biceps tendon itself.
During a biceps tenodesis procedure the surgeon cuts the attachment of the biceps tendon to the labrum and then reattaches it to the humerus bone. By performing a biceps tenodesis, the pressure is thereby removed from the labrum or biceps tendon in the shoulder and a portion of the biceps tendon can then be surgically removed.
If pain and disability of the shoulder persist, despite nonoperative treatment, surgery may be considered. Surgery for bursitis or impingement surgery called a “subacromial decompression” involves removal of the inflamed bursal tissue over the rotator cuff and shaving of the acromion bone which can narrow the space above the rotator cuff. A partial rotator cuff tear may only require a trimming or smoothing procedure called a “debridement. However, if the tendon is completely torn away from its insertion on the humerus bone, it can be repaired directly to the bone.
Most surgical procedures can be performed on an outpatient basis. The surgical procedure in the majority of cases involves minimally invasive shoulder arthroscopy. Through the use of a tiny fiber optic scope and other small instruments inserted through small incisions, your physician can perform the bony shaving and tendon “debridement” under video control. This eliminates the need for a large, open incision.
Broken Collar Bone Surgery
Surgery is indicated in young, active patients with severe displacement or shortening of the collarbone. Recent studies indicate that surgery is preferred over non-operative treatment if the fracture is severely displaced or the skin is broken.
Biceps Tendon Rupture Surgery
When the rupture occurs at the distal biceps tendon on the elbow, where there is only one attachment, then surgical repair is often recommended.
If pain persists after a proximal biceps tendon rupture, other possible causes of shoulder pain should be considered. These may include rotator cuff tears, impingement syndrome, or fractures around the shoulder.
Surgery to repair the torn labrum is sometimes necessary. The purpose of the surgery is to reattach the torn labrum to the socket of the shoulder. Large labral tears that are the result of trauma generally need to be fixed in surgery. The success rate of this surgery is quite good, with over 90 percent of patients returning to their normal activities without any further dislocations.
In many cases, this surgery is performed arthroscopically; however, there are some individuals who should have a Bankart (labral) repair performed through an open incision.
With a small labral tear, the patient may be directed to avoid vigorous activities that cause shoulder pain, rather than undergo surgery.
Rotator Cuff Surgery
Unfortunately tears of the rotator cuff have little ability to heal themselves. If a patient does not respond to nonoperative treatment, your sports medicine physician may then prescribe surgery.
Surgery may also be an option if the tear is acute and extremely painful, if it is the dominant arm of an athlete or worker, or if maximum strength is needed for daily occupational activities.
Early surgery is indicated if the tear was caused by a significant injury and is associated with weakness or inability to raise the arm.
The type of surgery performed depends on the shape, size, and location of the tear. In cases of tendonitis, surgery, which is termed “subacromial decompression”, involves removal of the inflamed bursal tissue over the rotator cuff and shaving of the acromion bone which can narrow the space above the rotator cuff.
A partial tear may only require a trimming or smoothing procedure called a “debridement.”
A complete tear that occurs within the substance of the tendon is repaired by stitching the two sides of the tendon. However, if the tendon is completely torn away from its insertion on the humerus bone, it can be repaired directly to the bone.
Most surgical procedures can be performed on an outpatient basis. There are three general approaches available for surgical repair:
Arthroscopic Repair– Through the use of a tiny fiber optic scope and other small instruments inserted through small puncture wounds, your physician can repair the damaged tendon under video control. This eliminates the need for a large, open incision.
Mini-Open Repair– Advanced instrumentation and techniques now allow orthopaedic surgeons to perform complete rotator cuff repair procedures through a four to six centimeter incision.
Open Surgical Repair– If the rotator cuff tear is large or complex or if additional reconstruction (such as a tendon transfer) has to be performed, then a traditional open surgical incision is required. In some extreme cases, where arthritis has developed, shoulder replacement surgery may be required.
Arthroscopic rotator cuff repairs cause minimal trauma to the tissues that surround the shoulder and the rotator cuff. This leads to patients having smaller scars and less damage to these nearby structures.
Most important of these surrounding structures is the large deltoid muscle over the outside of the shoulder. One potential complication of an open rotator cuff repair is detachment of the deltoid.
This potential problem is avoided by the arthroscopic technique.
Shoulder Separation Surgery
Some surgeons prefer to repair severe grade three AC separations, especially in high-level throwing athletes. The surgery is usually done through a four inch incision over the AC joint.
The surgeon starts by putting the joint into its correct position. A screw or some other type of fixation may be used to hold the clavicle in place while the ligaments heal. The procedure can sometimes be done arthroscopically.
To fix the joint using a screw, the surgeon inserts the screw through the top of the clavicle and into the coracoid process. When a screw is used, it is usually removed six to eight weeks after the surgery. If it is not removed, the screw may break.
Some surgeons use surgical tape to connect the clavicle and coracoid. A small drill hole is made in the clavicle and corocoid. The surgical tape is looped through each hole and pulled snugly.
In some cases, sutures are also used to repair and reinforce the torn coracoclavicular ligaments.
Shoulder Replacement Procedure
Shoulder replacements are usually performed to relieve pain. The most common type of shoulder replacement involves replacing the damaged bone and cartilage with a highly polished metal ball attached to a stem and a plastic socket.
Much like the hip joint, the shoulder is basically a ball-and-socket joint. The ball is the top of the humerus (arm bone) and the socket is within the scapula (shoulder blade). The design of this joint allows individuals a great range of motion at the shoulder.
During shoulder replacement surgery, the ball is removed from the top of the arm bone and then replaced with the metal implant. This implant is shaped like a half-moon and is attached to a stem that is inserted down the center of the arm bone. The socket portion of the joint is then shaved clean and replaced with the plastic socket that is cemented into the shoulder blade.
The type of surgery performed depends on the pathology. However, commonly performed procedures in the throwing elbow include: medial collateral ligament reconstruction (Tommy John procedure) and arthroscopic debridement.
Commonly performed shoulder procedures include arthroscopic posterior capsular contracture release, labral repair, and rotator cuff repair.
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