Shoulder

Shoulder Arthroscopy

Arthroscopy is a minimally invasive surgical technique that involves several small incisions into which a fiber-optic device (arthroscope) and tiny surgical instruments are inserted. Orthopedic surgeons can diagnose and treat many different shoulder conditions with arthroscopy, while patients can benefit from less tissue damage, shorter recovery times, less scarring and less post-operative pain. This technique also avoids cutting any muscles or tendons in order to gain access to the affected area.

Shoulder arthroscopy is often performed to confirm a diagnosis after a physical examination and other imaging procedures have been performed. Some conditions can also be treated during the same procedure by inserting a few additional instruments into the joint area.

Arthroscopy can be used to treat many conditions affect the shoulder joint. Shoulder arthroscopy, also known as shoulder scope, can be used to treat:

  • Rotator cuff tears
  • Labral tears
  • Impingement syndrome
  • Biceps tendonitis
  • AC joint arthritis

While arthroscopy offers many benefits over a traditional open procedure, it is not for everybody. Some conditions, especially those that are not easily visible with the arthroscopic camera, may be better suited for traditional surgery. Dr. Goldberg will decide which type of procedure is right for you.

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SLAP Repair

A superior labral anterior-posterior (SLAP) lesion is an injury to the labrum of the shoulder joint, the cuff of cartilage that forms a cup for the arm bone to move within, increasing shoulder stability. Injury to the labrum is often caused by a pulling on the biceps tendon during an overhead throw or from other types of trauma.

Patients with a SLAP lesion may experience pain with movement, limited range of motion, frequent dislocation and a catching sensation in the shoulder. There are several different types of SLAP lesions, each of which may require its own specific treatment.

Some SLAP lesions may only cause mild pain that patients can choose to deal with if they do not want to undergo surgery, as this condition does not usually worsen with time. For those that cause more severe pain, surgery is usually performed, which may include:

  • Debridement of fraying tissue to prevent a tear
  • Securing the loose labrum to the cup of the joint
  • Repair or removing torn labrum tissue
  • Removing labral tear and repairing biceps tendon

Surgery for SLAP lesions is performed on an outpatient basis and takes about 90 minutes. These procedures can usually be performed arthroscopically through several small incisions, into which a camera and tiny surgical instruments are inserted. Physical therapy may be required for six to 12 weeks after surgery to ensure that the joint heals properly.

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Reverse Total Shoulder Replacement

Reverse total shoulder replacement is a variation of the traditional replacement procedure that involves switching the position of the prosthetic socket and metal ball, attaching the metal ball to the shoulder bone and the plastic socket to the humerus bone.  This technique is most effective for patients with a completely torn rotator cuff, severe arthritis or previous joint replacement surgery that has failed. It is considered to be a last resort for patients still experiencing pain even after several other treatments.

After reverse total shoulder replacement, many patients experience an increased range of motion and the restored ability to perform daily tasks such as eating, drinking, combing their hair and more. This procedure is usually recommended for older patients.

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Rotator Cuff Repair

The rotator cuff is a group of tendons and muscles that support the shoulder joint and allow for complete movement while keeping the ball of the arm bone in the shoulder socket. These tendons and muscles may become torn or otherwise damaged from injury or overuse and can lead to pain, weakness and inflammation. Surgery may be used to treat this often serious condition.

Rotator cuff surgery may be performed laparoscopically or through an open procedure, depending on the type and severity of the condition. Both procedures are performed under general anesthesia and aim to reattach the tendon back to the arm, along with removing any loose fragments from the shoulder area.

Rotator cuff repair surgery is usually successful in relieving shoulder pain, although full strength cannot always be restored. Recovery time depends on the type of surgery, but can take several months. As with any surgery, there are certain risks involved with rotator cuff repair such as infection, pain or stiffness, nerve damage or the need for repeated surgery. These complications are rare and most people receive successful outcomes from this procedure.

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Total Shoulder Replacement

Severe shoulder conditions with persistent symptoms that have not responded to conservative treatments may benefit from shoulder replacement surgery. Shoulder replacement surgery replaces the damaged joint with an artificial one that allows patients to enjoy painless motion and resume their regular activities. 

Shoulder replacement surgery is often performed to treat conditions such as:

  • Osteoarthritis
  • Rheumatoid arthritis
  • Rotator cuff tears
  • Osteonecrosis

Patients with severe cases of these conditions often experience pain, limited range of motion, stiffness, swelling and more. These symptoms can be effectively relieved by replacing the damaged bone and cartilage with a metal and plastic implant. Similar to the hip, the shoulder is a ball-and-socket joint that can be significantly improved with joint replacement surgery. 

Shoulder replacement surgery takes about two hours to perform and is usually done under general anesthesia. It may be performed arthroscopically or through a traditional open procedure that requires a four to six inch incision.

Patients will be required to stay in the hospital for one to three days and will need physical therapy in order to restore function to the joint after surgery. Most patients are able to return to all of their regular activities after two to three months.

While shoulder replacement surgery has been performed successfully for many years, there are certain risks involved with any surgical procedure. Some of these risks may include infection, blood clots, nerve injury, instability and loosening of the implant.  These risks are considered rare, and most patients experience symptom relief and improved range of motion after this procedure.

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