 Shoulder
Surgery
The Shoulder
The shoulder joint has a wider range of movement than any other joint in the body. It consists
of three bones: the scapula; the humerus; and the clavicle. The scapula or shoulder blade
is the large triangular bone located on the backside of the upper body The humerus is also
known as the upper arm bone. The clavicle or collarbone attaches the shoulder to the rib
cage and holds the shoulder out from the body.
Several ligaments stabilise the shoulder joint, whilst other soft tissue helps the joint
to move and flex easily. The rotator cuff is a complex of four tendons that connect the
upper arm with the shoulder blade. It holds the head of the upper arm firmly into the shoulder
socket when moving. The tendons connect the muscles with the bone, which moves when the
muscles pull on the bone. The bursa is a pocket of lubricating fluid, which allows muscles
to move freely over each other. It is located under the collarbone, between the rotator
cuff muscles and the larger surrounding muscles.
Symptoms
In the early stages of shoulder problems, pain is often experienced in the entire shoulder.
As the shoulder causes discomfort with every movement, sleeping problems are likely. It
is common to experience pain when reaching behind, for example, for one’s back pocket
or trying to reach for something on the back seat of the car. The longer the pain is there,
the more likely it is that stiffness in the entire shoulder occurs, eventually preventing
normal lifting or normal mobility of the arm.
Diagnosis and Treatment
The surgeon will conduct a physical examination and may order X-rays, CT Scans or even an
MRI to determin the exact cause of the problem. It may be necessary to perfom a shoulder
arthoscopy to ascertain teh extent of damage or to locate the problem.
Initial treatment may be a course of physiotherapy or cortizone injections
to promote natural healing. the surgeon may suggest taht the arm is imobilised in a sling
so as to allow the damaged tendons and ligaments to heal. If the damage is considered to
bad or the above methods fail to improve the condition then surgery may be considered.
Types of Shoulder Surgery
Shoulder surgery can be used for a number of treatments:
- Arthroscopic acromioplasty
- This is an arthroscopic proceedure to widen the space
between the upper arm and the shoulder blade so that the rotator cuff tendons do not get
stuck between them.
Arthroscopy with shoulder instability - In case of dislocation of the shoulder, it is
normal to have an arthroscopy. It is often possible to
repair damage to the shoulder but sometimes a separate operation is needed.
- Rotator Cuff Repair
- Arthroscopic repair of the shoulder tendons. The goal
of these procedures is to minimize the pain, restore strength and functionality.
- Total
Shoulder Replacement - Shoulder arthroplasty - With loss of cartelage
the patient will suffer severe shoulder arthritis. This is quite painful, and can cause
restriction of motion eventualy surgical treatment is necessary.
Shoulder Arthroscopy
After an anesthetic has been administered, your surgeon and the operating
room staff will then make sure that you are correctly position on the operating table. For
some shoulder surgeries you will be placed in the "beach chair" position, as if
you are reclining on a beach chair.
Other types of shoulder surgery require that you lie on your side and have
your arm in traction. This position is becoming more popular and is now quite
common for arthroscopic rotator cuff repairs.
Once you are in the correct position on the operating table your arm will be cleaned with
special surgical soaps and the draped off from the rest of your body with sterile surgical
drapes. Some of the surgical soaps that are used today create a film that adheres to the
skin very well and does not wash off easily. It can often take days for this type of soap
to wash off completely, but don't worry, it does not stain the skin permanently. After the
shoulder has been "prepped and draped", the surgeon is then ready to begin the
procedure.
Shoulder arthroscopy is performed through "portals".
These are small incisions, generally about 10cm long are located over particular areas of
the joint that the orthopedic surgeon will need to operate upon. Small plastic tubes, called
"cannulas" are then inserted into the portals so that instruments can easily be
placed in the shoulder joint. Shoulder arthroscopy itself
involves inserting a specially designed video camera with a very bright fiber optic light
source into the shoulder joint so that the important parts of the joint can be seen. Instruments
that have been specially designed to remove inflamed tissue, attach sutures to bone, and
repair tears and damaged tendons are then used to operate inside the shoulder.
Once the procedure is finished, the instruments, camera, and cannulas are remved, the wounds
are closed with either suture or staples, and a sterile dressing is applied to the shoulder.
The shoulder is then placed in a sling or immobilizer, the patient is moved from the operating
table to a hospital bed, and then wheeled back to the recovery room.
Recovery from Shoulder Arthroscopy?
In most cases, it will be possible to do light work within a few days. Most normal activities
can be carried out within four to six weeks. Heavy labour and contact sports may be restricted
for as long as six months. After surgery you will need to wear an arm sling for a few days.
Full recovery from shoulder surgery typically needs a great deal of intensive physiotherapy.
You will need to ask a Physiotherapist about setting a coarse of treatment for you.
Typical Scenario
- Day 1 – arrival and MRSA test
- Day 2 – consultation + preoperative x-rays, Ct Scans + blood
tests
- Day 3 – Admission to hospital + surgery (+ possible overnight
depending on procedure)
- Day 4 - Day In hospital (depending on procedure)
- Day 8 – Post-operative check and departure
Rotator Cuff Tear
The most common symptoms of rotator cuff tears are:
- Pain - Often the pain is felt over the outside of the shoulder and
upper arm. Pain while performing overhead activities (with the arm above head height)
and pain at night are also quite common. When the condition is more severe, the pain may
awaken patients from sleep.
- Decreased strength - Strength of the rotator cuff tendons can be tested
by your doctor. By isolating the different tendons of the rotator cuff with special tests,
your doctor can determine the extent of the tear. Depending on the severity of the rotator
cuff tear, there may also be a loss of motion. Significant rotator cuff tears may affect
a patients ability to raise up their arm over their head.
- Loss of Mobility- Patients often have difficulty performing activities
such as combing their hair, clasping a bra behind their back, reaching behind their back,
or sleeping on the affected shoulder.
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Diagnosis of Rotator Cuff
As well as a physical diagnosis the follwing diagnostic tools can be used:
- X-rays of the shoulder will be obtained if there is
a concern of a rotator cuff tear. The surgeon will look for signs of a rotator cuff tear,
although the rotator cuff tear itself cannot be seen on a regular x-ray. Signs of a problem
within the rotator cuff include a narrowing of the space for the rotator cuff and bone
spurs around the rotator cuff tendons.
- MRI - is helpful because it can show both complete
rotator cuff tears and partial rotator cuff tears. The MRI can also show evidence of shoulder
bursitis and other common shoulder problems.
- Arthrogram - once was the most commonly used test
to diagnose a rotator cuff tear. In this study a dye (contrast dye) that shows up on x-ray
is injected into the shoulder joint. An intact rotator cuff should contain the dye within
the joint, while a rotator cuff tear will allow the dye to leak into surrounding tissues.
By taking an x-ray after an injection, your doctor can see evidence of a rotator cuff
tear.
- Ultrasound - operated by a skilled technician, can
be as effective detecting a rotator cuff tear as these other methods. Depending on your
doctor's preference, you may undergo an ultrasound study to diagnose a rotator cuff tear.
Rotator Cuff Treatment
The first steps of rotator cuff treatment include:
- Physiotherapy - is the most important step in the treatment of a rotator
cuff injury. Strengthening the rotator cuff muscles is important to maintain normal shoulder
function. A physotherapist can show you exercises to help alleviate and prevent a recurrence
of your shoulder pain.
- Anti-Inflammatory Medications - anti-inflammatory medications can be
taken regularly for a short period, and can be used to alleviate pain and when symptoms
of a rotator cuff tear flare up.
- Cortisone Injections - Cortisone injections promote rapid healing
and can limit the acute inflammatory process, allowing the patient to begin therapy. It
is important to participate in the therapy and exercises even if the shoulder feels better
after an injection. Physiotherapy will help prevent a recurrence of symptoms. This may
help to relieve pain and strengthen the muscles around the joint.
If conventional treatments
dont work?
Physiotherapy is first attempted, especially in older patients or in patients who have chronic
long-term injuries. In younger patients who have an acute, traumatic injury surgery is considered
early on as there is less likelihood that physiotherapy will help. Where non surgical treatment
have failed then surgery must be considered.
Rotator Cuff Surgery
This is an arthroscopic procedure and takes place in a theatre
under full anaesthesia. The surgery takes no more than 1 hour after which the patient is
returned to the recovery area. shortly afterwoods the patient will be returned to their
room.
Total stay in hospital is 5 days, after surgery you will need to wear an arm sling for a
few days. Full recovery from shoulder surgery typically needs a great deal of intensive
physiotherapy. You will need to ask a Physiotherapist or sports traumatologist about setting
a coarse of treatment for you.
Rotator cuff injuries heal slowly as the rotator cuff, like all tendons, gets little blood.
All bodily tissues need blood to heal. Parts of the body that have a better blood supply
heal faster than those with a poor supply of blood.
Total Shoulder Replacement
Shoulder replacement surgery is an option for treatment of severe arthritis of the shoulder
joint. Arthritis is a condition that affects the cartilage of the joints. As the cartilage
lining wears away, the protective lining between the bones is lost--when this happens, painful
bone-on-bone arthritis develops. Severe shoulder arthritis is quite painful, and can cause
restriction of motion. While this may be tolerated with some medications and lifestyle adjustments,
there may come a time when surgical treatment is necessary.
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Indications
for a Total Shoulder Replacement
Indications for a total shoulder replacement may include:
- Arthrosis - A shoulder prosthesis or full shoulder replacement may
be indicated when elasticity of the bones has gradually disappeared; or the smooth surface
has become rugged and uneven, and so mobility is greatly reduced and movement itself is
painful. Also, when there is a history of bone fractures or dislocation.
- Rheumatism - Rheumatism is a cause of deterioration of shoulder cartilage.
Even at a young age, this can lead to destruction of the joint and provoke bad shoulder
function leading to the requirement of a shoulder replacement.
- Fractures - Certain types of fractures can lead to damage of small
blood vessels in the shoulder joint. Because of the disruption of the blood flow in the
shoulder, the shoulder is slowly damaged.
- Avascular Necrosis - Avascular Necrosis is developed due to insufficient
blood flow to the bone. The bone becomes exceptionally soft and weak, which can lead to
deformation. In these cases a full shoulder replacement is the best solution.
An
Artifical Shoulder joint
Symptoms of severe arthritis
of the shoulder
| Common symptoms of shoulder arthritis
include:
- Stiffness of the shoulder
- Tenderness around the joint
- A feeling of grinding or catching within the joint
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Worn
Shoulder Joint |
What is a Total Shoulder
Replacement?
Total shoulder replacement surgery replaces damaged bone and cartilage with a metal and
plastic implant. The shoulder joint is a ball-and-socket joint, much like the hip joint.
The ball is the top of the arm bone (the humerus), and the socket is within the shoulder
blade (scapula). This joint allows people an enormous range of motion at the shoulder.
When shoulder replacement surgery is performed, the ball is removed from the top of the
humerus and replaced with a metal implant. This is shaped like a half-moon and attached
to a stem inserted down the center of the arm bone. The socket portion of the joint is shaved
clean and replaced with a plastic socket that is cemented into the scapula.
What is Total Shoulder
Replacement Surgery Like?
Shoulder replacement surgery lasts about two hours and is carried out under general anesthesia.
The incision for the surgery is along the front of the shoulder joint and usually about
four to six inches long.
The total stay in hospital is 9 days, some physiotherapy is provided, however the patient
may need further physiotherapy on their return home.
After Total Shoulder Replacement
Surgery
You will need to wear an arm sling for a few days. You should not attempt to use the arm
except as specifically instructed by your doctor. Most physicians will begin some light
physiotherapy immediately following surgery, but this may not be true in every case. Usually
within two to three months, patients are able to return to most normal activities and place
an emphasis on strengthening the muscles around the shoulder and maintaining range of motion.
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