Shoulder

Shoulder Arthroscopy | Rotator Cuff Repair | Shoulder Surgery

Shoulder Arthroscopy

Arthroscopy is a minimally invasive surgical technique that involves several small incisions into which a fiber-optic device (arthroscope) and tiny surgical instruments are inserted. Orthopedic surgeons can diagnose and treat many different shoulder conditions with arthroscopy, while patients can benefit from less tissue damage, shorter recovery times, less scarring and less post-operative pain. This technique also avoids cutting any muscles or tendons in order to gain access to the affected area.

Shoulder arthroscopy is often performed to confirm a diagnosis after a physical examination and other imaging procedures have been performed. Some conditions can also be treated during the same procedure by inserting a few additional instruments into the joint area.

Arthroscopy can be used to treat many conditions that affect the shoulder joint. Shoulder arthroscopy, also known as shoulder scope, can be used to treat:

  • Rotator cuff tears
  • Labral tears
  • Impingement syndrome
  • Biceps tendonitis
  • AC joint arthritis

Labral Tear

The socket of the shoulder, or glenoid, is covered with a layer of cartilage called the labrum that cushions and deepens the socket to help stabilize the joint. Traumatic injuries and repetitive overhead shoulder movements can tear the labrum, leading to pain, limited motion, instability and weakness in the joint.

Symptoms of a labral injury can include shoulder pain and a popping or clicking sensation when the shoulder is moved, as well as rotator cuff weakness. One of the most common labral injuries is called a SLAP lesion, a tear where the biceps tendon meets the glenoid. Another kind of labral injury is a Bankart lesion, where the labrum pulls off the front of the socket. This happens most often when the shoulder dislocates. If a Bankart tear doesn’t heal properly, it can facilitate future dislocations, instability, weakness and pain.

Rotator Cuff Repair

The rotator cuff is a group of tendons and muscles that support the shoulder joint and allow for complete movement while keeping the ball of the arm bone in the shoulder socket. These tendons and muscles may become torn or otherwise damaged from injury or overuse and can lead to pain, weakness and inflammation. Surgery may be used to treat this often serious condition.

Rotator cuff surgery may be performed laparoscopically or through an open procedure, depending on the type and severity of the condition. Both procedures are performed under general anesthesia and aim to reattach the tendon back to the arm, along with removing any loose fragments from the shoulder area.

Rotator cuff repair surgery is usually successful in relieving shoulder pain, although full strength cannot always be restored. Recovery time depends on the type of surgery, but can take several months. As with any surgery, there are certain risks involved with rotator cuff repair such as infection, pain or stiffness, nerve damage or the need for repeated surgery. These complications are rare and most people receive successful outcomes from this procedure.

Shoulder Separation

A separated shoulder is a common injury that most often affects athletes in contact sports. This injury to the acromioclavicular (AC) joint is usually the result of a fall on an outstretched hand (FOOSH), severe lateral sheering-force, or a fall on the tip of the shoulder. It is important to note that this is not the same as a shoulder dislocation: a dislocation (subluxation) of the shoulder occurs exclusively in the glenohumeral joint.

Types of Shoulder Separation

Shoulder separation injuries are classified according to their severity, with type I being the most benign and type VI being the most severe. Type I injuries consist of general trauma to the AC ligaments with no serious tears or fractures. A type II injury is tougher, as it must involve a completely severed AC ligament in addition to an acutely traumatized coracoclavicular ligament.

Type III injuries are composed of fully severed AC and coracoclavicular ligaments and formation of a permanent bump on the clavicle. The most severe types require the same makeup as a type III injury, but with additional displacement of the clavicle into various soft tissues surrounding the area.

Typically, types IV through VI all require surgery but there is controversy as to whether a type III injury would benefit significantly from surgery. Recently, it has been recommended to consider surgery as a preemptive measure against future arthritis concerns.

Treatment

Treatment and recovery varies greatly between the classes of shoulder separation, from a few weeks of bed rest with anti-inflammatory drugs to arthroscopic surgery requiring months of physical rehabilitation.

The Weaver-Dunn Procedure is the most frequently used surgical technique for the repair of shoulder separation. This procedure allows stability in the joint to be maintained effectively by attaching the acromial end of the coracoclavicular ligament to the displaced clavicle bone, while replacing the aforementioned ligament with alternative connective apparatus or tissue.

Shoulder Dislocation

The shoulder is a “ball-and-socket” joint where the “ball” is the rounded top of the arm bone (humerus) and the “socket” is the cup (glenoid) of the shoulder blade. A layer of cartilage called the labrum cushions and deepens the socket. A dislocation occurs when the humerus pops out of its socket, either partially or completely. As the body’s most mobile joint, able to move in many directions, the shoulder is most vulnerable to dislocation.

Dislocation causes pain and unsteadiness in the shoulder. Other symptoms may include swelling, numbness, weakness and bruising. The majority of dislocations occur when the humerus slips forward, a condition called anterior instability. This may happen during a throwing motion. The humerus is also capable of dislocating backwards or downwards. In most cases, the dislocated shoulder can be manipulated back into place by a doctor in a process known as closed reduction.

Complications of shoulder dislocation or reduction can include a labrum or cartilage tear, a lesion on the glenoid bone after the humerus strikes it, tendon or ligament injuries, and blood vessel and nerve damage. Shoulders that have dislocated once are more likely to dislocate in the future, potentially resulting in chronic shoulder instability and weakness.

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