Arthroscopic acromioplasty, also known as subacromial decompression, is an arthroscopic procedure on the part of the shoulder (the acromion) that extends over the shoulder joint. The surface of the acromion often becomes rough and develops bone spurs due to overuse, age, or other conditions, often leading to a narrowed space and restricting movement. This shoulder impingement (also known as bursitis or tendonitis,) causes the tendons to become inflamed and restricts the shoulder’s full range of motion. The shoulder surgeon will make several small incisions in the shoulder, and while using a small video camera, remove or shave parts of the acromion in order to relieve the pressure and provide more room for the rotator cuff. Many patients will experience relief immediately following the shoulder scope; however, it may take a few months for the symptoms to subside and for the patient to regain range of motion. Light work can often be done a few days after surgery. Physical therapy plays a key role in shoulder surgery recovery. The chances of a full recovery greatly increase if the patient is committed to their physical therapy exercises. Most patients will begin their rehabilitation program immediately following their shoulder scope. Patients will remain in therapy from 4-6 weeks, depending on the amount of repair done during surgery.
Rotator Cuff Surgery
The rotator cuff is a group of muscles that provide the shoulder joint stability, strength, and movement. Acute injury, aging, or overuse can cause damage to the rotator cuff resulting in decreased mobility, weakness, and pain. There are many rotator cuff injury symptoms.
• Pain and muscle spasms in the upper arm and shoulder
• Shooting pain in the upper front and back of the shoulder
• Inability to raise the shoulder outward to the side
• Inability to sleep due to shoulder pain and discomfort (night pain)
• Shoulder weakness
• Deep pain in the deltoid muscle (outside upper arm muscle)
The SportsMED shoulder surgeons recommend rest, ice, and anti-inflammatories for shoulder pain. Physical therapy and range of motion exercises can help regain shoulder strength and mobility. Steroid injections can also provide pain relief. If the pain persists or prevents daily activities and overhead reaching, contact your physician.
If the treatments listed above do not provide pain relief, then a physician can perform a physical evaluation of the shoulder and may order additional tests to help determine if the rotator cuff has been torn and needs to be surgically repaired. There are two types of rotator cuff surgeries, open and arthroscopic. The surgeon will decide which option to use based on the patient’s anatomy, severity of the tear, and quality of the tendon, to name a few. Patients that have a torn rotator cuff often have osteoarthritis in the shoulder, other soft tissue tears, and bone spurs. Surgeons will often do a debridement during a rotator cuff repair surgery to help clean up and remove some of these problems.
In an open rotator cuff repair, the surgeon makes an incision in the front of the shoulder and cuts through the deltoid muscle to gain access to the shoulder tendons. Once inside the shoulder, the surgeon will remove any scar tissue or bone spurs affecting the area. If the acromion (the area between the upper arm and the shoulder blade) is narrowed and pinching the tendons, the surgeon will shave part of the bone in order to make more room for movement. This procedure is called an acromioplasty. After the shoulder has been cleaned of debris, the tendon is attached to the bone with small anchoring screws.
Depending on the size and severity of the tear, the physician may decide to perform the rotator cuff repair arthroscopically. A small incision is made in the shoulder and a small camera is inserted through a pencil sized tube. Using a video monitor as a guide, the surgeon will then repair the tendon through the small incision using suture anchors.
Recovery from Rotator Cuff Surgery
Patients undergoing an open repair may be required to spend the night in the hospital. Arthroscopic patients generally go home the same day as their procedure. Patients will go home with their arm in a sling to restrict the shoulder from moving. Patients should avoid moving the shoulder above the head or away from their body until cleared by the physician. The physician will instruct the patient when it is safe to drive.
Physical therapy plays a vital role in rotator cuff recovery. A patient will be prescribed physical therapy following surgery. The therapist will assist the patient with exercises to improve strength and mobility and to also prevent scar tissue from forming in the shoulder. The injured arm should only be used for this therapy. Writing and other small movements from the elbow to the hand are permitted, but any exercise causing shoulder movement should only be done under the care and permission of the physical therapist. Physical therapy is prescribed for 6-12 weeks. Rotator cuff recovery varies for each patient. A full recovery can range from 4-12 months.
The shoulder joint is a ball and socket joint covered in smooth cartilage which allows the arm to move. Conditions such as osteoarthritis, rheumatoid arthritis, trauma, and rotator cuff tears can cause damage to the joint and affect the shoulder’s mobility. Osteoarthritis is the most common cause for patients needing a shoulder replacement. Symptoms of osteoarthritis in the shoulder consist of shoulder pain, decreased shoulder mobility, grinding noise upon shoulder movement, difficulty sleeping at night due to shoulder pain, and the shoulder locking or popping upon movement. The physician will perform a physical exam to evaluate the shoulder’s mobility and may order tests, such as an X-RAY or an MRI, to help determine the severity of damage in the joint. The physician may try prescribing anti-inflammatories, injections, and physical therapy to help alleviate pain and improve mobility. If the patient’s arthritis has progressed to the bones rubbing against each other (often referred to as bone on bone) then physical therapy may be too painful and surgery is the next option.
If non-surgical options fail then shoulder replacement surgery may be needed. Shoulder replacement surgery removes the damaged portions of the shoulder and replaces them with plastic or metal implants. The humerus and the scapula make up the shoulder ball and socket joint. A metal implant replaces the ball portion of the humerus. The metal ball is attached to a metal stem which is inserted down the middle of the humerus. The scapula is then smoothed using shaving instruments and a plastic socket implant is inserted. Implants are usually secured using bone cement, but, occasionally, if the bone has little damage, press-fit implants are used. The surgeon may decide that a partial replacement is needed where only the ball portion of the joint is replaced. This is often used when the shoulder was fractured and the socket remained in good condition.
A relatively new procedure, called a reverse total shoulder replacement, was approved by the FDA in 2004. Reverse replacements are often used for patients with fully torn rotator cuffs accompanied by severe osteoarthritis, or a patient that has a failed traditional replacement. Patients that would not experience pain relief from a traditional shoulder replacement and have severe damage to the rotator cuff are often candidates. In a reverse shoulder, the metal ball portion of the implant is inserted in the shoulder socket (the glenoid) and the plastic socket is inserted in the upper part of the humerus. This allows the patient to use the deltoid muscle to lift the arm instead of the rotator cuff, which is often beyond a full repair. Each shoulder patient’s treatment is individualized and your surgeon will decide which option is best for you.
Recovery from Shoulder Replacement Surgery
Patients will begin physical therapy (also known as rehabilitation) the first day following surgery. Physical therapy plays a vital role in the success of a shoulder replacement. Patients will have their arm in a sling for the first few weeks following their surgery. Most patients will be able to return to simple daily activities, such as eating, bathing, writing, etc., after 2-3 weeks. Your physician will let you know when it is safe for you to drive, which is normally around 6 weeks post-op. While all patients recover differently, a full recovery from a shoulder replacement can range from 6-12 months.
Because of the very shallow shoulder socket, the humeral head is susceptible to "going out of place." Patients who present a history that their shoulder "popped out and then went back in," probably experienced subluxation of the joint which means the head slipped out onto the rim of the socket and then reduced back into place on its own. When the humeral head comes completely out of socket for the first time, it's virtually impossible for the acutely injured patient to reduce the dislocation themselves and medical assistance is required. This can be extremely painful. Treatment of subluxations or dislocations after the shoulder is back in place requires ice, two to three weeks immobilization, and follow-up therapy to get the shoulder back to its normal motion and strength. Patients are warned that this injury often results in recurrent instability and may later require surgical stabilization that must address the torn ligament that are supposed to hold the humeral head in the socket.
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