Shoulder surgery may be required to relieve pain and improve range of motion that has been diminished due to an injury or condition or arthritis of the shoulder joint. Surgeries can be performed at either St. Francis Downtown or St. Francis Eastside.
The shoulder is the most mobile joint in the body. The muscles and joints of the shoulder allow it to move through a wide range of motions, making it unstable and easily subject to injury and dislocation. Injuries are frequently caused by athletic activities that involve repetitive motion, but they also can occur during everyday activities.
Candidates for Surgery
- Patients with a shoulder fracture. A fracture involves a partial or total break through a bone and usually occurs as a result of an impact injury, such as a fall or a blow. Fractures commonly involve injury to the clavicle, top of the humerus, and scapula. Fractures usually cause severe pain, swelling and bruising, and can be confirmed by X-rays. Some fractures can be treated without surgery with immobilization, icing, and pain medication. However, fractures that have broken through the skin or are severely out of place do require surgical repair.
- Patients with a shoulder separation. Shoulder separations occur due to a tear or weakening of the ligaments that hold the shoulder joint together. Most often, this is caused by a blow to the shoulder or by falling on an outstretched hand. Treatment of a shoulder separation is based on the severity of the injury as well as the direction of the separation and the physical requirements of the patient. Most shoulder separations can be treated without surgery, simply requiring rest, a sling and possibly physical therapy. However, if ligaments are severely torn, surgical repair may be required to hold the clavicle in place.
- Patients with a torn rotator cuff. A rotator cuff tendon may become inflamed from overuse, aging, heavy lifting, a fall on an outstretched hand, or a collision. Patients with a rotator cuff injury will experience pain when their arm is raised or extended out from their body, or when their arm is lowered to their side. Patients with a rotator cuff injury often are encouraged to rest the shoulder and take medicine to relieve pain. Physical therapy might be prescribed to build flexibility and strength, and the patient may need to wear a sling for a few days. If there is no improvement, surgical repair of the torn rotator cuff may be required.
- Patients with arthritis. Arthritis is an inflammation that can destroy the joint and surrounding tissue. It also can cause degeneration and tearing of the capsule or the rotator cuff. Those with arthritis often have swelling or stiffness in the joints with a loss of flexibility. If arthritis fails to respond to more conservative treatments like medication and physical therapy, surgery may be an option.
Shoulder arthroscopy is a minimally-invasive procedure that can be performed for:
- Torn or damaged cartilage ring (labrum) or ligaments;
- Shoulder instability, where the shoulder joint is loose and slides around too much or becomes dislocated (slips out of the ball and socket joint);
- Torn or damaged biceps tendon;
- Torn rotator cuff;
- 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 (collarbone);
- Removal of loose tissue;
- Shoulder impingement syndrome, to make more room for the shoulder to move around.
First, your surgeon will examine your shoulder with an arthroscope, a small camera that can be inserted through a small incision. Your surgeon will inspect all the tissues of your shoulder joint and the area above the joint, including the cartilage, bones, tendons, and ligaments. Your surgeon also may be able to repair any damaged tissues. To do this, your surgeon will make one to three more small incisions and insert other instruments through them. A tear in a muscle, tendon, or cartilage will be fixed. Damaged tissue may need to be removed.
At the end of the surgery, using the arthroscope, your incisions will be closed with stitches and covered with a dressing (bandage). Most surgeons take pictures from the video monitor during the procedure to show you what they found and what repairs they made. Your surgeon may need to do open surgery if there is a lot of damage. Open surgery means you will have a large incision so that the surgeon can get directly to your bones and tissues.
Shoulder Replacement Surgery
Shoulder replacement surgery is usually done when the joint is badly damaged and there is pain or loss of motion. Causes of damage could include arthritis, badly broken bones, damaged or torn tissues, or tumors in or near the shoulder.
For total shoulder replacement, the round end of the arm bone is replaced with an artificial stem that has a rounded metal head. The socket part of the shoulder joint is replaced with a smooth plastic shell held in place with special cement. If only one of these two bones needs to be replaced, the surgery is called a partial shoulder replacement.
For shoulder joint replacement, your surgeon will make an incision over your shoulder joint. Then your surgeon will:
- Remove the head (top) of your upper arm bone (humerus).
- Cement the new metal head and stem into place.
- Smooth the surface of the old socket and cement the new shell in place.
- Close your incision with staples or sutures.
- Place a dressing (bandage) over your wound.
Surgical Repair of a Shoulder Fracture
Surgery to repair a fracture usually involves stabilizing the bone with plates, screws, pins, or wires through an open incision. In some cases, a shoulder fracture may require a shoulder replacement (see description above).
Surgical Repair of a Shoulder Separation
Several different procedures may be used to surgically repair torn shoulder ligaments, and many can be performed in a minimally invasive way. Most of these surgeries attempt to stabilize the end of the clavicle in its proper position with strong sutures or screws until the injured ligaments can heal.
Surgical Repair of a Torn Rotator Cuff
Torn rotator cuffs are usually repaired with shoulder arthroscopy. This type of surgery uses a small camera that is inserted through a small incision to allow the surgeon to examine and repair the tissues in and around the shoulder joint. The goal is to attach the tendon back to the bone where it tore off.
During the procedure, the edges of the muscles are brought together and the tendon is attached to the bone with sutures. Small rivets (called suture anchors) are often used to help attach the tendon to the bone. The anchors can be made of metal or plastic and do not need to be removed after surgery.