Below are the four most common procedures I perform for shoulder conditions:
This type of procedure is best suited for patients with a history of chronic shoulder pain but no tear and have failed all other treatment: Physical therapy, oral pain medications, and injections. It involves two to three small “poke holes” around the shoulder and removing any irritated or inflamed tissue, scar tissue, or bone spurs that may be impinging on healthy tissue. During this procedure I will also remove any debris from inside the joint that may be causing pain. The surgery takes less than 1 hour, patients go home the same day and are in a sling for two to four weeks.
Arthroscopic Bankart procedure (Labral repair) / Shoulder stabilization
The shoulder joint is a ball and socket joint. By design, it is a very shallow joint to allow a great degree of motion. While this allows you to put your hand where you need it, it also lends itself to making the shoulder less stable. To make the shoulder more stable, the body has developed a soft tissue “bumper” that surrounds the bony part of the shoulder socket. This functions to deepen the socket and make it harder to dislocate. Unfortunately, when you dislocate your shoulder, the labrum and the lining of the shoulder joint, or the capsule, is typically torn away from the bone.
If you have dislocated your shoulder and have continued pain or the feeling of instability, an arthroscopic Bankart repair can be extremely successful in getting you back to the activities that you enjoy. This involves the placement of small absorbable anchors into the bone of the shoulder socket. These anchors are attached to thread that is looped around the capsule and labrum and tied with special instruments. This provides compression of the tissue back to the bone and allows healing. This procedure typically takes about an hour and you will go home the same day. You will be in a sling for four to six weeks and full return to sports with three to four months.
Rotator cuff repair
Rotator cuff tears are very common as we age. They may be related to an injury such as a fall or a sudden jerking movement. However, they can also occur without any identifiable cause. The rotator cuff is the tendon attachment of four small muscles to the upper part of the arm bone (humerus). When functioning, these muscles help hold the ball in the socket and allow the stronger shoulder muscle, the deltoid, to elevate the arm. When the rotator cuff is not working, due to a tear for example, the upper end of the arm bone moves up and hits the roof of the shoulder causing impingement and making it difficult, if not impossible, for you to lift your arm above your head. In extreme cases, you may not even be able to shake someone’s hand.
The pain is typically felt over the lateral part of the shoulder in the region of the deltoid muscle. The diagnosis is confirmed with an MRI. For my patient s that require a rotator cuff repair, I prefer to use minimally-invasive arthroscopic techniques with specially designed instruments to perform the repair though smaller incisions. Similar to the labral repair, small anchors with thread are placed in the bone and the tissue is tied back down to the bone. The surgery typically takes about an hour and a half, you will go home the same day. You will be in a sling for four to six weeks and typical recovery is four to six months, but you will continue to improve for up to a year.
Arthritis of the shoulder is less common than the hip or knee, but can still cause significant pain and disability. Once the protective cartilage in the shoulder is gone, there unfortunately is little we can do to replace it. In the early stages of arthritis, you may be a candidate for an arthroscopic procedure to clean out debris and debride any loose flaps of cartilage. In more advance cases, a shoulder replacement provides the most predictable long-term relief of your symptoms.
Shoulder replacement comes in three basic types:
- Hemi-arthroplasty replaces just the upper part of the arm bone (humerus) and is most often used to treat younger patients with arthritis that is primarily on the ball part of the socket.
- Total shoulder arthroplasty is typically reserved for the older population as it is not well tolerated in the younger, active population. It is very successful in treating the pain related to shoulder arthritis.
- Reverse total shoulder replacement is used in those patients that do not have a functioning rotator cuff. Each of these procedures typically requires overnight stay in the hospital, recovery is typically three to four months.