Shoulder Surgery

• Arthroscopic repair: this allows the surgeon to insert a thin device with a small lens into tiny incisions to see inside the joint. The images are transmitted to a television screen, allowing the doctor to guide and make a diagnosis.
• Open repair: in some cases, open repair surgery is necessary. It is done through small incisions, which are only a few centimeters long and need to be done if the tear is large. It is a good option if the tear is complex or if an additional reconstruction needs to be done, like tendon transfer.

Responding in a concrete way and with deadlines to this type of question is practically impossible, since in addition to the individual response to any recovery process, There is NO standard guideline that is accepted by the entire international medical community. Thus, the criteria that mark the periods of immobilization after shoulder interventions depend on each school, each service and even each specialist although, usually, remain within proximity margins. The answer that we develop here is based on practical experience as an arthroscopist and the feedback obtained from many patients who have had this pathology and have undergone surgery in our service..

The biological healing period requires a first phase, around three weeks, to establish bridges and for this, immobilization using specific orthoses is essential; although the immobilization has been strictly complied with and that they have already elapsed 3 weeks, the healing achieved is very weak and the risk of undoing it, very high. That is why after this first phase of absolute immobilization with the arm glued to the chest, a recommended second level or period of others three weeks partial immobilization. Small movements of the arm are allowed without detaching it excessively. We can use the hand to pick up not very heavy objects and flexo-extend the elbow keeping the shoulder in the initial position except for small pendulum movements..

After the sixth week, the most widespread criterion advises constant work to regain lost mobility. Biological healing has concluded and functional recovery of the shoulder now prevails, starting with the recovery of mobility; it is important to recover all arcs of movement, and in this sense it is necessary to be aware that the older the age of the patient, more difficult it will be to achieve that goal. In elderly people we often settle for recovering a degree of mobility that allows us to perform elementary functions such as combing hair or taking a spoon to the mouth, although it is not possible to fully raise the arm, much less abduct it above 90º.

The rotator cuff is a group of tendons that holds the shoulder joint in place and allows people to lift their arm up to the top of their head.. Some individuals may have shoulder pain related to rotator cuff wear.. There may also be inflammation of the tendons of the shoulder or bursa (another part of the shoulder that helps in movement) and pressure on the tendons exerted by the overlying bone when lifting the arm up (pinch). Pain is often made worse by sleeping on the affected shoulder and by moving the shoulder in certain directions.

Rotator cuff surgery may include removing part of the bone to take pressure off the rotator cuff tendons. (acromioplastia), removing any swollen or inflamed bags (the small bag of fluid that cushions the shoulder joint) and the removal of any injured tissue or bone to widen the space where the tendons pass (subacromial decompression). Most rotator cuff surgeries are now performed arthroscopically (surgical instruments are inserted through an incision or small hole to perform surgery).

To understand your options for pain relief after shoulder surgery, it is important to understand the anatomy of the shoulder first. The shoulder contains a series of bones, joints, muscles and ligaments, working together to make the many movements of the shoulder possible. The shoulder joint, one of the largest and most complex in the body, consists of the humerus and scapula, that fit like a ball and a socket. Another important joint in the shoulder area is the acromioclavicular joint., that joins the clavicle (clavicle) al acromion, what is part of the scapula. An important additional component of the shoulder is the rotator cuff., a group of muscles and tendons that supports the shoulder and provides its wide range of motion.

Pain signals travel through nerves, the extensive “information highway” of the body.

Shoulder pain is sent primarily to the brain through a group of nerves known as the brachial plexus.. These nerves start in the spinal cord and travel through the neck and down the arm..

Peripheral nerve blocks are a type of regional anesthesia that blocks the path of pain signals from specific nerves.. They are commonly used to relieve pain during and after shoulder surgeries. Nerve blocks can be given as a single injection or continuously using a thin tube called a catheter.. The catheter is placed close to the target nerve bundle. Continuous infusions are used when higher levels of pain are expected and can provide longer periods of pain relief.

Nerve blocks are performed using one of two techniques: nerve stimulation or ultrasound guidance. Nerve stimulation and ultrasound guidance can be used separately or together to properly perform nerve block. During nerve stimulation, your anesthesiologist applies very small, short pulses of electrical current through a small needle to stimulate a nerve. Later, watches specific muscles for contractions, indicating that the needle is close to the nerve. With the ultrasound guidance method, your anesthesiologist will use an ultrasound to view the group of nerves supplying the shoulder and will inject an anesthetic medicine around them, numbing only his shoulder. You can also insert a catheter next to these nerves if necessary..

Bursitis or tendonitis can occur with overuse of repetitive activities, how to swim, painting or lifting weights. These activities cause rubbing or compression (pinch) rotator cuff below the acromion and at the acromioclavicular joint. Initially, These problems are treated by modifying the activity that causes the pain symptoms and with a shoulder rehabilitation program.

Partial-thickness rotator cuff tears can be associated with chronic inflammation and the development of spurs in the lower part of the acromion or acromioclavicular joint..

Nonsurgical conservative treatment is activity modification, light exercise and, occasionally, a cortisone injection. Non-surgical treatment is successful in most cases. If you are unsuccessful, surgery is often needed to remove the spurs on the underside of the acromion and repair the rotator cuff.

Full thickness rotator cuff tears are often the result of impingement, partial thickness rotator cuff tears, lifting heavy objects or falls. Non-surgical treatment with activity modification is successful in most cases.

If the pain continues, surgery may be needed to repair full-thickness rotator cuff tears. Arthroscopic techniques allow shaving of dewclaws, rotator cuff evaluation and repair of some tears.

Both techniques require extensive rehabilitation to restore shoulder function..

Instability occurs when the head of the arm bone is pushed out of the shoulder socket. This can happen as a result of a sudden injury or overuse of the shoulder ligaments..

The two basic forms of shoulder instability are subluxations and dislocations.. A subluxation is a partial or incomplete dislocation. If the shoulder is partially out of the shoulder socket, may eventually dislocate. Even a minor injury can pull the arm bone out of its socket. A dislocation occurs when the head of the arm bone pops out of the shoulder socket. Some patients have chronic instability. Shoulder dislocations can occur repeatedly.

Patients with repeated dislocation often require surgery. Open surgical repair may require a short hospital stay. Arthroscopic surgical repair is often done on an outpatient basis. After any procedure, extensive rehabilitation is necessary, which often includes physical therapy, for healing.

A fractured clavicle and acromioclavicular separation are common injuries of children and others who fall to the side of the shoulder when playing.. Most of these injuries are treated non-surgically with slings or splints.. Severely displaced fractures or separation of the acromioclavicular joint may require surgical repair.

Osteoarthritis and rheumatoid arthritis can destroy the shoulder joint and surrounding tissue. They can also cause degeneration and tear of the rotator cuff or capsule.. Osteoarthritis occurs when the articular surface of the joint thins. Rheumatoid arthritis is associated with chronic inflammation of the lining of the synovium that can produce chemicals that eventually destroy the inner lining of the joint., including articular surface.

Shoulder replacement is recommended for patients with sore shoulders and limited movement. Treatment options are replacement of the head of the bone or replacement of the entire socket. Your orthopedic surgeon will discuss with you the best option.