Shoulder Surgery

Shoulder Arthroscopy

Shoulder Arthroscopy web based movie

Shoulder arthroscopy is a surgical procedure in which an arthroscope is inserted into the shoulder joint. The benefits of arthroscopy are smaller incisions, faster healing, a more rapid recovery, and less scarring. Arthroscopic surgical procedures are often performed on an outpatient basis and the patient is able to return home on the same day.

Arthroscopy may be recommended for shoulder problems such as:

  • Evaluation and treatment of instability
  • A torn or damaged cartilage ring (labrum) or biceps tendon
  • A torn rotator cuff
  • Stiffness of the shoulder
  • Subacromial decompression
  • Arthritis of the end of the clavicle
  • Treatment of frozen shoulder
  • Removal of loose bodies
  • Debridement / drainage of shoulder joint infection

Arthroscope is a small fiber-optic viewing instrument made up of a tiny lens, light source and video camera. The television camera attached to the arthroscope displays the image of the joint on a television screen, allowing the surgeon to look, throughout the shoulder- cartilage, ligaments, and the rotator cuff.

The surgeon makes small incisions around the joint area. In one portal, the arthroscope is inserted to view the shoulder joint. Along with the arthroscope, sterile solution is pumped to the joint which expands the shoulder joint, giving the surgeon a clear view and room to work. Other portal is used for the insertion of surgical instruments to probe various parts within the joint to repair the damaged shoulder.

Arthroscopy is much less traumatic to the muscles, ligaments and tissues than the traditional method of surgically opening the shoulder with long incisions (open techniques).

Following the surgery, your surgeon may recommend you to practice certain measures for better outcomes. Pain medications will be provided, bandage will be given around the operated shoulder which can be removed after 24 hours and dressings can be placed to cover the wounds. Slight swelling of the shoulder may be present after the surgery which is normal. Placing ice-packs on the shoulder for about 20 minutes, 3-4 times a day helps reduce the swelling. You can return to normal activities when you feel comfortable and a follow-up visit should be scheduled 7-10 days after surgery to monitor your progress.

Shoulder Joint Replacement

Shoulder Joint Replacement web based movie

Shoulder joint replacements are usually done to relieve pain and when all non-operative treatment to relieve pain have failed.

The shoulder is a highly movable body joint that allows various movements of the arm. It is a ball and socket joint, where the head of the humerus (upper arm bone) articulates with the socket of the scapula (shoulder blade) called the glenoid. The two articulating surfaces of the bones are covered with cartilage, which prevents friction between the moving bones. The cartilage is lubricated by synovial fluid. Tendons and ligaments around the shoulder joint provide strength and stability to the joint.

The shoulder is a highly movable body joint that allows various movements of the arm. It is a ball and socket joint, where the head of the humerus (upper arm bone) articulates with the socket of the scapula (shoulder blade) called the glenoid. The two articulating surfaces of the bones are covered with cartilage, which prevents friction between the moving bones. The cartilage is lubricated by synovial fluid. Tendons and ligaments around the shoulder joint provide strength and stability to the joint.

The shoulder is a highly movable body joint that allows various movements of the arm. It is a ball and socket joint, where the head of the humerus (upper arm bone) articulates with the socket of the scapula (shoulder blade) called the glenoid. The two articulating surfaces of the bones are covered with cartilage, which prevents friction between the moving bones. The cartilage is lubricated by synovial fluid. Tendons and ligaments around the shoulder joint provide strength and stability to the joint.

Indications

Total shoulder joint replacement surgery is indicated for conditions such as osteoarthritis or rheumatoid arthritis when medication, injections, physical therapy, and activity changes do not help relieve pain. Your doctor recommends surgery when you have the following symptoms:

  • Severe shoulder pain that restricts daily activities
  • Moderate to severe pain during rest
  • Weakness and/or loss of motion

Diagnosis

To decide whether total shoulder replacement is a good option for you the surgeon will evaluate your condition thoroughly.

Your surgeon reviews your medical history and performs a physical examination of your shoulder to assess the extent of mobility and pain. Imaging tests such as X-ray or MRI (magnetic resonance imaging) are ordered.

Procedure

The surgery is done under regional or general anesthesia. An incision is made over the affected shoulder and the underlying muscles are separated to expose the shoulder joint. The surgery may be performed as open surgery, where a large incision is made, or minimally invasive, where small incisions are made to insert an arthroscope (a thin tube with a camera and light source) and surgical tools.

The upper arm bone (humerus) is separated from the glenoid socket of the shoulder bone. The arthritic or damaged humeral head is cut and the humerus bone is hollowed out and filled with cement. A metal ball with a stem, is gently press fit into the humerus.

Next, the arthritic part of the socket is prepared. The plastic glenoid component is fixed in the shoulder bone.

After the artificial components are implanted, the joint capsule is stitched and the wound is closed.

Post-operative care

After the surgery, pain medications and antibiotics are prescribed to control pain and prevent infection. Your arm may be secured in a sling or cast. The rehabilitation program includes physical therapy, which is started soon after the surgery and is very important to strengthen and provide mobility to the shoulder. You may be able to perform gentle daily activities two to six weeks after surgery.

Risk and complications

As with any major surgery, there may be potential risks involved:\

  • Anesthetic complications such as nausea, dizziness and vomiting
  • Infection of the wound
  • Dislocation, requiring repeat surgery
  • Damage to blood vessels, nerves or muscles
  • Failure to relieve pain
  • Pulmonary embolism
  • Wear and tear of prosthesis
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