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 determine the exact cause of the problem.
It may be necessary to perform a shoulder Arthroscopy to ascertain
the extent of damage or to locate the problem.
Initial treatment may be a course of physiotherapy
or cortisone injections to promote natural healing. the surgeon
may suggest that the arm is immobilized 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
procedure 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 cartilage the patient will suffer severe shoulder
arthritis. This is quite painful, and can cause restriction of
motion eventually 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 removed, 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 following 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 physiotherapist 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 don't 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 afterwards 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
Artificial 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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