How Does Your Shoulder Work
Similar to the hip joint, your shoulder is a large ball and socket joint. It can rotate through a greater range of motion than any other joint in your body. The shoulder joint is made up of bones, tendons, muscles and ligaments which hold the shoulder in place and allows for its movement. Bones of the shoulder joint include the Clavicle , Scapula and Humerus .
Your clavicle connects with the shoulder blade at the acromioclavicular joint, or A.C. joint. The clavicle attaches your shoulder to your rib cage and holds it out and away from your body. The rounded head of the humerus, or upper arm bone, rests against the socket in the shoulder blade. The surfaces of the bones where they touch are covered by a smooth substance called cartilage that protects your bones and enables them to glide and move easily. The muscles and tendons that surround the shoulder provide stability and support. A thin, smooth tissue called the synovial membrane covers all remaining surfaces inside the shoulder joint. In a healthy shoulder, this membrane makes a small amount of fluid that lubricates your cartilage and eliminates almost any friction in your shoulder.
Frequently Asked Questions About Arthroscopic Rotator Cuff Surgery
Is my rotator tear “too big” to be fixed using arthroscopy?
The primary advantage of all-arthroscopic repair is that it allows a surgeon “global” access to the rotator cuff and tear for adequate cuff evaluation, repair and fixation to bone. For this reason, the LARGEST tears are often that require the greatest degree of skill and familiarity with arthroscopic techniques. Surgeons who are facile with arthroscopic techniques actually prefer to prepare and evaluate the cuff using the arthorscope, as this allows better visualization.
Will I recover or “heal” faster after arthroscopic rotator cuff repair?
Are the results as good as with “mini-open” techniques?
Most of the recent studies show that in the hands of surgeons who are expert in all-arthroscopic rotator cuff repair, the results are comparable to open techniques. Specifically, the best results reported for open repairs are as high as 97% success.1,7,11,142-6,8-10,12,13 Reports of the traditional open fixation tend to demonstrate that the success rates are less favorable for larger tears. Interestingly, the studies of arthroscopic repairs show otherwise: the results do not appear to be significantly worse with larger tear sizes.4 This is probably due to the global access to larger tears with the arthroscopic techniques. Recent articles reported on arthroscopic fixation using the latest instruments and techniques demonstrate 93% to 95% good and excellent results.
What happens without surgery?
Obtain Tools For Bathroom Access And Safety
Stock a big supply of waterproof bandages or plastic bags and tape in the bathroom so youre prepared to shower without getting your incision wet. A detachable showerhead helps keep water away from your shoulder, and pump soap makes bathing easier when you can use only one arm.
Place non-slip bath mats in the shower and on the floor outside your bathtub or shower. A shower chair is also great for safety because you may tire easily during your recovery.
If your dominant hand and arm are immobilized, practice activities like brushing your teeth with your other arm. If its too difficult, look for hacks. For example, you can get powdered toothpaste that you can pour into a bowl and then dip a wet toothbrush in the powder.
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Eliminate Pain Medication As Quickly As Possible
Its normal to feel pain and discomfort after rotator cuff surgery or just about any surgery, for that matter. While medication can increase your comfort while you heal, it can also mask your pain during physical therapy. This reduced sensation can make it easy to overdo your activity and unintentionally set your recovery back.
The faster you can comfortably eliminate painkillers after surgery, the easier it is to assess your recovery so you can adjust your physical activity as needed.
How Do You Describe The Size Of Tendon Tears
The first way to describe tears of the rotator cuff tendons is whether tears are part of the way through or all the way through the tendon or they can progress to tears all the way through the tendon . Once a tear is all the way through the tendon , the next issue to consider is the size of the hole in the tendon. As the tendons tear more, they can be of any size .
The normal anatomy of the shoulder and rotator cuff tendons are demonstrated in Figure 6. Full thickness tears of the rotator cuff are described as small, medium, large or massive . Since most rotator cuff tendons are about as wide as three of your fingers, a small tear would be one the size of your fingernail or smaller . A moderate size full thickness tear through the tendon would be one that is the size of three fingernails . Usually tears of this size mean the whole tendon width is pulled off of the bone . A large tear is one that would mean the tendon is torn from the knuckle to your fingertip this is called a large or massive tear . It is also possible to tear more than one tendon completely. The size of the tear is very important as it determines the chances that the tendon will heal with surgery.
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How Do I Know If I Need Shoulder Surgery
Once diagnosed, Dr. Pifer will create a treatment plan to address your needs. Conservative treatments benefit certain types of shoulder problems. Dr. Pifer may recommend surgery when nonsurgical treatment approaches fail to ease persistent pain or restore shoulder function. Surgery may also be necessary for situations where the damage to the shoulder is extensive.
Signs you may need surgery include:
- Chronic pain not alleviated by conservative treatment
- Advanced joint disease
- Inability to raise the arm
- Significant weakness in the impacted shoulder
- Inability to carry items using the impacted arm
These are some of the reasons why Dr. Pifer may recommendshoulder surgery to restore the function of your shoulder and ease the pain. But, there are other reasons that may warrant surgery.
Surgical Options For Shoulder Replacement
Replacing or reshaping the damaged or diseased joint with a prosthetic one is called an arthroplasty. Depending on your age, overall health, and your specific shoulder joint problem, your may recommend one of the following procedures:
partial shoulder replacement reverse total shoulder replacement total shoulder replacement
Hemiarthroplasty replaces the head of the humerus with a prosthesis. The glenoid surface is left alone. Hemiarthroplasty can be done to repair a fracture of the humeral head or neck when the glenoid cavity isnt affected and is still functional. Besides fractures, other indications for hemiarthroplasty include:
osteoarthritis osteonecrosis of the humeral head Tumors of the humeral head Rotator cuff tears that cant be repaired, especially if accompanied by severe arthritis
Shoulder resurfacing replaces the surface of the humeral head with a metal covering, or cap. The glenoid surface may also be replaced using a plastic prosthesis. Shoulder resurfacing may be an option for younger, active patients with:
osteoarthritis osteonecrosis of the humeral head Rotator cuff tears that cant be repaired, especially if accompanied by arthritis
A major advantage of resurfacing is that it preserves bone for future shoulder procedures and surgeries. However, resurfacing is not recommended when severe bone loss is present or if the bone is not healthy enough to support the prosthesis.
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What Causes The Conditions Treated By Shoulder Replacement Surgery
There are two basic types of arthritis that affect the shoulder.
Alternatives To Shoulder Replacement Surgery Prp And Prolotherapy
In this section, we will discuss the realistic treatment options to shoulder replacement surgery. We will focus on Prolotherapy and PRP injections.
- PRP treatment takes your blood, like going for a blood test, and re-introduces the concentrated blood platelets from your blood into areas of chronic joint and spine deterioration.
- Your blood platelets contain growth and healing factors. When concentrated through simple centrifuging, your blood plasma becomes rich in healing factors, thus the name Platelet RICH plasma.
- The procedure and preparation of therapeutic doses of growth factors consist of an autologous blood collection , plasma separation , and application of the plasma rich in growth factors In our office, patients are generally seen every 4-6 weeks. Typically three to six visits are necessary per area.
- Prolotherapy is an in-office injection treatment that research and medical studies have shown to be an effective, trustworthy, reliable alternative to surgical and non-effective conservative care treatments. In our opinion, based on extensive research and clinical results, Prolotherapy is superior to many other treatments in relieving the problems of chronic joint and spine pain and, most importantly, in getting people back to a happy and active lifestyle.
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Categories Of Reasons For Shoulder Pain
Most causes of shoulder pain can be classified into four key categories.
- Tendon inflammation or a tendon tear
- Instability of the shoulder
Other less widespread causes of shoulder pain include tumors, infection, and nerve-related issues.
Lets explore some of the most common causes of shoulder joint pain from the lowest risk types of causes to the highest.
Preparing For Your Surgery
Before you get your new shoulder, youâll likely get a full physical exam and X-rays or other imaging tests so the surgeon can get a look at the joint.
Talk to your doctor about any other conditions you have and any medications you take. Youâll have to stop taking certain drugs, especially painkillers, several weeks before surgery.
You may have to cut back on drinking and get more , too. If you smoke, youâll be asked to quit. Scientists have found folks who smoke are more likely to have complications from joint replacement surgery than those who dont.
Donât eat or drink anything after midnight on the night before your operation.
The procedure takes about 3 hours. Doctors will give you drugs to put you under during the surgery.
Youâll want to be sure you have some help with your daily routine lined up for a few weeks after you come home from the hospital. You wonât be able to move your arm very much. If you donât have a relative or friend who can help you out, you might want to check into a rehabilitation center until you can do more things on your own.
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What Should You Expect
Surgery is a stressful experience for many people, but knowing what to expect can alleviate some of that worry. Here are the necessary steps to know.
- Preoperative clearance: Before undergoing surgery, your doctor will perform an exam to ensure you are healthy enough for surgery. Depending on your overall conditions, additional tests may be necessary. Your doctor will discuss any risks associated with the surgery and give you all the preoperative instructions you need, such as what medications you can and cannot take before the procedure.
- The day of the surgery: The day of your scheduled surgery, you will need to avoid eating or drinking anything after midnight. When you arrive at the hospital, you will change into a surgical gown and wait to go to the operating room.
- Anesthesia: Once you are in the operating room, an anesthesiologist will administer general anesthesia, a combination of medications that will put you to sleep for the duration of the surgery. You will not feel anything. The anesthesiologist may also administer a nerve block, which will numb the shoulder. Nerve blocks last after you wake up, so you will likely feel very little pain when you first wake up from the surgery.
The Anatomy Of The Shoulder
The shoulder is a complex joint capable of more movement than other joints in the body. Its made up of several bones.
Besides bones, other components are responsible for function and movement.
- Ball and socket: Your upper arm bone head fits into your shoulder blade through a rounded socket known as your glenoid. Your articular cartilage, which is a slippery tissue, covers the surface of your ball and socket, creating a frictionless, smooth surface that helps your bones easily glide across one another. Strong fibrous cartilage rings your glenoid, which creates a gasket around your socket, adding stability and cushioning the joint.
- Shoulder capsule: Bands of tissue called ligaments surround your joint, forming a capsule that holds it together. Your synovium, which is a thin membrane, lines the capsules undersurface. It makes synovial fluid that provides lubrication for your shoulder joint.
- Rotator cuff: You have four tendons surrounding your shoulder capsule that help center your arm bone in your shoulder socket. This is your rotator cuff and is a thick tendon material. Your rotator cuff covers your humerus head, attaching it to your shoulder blade.
- Bursa: Your bursa is a lubricating sac between the bone on top of the shoulder and your rotator cuff. Your bursa helps your rotator cuff tendons smoothly glide when youre moving your arm.
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Why The Procedure Is Performed
Arthroscopy may be recommended for these shoulder problems:
- A torn or damaged cartilage ring or ligaments
- Shoulder instability, in which the shoulder joint is loose and slides around too much or becomes dislocated
- A torn or damaged biceps tendon
- A torn rotator cuff
- A bone spur or inflammation around the rotator cuff
- Inflammation or damaged lining of the joint, often caused by an illness, such as rheumatoid arthritis
- Arthritis of the end of the clavicle
- Loose tissue that needs to be removed
- Shoulder impingement syndrome, to make more room for the shoulder to move around
What Causes Shoulder Pain
There are many causes for shoulder pain. Shoulder pain can be caused by inflamed tendons, pulled muscles, a damaged rotator cuff, and even injury to other parts of the body such as the arm or neck. Some of the most widespread shoulder pain causes are arthritis, cuff tendinitis, rotator cuff impingement or damage, or a condition called bursitis, which is caused by the formation of a fluid sac underneath the top part of the shoulder.
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Open Surgery On The Heel Bone
If a person fractures their heel bone, they may need surgery. An operation is not always necessary if the bone has not moved too far out of place.
To repair the fracture, a surgeon must cut into the skin to get to the broken bone. They can then fix the bone back together, using plates or screws.
The skin around the heel is thin, and this area does not have a lot of soft tissue. It is easy to damage the nerves around the heel bone during surgery. Along with the attachment of screws to the bone, this can make the operation and recovery painful.
Traditional Total Shoulder Replacement Surgery
Traditional shoulder replacement surgery involves replacing the damaged parts of the ball-and-socket shoulder joint with prosthetic materials. Either the humeral head alone or both the humeral head and the glenoid socket are replaced with prostheses. The humeral head is replaced with a metal prosthesis, which is attached to a stem, while the glenoid socket is replaced with a medical-grade plastic prosthesis.
Osteoarthritis and rheumatoid arthritis are the most common reasons for having traditional total shoulder replacement . However, if you have a completely torn rotator cuff, your orthopedic surgeon may recommend a reverse total shoulder replacement.
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What To Expect After A Total Shoulder Replacement Surgery
After total shoulder replacement surgery, youll be sent home with your arm in a removable sling. Most patients notice right away that there is no more grinding in their shoulder joint and arthritis pain is gone, though pain from the surgery itself is still present at the outset. You will be sent home with pain medication to help you feel comfortable as you heal.
Youll be able to use your hand and wrist right away, and youll gradually begin to move the arm itself in non-weight bearing movements. The following milestones are averages. Your recovery schedule may vary from this list.
6 weeks Youll be able to move the entire arm for light activity.
8 weeks Youll enjoy movement of your arm without restriction, but will experience some weakness and lack of range of motion.
3 months Youll be back to about 1/2 your normal range of motion with slight weakness.
6 months You should be pain free and have achieved 2/3 of your normal range of motion.
12 months 95% of all shoulder replacement patients report being completely pain free at one year.
Acromioclavicular Joint Repair For Arthritis
The acromioclavicular joint is where the collarbone and the shoulder bone meet. Its called the AC joint because the part of the shoulder blade that touches the collarbone is known as the acromion. Conditions in the AC joint include fractures, separations, and arthritis.
If non-surgical treatments fail, Dr. Bennett might recommend surgery to remove the end of the collarbone. He does the repair through several small incisions using an arthroscope.
Most patients go home in a sling on the same day as the surgery. Full recovery varies from one patient to the next, but most patients are back to full activity in about three months.
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