The human shoulder is a marvel of engineering. It is the most flexible joint in our bodies, allowing us a huge range of arm movements in front, above, to the side, and behind our torso. But this intricacy also makes the shoulder susceptible to injury.
At Urgent Orthopedic Specialists, when a patient has either chronic shoulder pain or instability or suffers a traumatic injury, our first treatments are usually nonsurgical. Sometimes, however, as in some dislocations or tears, immediate surgery is necessary. Also, when nonsurgical treatments aren’t having the desired effect, surgery will return function and alleviate pain. Since our shoulders are so critical to our quality of life, their health is a mainstay of our mission here at Urgent Orthopedic Specialists.
Toward that end, here’s some information on common shoulder injuries and possible surgical solutions for them.
What Makes Up The Shoulder?
Our shoulder is a ball-and-socket joint consisting of three bones: the upper arm bone (humerus), shoulder blade (scapula), and the collarbone (clavicle). The top of the humerus fits into a small socket of the shoulder blade to form the shoulder joint. Cartilage tops the humerus and lines the shoulder joint to ensure smooth movement. Muscles and tendons, such as the rotator cuff, attach the upper arm to the shoulder blade and help keep the arm bone in the shoulder socket. A sac-like membrane, the bursa, sits between the rotator cuff and the shoulder blade to cushion and lubricate motion between the two parts of the shoulder.
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What Are Common Shoulder Injuries and Their Treatments?
When repetitive shoulder movements, such as from weightlifting or swimming, cause inflammation of the bursa, this is known as bursitis or tendinitis. These movements cause the rotator cuff to rub or be squeezed under the shoulder blade and in the acromioclavicular joint (AC joint). Bursitis is treated through behavior modification and rehabilitation therapy.
Rotator cuff tears
The rotator cuff can develop partial tears from chronic overuse and from bone spurs that have developed under the shoulder blade or in the AC joint. Surgery isn’t usually required, unless it is necessary to remove these spurs.
In a full rotator cuff tear, usually the result of heavy lifting or falls, surgery may be necessary to repair the tear. This can often be done arthroscopically.
When the shoulder becomes unstable, that means the head of the humerus can leave the shoulder socket. This can happen due to trauma or due to chronic loosening of the shoulder socket. Prior partial or complete shoulder dislocations will lead to this instability.
If the patient is repeatedly dislocating his or her shoulder, surgery is usually necessary.
This common childhood injury usually results from a fall on the shoulder. These usually only require treatment with a sling or splint.
AC joint separation
The AC joint is where the collarbone is joined with the shoulder blade. This joint can be damaged in falls and can require surgery to repair it.
Fractured head of the humerus
If a person falls on an outstretched arm, say when diving for a ball in a softball game, or when an older person with osteoporosis falls and puts their arm out to brace the fall, the humerus can break just below the head. This fracture will often require surgery that may include replacement with an artificial joint.
Osteoarthritis and rheumatoid arthritis
Osteoarthritis (wear and tear arthritis) damages the shoulder when the cartilage cushioning wears out, leading to bone on bone impacts. Rheumatoid arthritis causes chronic inflammation that produces chemicals that begin to destroy the inner lining of the shoulder joint.
In these cases, shoulder replacement surgery is often necessary. This may be partial replacement, as in replacing the head of the humerus, or replacing the entire socket.
How We Decide The Best Course of Treatment
At Urgent Orthopedic Specialists, diagnosing and treating shoulder joint problems is a large part of our daily work. When evaluating your shoulder problems, we’ll evaluate using three sources:
- Medical history — We’ll evaluate your current symptoms and relate them to your past injuries, treatments, and conditions.
- Physical exam — We’ll test your range of motion, swelling and tenderness, weakness or instability, or areas of deformity due to injury.
- Diagnostic tests — X-rays, MRIs, and CT scans may all be used to get a picture of both the bony areas and soft tissues of your shoulder.
Who Is a Candidate for Shoulder Surgery?
At Urgent Orthopedic Specialists, we view shoulder surgery as the last treatment option, if possible. We exhaust nonsurgical treatment options before moving to surgery. Still, in some serious injuries, if the patient seeks to have full use of his or her shoulder again, surgery may be required. Or, in the case of osteoarthritis damage, surgical shoulder replacement may be the only real option to return function and end the cycle of chronic pain. As you would expect, every patient’s situation is unique.
Types of Shoulder Surgery
If we’ve exhausted nonsurgical treatment options and you still have loss of function or chronic shoulder pain, we may recommend shoulder surgery. Increasingly, we are able to use arthroscopic methods, which are less invasive, but sometimes open surgery is necessary.
- Arthroscopic surgery — The first step in arthroscopic surgery is to insert the arthroscope, a pencil-thin device with a small camera and light on the end, into the shoulder joint through a tiny incision. This allows Dr. Floyd or Dr. Rowland to see inside the joint as broadcast on a TV monitor adjacent to the surgical table. Once we get a clear picture of the damage, various surgical instruments are inserted through other small incisions to make repairs. Shoulder arthroscopy is done as an outpatient procedure.
- Open surgery — Open surgery may be necessary for larger injuries, such as full shoulder dislocations that have torn surrounding tissues. We try and limit the size of the incisions, but open surgery will entail more involved recovery than arthroscopic surgery. Open shoulder surgery usually requires at least one night in the hospital.
Some common shoulder surgeries:
- Rotator cuff repairs — This is the most common shoulder surgery. The goal of the surgery is to identify the damaged part of the rotator cuff and to clean out and reattach any torn or damaged tendons.
- Frozen shoulder — The second most common shoulder injury is a frozen shoulder, where the capsule surrounding the shoulder joint becomes overly tight and contracted. The goal of this surgery is to loosen the contracted tissue to allow the shoulder to move freely.
- Shoulder dislocation — This surgery is usually to repair a traumatic dislocation (usually in younger athletes) or to tighten up chronic shoulder instability.
- Shoulder impingement — When a patient has shoulder impingement, the tendons of the rotator cuff are intermittently trapped and compressed during movement. This causes damage to the tendons over time, along with the bursa. The goal of this surgery is to increase the space between the rotator cuff and the top of the shoulder.
- AC joint repairs — This joint between the collarbone and the shoulder blade can wear out due to arthritis, usually at the site of a former injury/strain. It can also deteriorate due to repetitive use. In this surgery, the end of the collarbone is removed to widen the AC joint space.
- Shoulder replacement — When arthritic damage is severe, or when other problems cannot be repaired any longer, it may be necessary to replace the shoulder. A typical shoulder replacement will replace the ball and socket joint with an artificial ball made of metal and a socket made of plastic.
Recovery from Shoulder Surgery
Recovery from shoulder surgery is involved due to the extensive range of motion that the joint encompasses. These recovery periods often last up to six months. Why does it take this long? It takes time for the tendon to heal and to re-attach properly to the bone. Of course, every patient’s recovery and rehabilitation is unique based on what the injury was and the degree of surgery performed.
- First six weeks of recovery — During this time, your repaired shoulder will need to be kept as immobile as possible. You’ll have your arm in a sling to keep the weight of your arm off the tendon. At some point, we will start you on a gentle physical therapy program.
- Six to 12 weeks — Now you will be able to have limited range of arm movements. You still, however, will not be able to lift or push heavy objects, as this can cause the sutures anchoring the tendon to the bone to pull out. You will still not be able to use this arm to support your body weight.
- Three to six months — Now you’ll begin to strengthen the muscles in the arm after the long period of inactivity. You’ll still need to be careful to not place too much strain on the joint, but you’ll be able to increase your physical therapy options.
Preventing Future Shoulder Problems
At Urgent Orthopedic Specialists, we place as much credence in prevention as in surgical repair. To that end, we advise our patients in the proper methods of daily stretching and strengthening of their shoulders, along with certain behaviors that they may want to curtail, to keep their surgically repaired shoulders functioning comfortably for the long haul.