As a connection point between the arm and our body, the shoulder plays an important role and serves many uses. And because it is used so often, injury damage and overuse lead to more than 50,000 shoulder surgeries every year.
The shoulder is made up of three main bones, two joints, tendons and muscles. With so many moving pieces, There are several different types of injuries that can occur and, Thus, a variety of different procedures to correct them.
Surgery can be an ideal treatment for many common shoulder problems , particularly those who do not respond to conservative therapy. They can range from minimally invasive arthroscopic procedures (in which the scope and surgical instruments are inserted through incisions in your shoulder) to more traditional open surgeries using a scalpel and sutures.
Each approach has its advantages, disadvantages, limitations and appropriate uses.
Arthroscopy involves making a small incision in the shoulder and inserting a tiny camera that allows the doctor to locate and identify any damage.. Later, an additional small incision is made and the surgeon inserts a small instrument that is used to repair the infected area.
Arthroscopic surgery is minimally invasive and does not require as much recovery time as open surgery.
The group of muscles and tendons that make up a sleeve o “sleeve” over the shoulder joint is known as the rotator cuff. The rotator cuff secures your arm within the shoulder joint and allows the shoulder joint to move and rotate properly.
Overuse or injury can damage the rotator cuff, what can be repaired with surgery. Depending on the type and extent of the damage, rotator cuff surgery may involve a larger open incision or smaller incisions to allow arthroscopic access to the damaged area.
The flat, shallow part of your shoulder blade is called the glenoid and this is where a gummy tissue known as the labrum is found.. The labrum forms a cup around the shoulder and serves as a cavity, allowing your arm to move while anchored on your shoulder.
When overuse or injury causes the gummy tissue to tear, surgery may be needed. Surgery to repair a torn labrum is usually performed arthroscopically to reattach the labrum to the shoulder socket..
Arthritis is caused by inflammation of a joint, what causes pain, discomfort, stiffness and limited range of motion. When other types of treatment are unsuccessful, surgery may be needed to remove shoulder arthritis.
Surgery to treat arthritis in the shoulder is most often done arthroscopically. Depending on the type and severity of arthritis, the doctor can simply clean the infected area. For more serious cases, a small amount of bone may be removed from the clavicle to free the shoulder, or the infected parts of the shoulder can be removed and replaced with an artificial material.
Sometimes, when a shoulder fracture occurs, broken bones are left positioned in a way that allows them to heal simply by immobilizing the shoulder in a sling. But other times, the broken bones are placed in a position that will require surgery to put them back in place.
Depending on the nature of the fracture, this type of surgery can be performed as an open incision or arthroscopically.
Shoulder replacement surgery generally reserved for advanced arthritis of the shoulder joint, but it can also be used for complex fractures and other problems that cannot be repaired with other techniques.
A typical shoulder replacement will replace the ball joint with an artificial ball made of metal and a plastic socket..
In cases where only the upper part of the arm bone (humerus) is broken or the arthritic shoulder socket is still intact , a partial replacement may suffice, known as hemiartroplastia . Hemiarthroplasty simply replaces the ball of the shoulder, leaving the cavity intact.
Another option is the reverse shoulder replacement . According to his name, the surgery reverses the location of the ball and socket so that the replaced ball goes where the socket was and the replaced socket goes where the ball was. Surgery can provide a mechanical advantage to people who have a condition called rotator cuff tear arthropathy in which both the labrum and rotator cuff are severely damaged.
Your shoulder is the most flexible joint in your body. Allows you to position and rotate your arm in many forward positions, above, to the side and behind your body. This flexibility also makes your shoulder susceptible to instability and injury..
Depending on the nature of the problem, nonsurgical treatment methods are often recommended before surgery. Nevertheless, in some cases, delaying surgical repair of a shoulder can increase the chance that the problem will be more difficult to treat later. Early and correct diagnosis and treatment of shoulder problems can make a significant difference in the long term.
The shoulder is a ball and socket joint. It is made up of three bones: the bone of the upper arm (humerus), shoulder blade (scapula) and the clavicle (clavicle).
The ball at the upper end of the arm bone fits into the small socket (glenoidea) of the shoulder blade to form the shoulder joint (glenohumeral joint).
The glenoid socket is surrounded by a soft tissue border (labrum).
A smooth and durable surface (Articular cartilage) on the head of the arm bone and a thin inner lining (son) of the joint allow smooth movement of the shoulder joint.
The top of the shoulder blade (acromion) projects onto the shoulder joint. One end of the clavicle is attached to the shoulder blade by the acromioclavicular joint (AC). The other end of the clavicle is attached to the sternum (breastbone) by the sternoclavicular joint.
The joint capsule is a thin sheet of fibers that surrounds the shoulder joint. The capsule allows a wide range of movement, but provides stability.
The rotator cuff is a group of muscles and tendons that attach the upper arm to the shoulder blade.. The rotator cuff covers the shoulder joint and joint capsule.
Muscles attached to the rotator cuff allow you to lift your arm, stretching your head and participating in activities such as throwing or swimming.
A sac-shaped membrane (Bursa) between the rotator cuff and the shoulder blade cushions and helps lubricate the movement between these two structures.
Shoulder surgery treats injured shoulders by repairing the muscles, connective tissue or damaged joints that occur from a traumatic injury or from where the shoulder has been overused. The shoulder is the most flexible joint in the body, allowing the arm to be positioned and rotated in many forward positions, above, to the sides and behind the body. This degree of movement makes the shoulder susceptible to injury..
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.
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