The shoulder is a remarkably flexible joint that is supported by substantial muscular strength in most directions, but over time inside and outside of that joint is susceptible to wear, which often leads to persistent, chronic pain. 

Sauk Prairie Healthcare Orthopedic surgeons specialize in finding solutions to joint pain, including shoulder surgery. Treatment options range from non-invasive solutions to arthroscopy and in many cases total shoulder replacement or total reverse shoulder replacement. 

Anatomy of the Shoulder

The shoulder is made up of three separate joints and layers of tissue holding those bones in place. 

The glenohumeral joint is what many think of as the shoulder: the meeting of the ball at the top of the upper arm, or humerus, with the glenoid, the socket of the scapula, widely known as the shoulder bone. The acromioclavicular joint, or AC joint, connects the clavicle, or collar bone, and the scapula. The scapulothoracic joint is not a true joint, but is made up of the shoulder blade meeting the rib cage in a “sliding joint” over the back of several the ribs. 

The shoulder is powered and held together by several groups of muscles and tissue. The outside part of the shoulder is made up of the large muscles of the deltoid, trapezius, and pectoralis. The middle layer is made up of the rotator cuff, which includes four small muscles surrounding the glenohumeral joint, keeping the “ball” of the joint in place. The inside layer of tissue is made up of ligaments between the humerus and the glenoid to keep the joint from dislocating. 

Rotator Cuff Tear

One of the most common surgical procedures in the United States is rotator cuff repair. When the rotator cuff tendon connecting the shoulder to the humerus is torn, by long-term wear or a sudden injury like a fall, it is often necessary to surgically repair the tissue or even reattach it to the bone. 

A partial tendon tear can often be treated by non-invasive methods, such as rest, icing and physical therapy. If shoulder pain and limited joint mobility continue to be a problem after about six months and despite conservative treatment, your Sports Medicine doctor may refer you to an Orthopedic surgeon. 

If the cause of your shoulder pain is a partial tear of the rotator cuff tendon, your Orthopedic surgeon may recommend an arthroscopic procedure to repair the tissue. During arthroscopic rotator cuff surgery, the patient will be given general anesthetic and “put to the sleep” during the surgery, or given a nerve blocker. 

Small incisions are made on either side of the shoulder and an endoscope, a small pencil-sized camera, is inserted in one side so the surgeon can view the joint on an attached monitor. Tiny surgical tools are inserted through the other incision, which the surgeon uses to trim and smooth tissue, otherwise called debridement, remove bone spurs, and stitch the tendon together at the site of the injury. 

In the event of a complete tear, separating the tendon from the bone, anchors are drilled into the top of the humerus bone and used to stitch the tendon back into place. 

If the injury requires a more complicated procedure, open surgery may be necessary, though arthroscopic surgery is far more common. Arthroscopic treatment allows for smaller incisions, less muscular damage and faster healing time. 

Although post-operative infection is rare in either case, infection is even less likely following minimally invasive arthroscopic procedures. 

The surgery can often be performed on an outpatient basis, with the patient returning home the same day. Recovery includes several weeks of the shoulder being immobilized with movement slowly reintroduced, first by passive exercise, guided by a physical therapist, leading to active exercise, building arm strength and control.  

Recovery times and experiences vary from person to person, though progress often depends greatly a person’s consistency following through with recommended physical therapy and at-home exercises. 

Shoulder Arthritis

Shoulder arthritis is less common than arthritis in the hip or knee, but the shoulder can be prone to several kinds of chronic joint pain. 

Rheumatoid arthritis is an autoimmune disease, which causes the body’s immune system to attack the synovium, or soft tissue that lines the joints. This causes swelling, resulting in pain and stiffness in the joint. 

Posttraumatic arthritis is a long-term condition caused by an acute injury that damages the cartilage and other tissue around the joint, causing an increase in friction and degradation of the tissue and then the bone. 

Avascular necrosis is weakness and decay in the bone caused by a lack of blood flow to the area. This can be caused by steroid use, alcoholism, sickle cell disease, or a traumatic injury that interrupts blood vessels in the area. 

The most common form of shoulder arthritis is osteoarthritis, or degenerative joint disease, known as wear-and-tear arthritis. Symptoms of osteoarthritis include: 

  • Loss of strength
  • Loss of mobility
  • Crepitus, or a crackling sound with movement
  • Joint enlargement
  • Pain in the form of a deep ache at the back of the shoulder
  • When the AC joint is affected, pain on top of the shoulder radiating up the side of the neck 

Arthritis is a degenerative condition and cannot be reversed or cured, but a range of options are available for treatment. Your Orthopedic surgeon will often begin treatment recommending or finding out if you have already tried non-invasive treatment, which can include change in activity, physical therapy, and non-steroid anti-inflammatory medication such as ibuprofen. 

Arthritis symptoms can be treated with minimally invasive arthroscopic surgery, in which tiny tools are guided by a pencil-sized camera fed through a tube, with images coming through to a monitor that the surgeon will view during the procedure. During the operation the surgeon removes frayed cartilage, bone spurs, and loose bone and tissue, which can get in the way of smooth motion of the joint. 

Late and end-stage arthritis is often treated through arthroplasty, or shoulder replacement surgery, which can be performed in several variations such as the traditional shoulder replacement, reverse arthroplasty, or hemi-arthroplasty. 

Recurrent Shoulder Dislocation

When a young person is treated for a dislocated shoulder, the first priority is getting the shoulder back into its socket, but this is often followed by discussion of possible treatment to prevent recurrent shoulder dislocation. 

Shoulder dislocations are an unusual case in which a younger patient is likely to be a more suitable candidate for joint repair surgery than an older patient. The reason for this is that a younger person, like a teenage athlete who has suffered a dislocated shoulder, is more likely to have the injury repeated in the future, causing other chronic injuries, as compared to someone who is in their 30s seeing a doctor for a shoulder dislocation for the first time. 

Studies have also shown a trend of earlier surgical intervention proving to be more economical and more effective in the long run. While a common approach to shoulder dislocation treatment in young people is to treat the first instance as a stand-alone case and wait to see if a second dislocation marks a need for further discussion, some Orthopedic surgeons have made the case for pursuing surgical repair after the first dislocation. 

Chronic shoulder instability is often accompanied by symptoms such as: 

  • Feeling of looseness in the joint
  • A “dead arm” sensation
  • Among athletes, issues of not being able to throw objects as far, fast or accurately as before their shoulder injury 

A common shoulder repair is arthroscopic stabilization, or Bankart repair, also called arthroscopic labral repair. In this procedure an Orthopedic surgeon, using arthroscopic tools, installs about three or four anchors in the bone, which are used to fix the damaged labral tissue in place, supporting the shoulder joint. 

If there is bone injury, soft tissue repair may not be enough to keep the joint in place. Given the large surface area of the ball of the upper arm compared to the cup of the shoulder joint, the arrangement is often compared to a golf ball and a tee. 

When there is damage to the edge of the tee, or the joint, the ball will no longer reliably stay centered in place. During a Latarjet shoulder stabilization procedure, the Orthopedic surgeon will cut a piece of shoulder bone with muscle from the coracoid process, grafting it to the broken part of the glenohumeral joint, and giving extra support by the movement of muscle tissue. 

Shoulder surgery is often preceded by physical therapy to prepare the shoulder for repair, with therapy continuing after the procedure and initial recovery period. Patients are usually able to return to full activity, but should avoid contact sports for about six months. 

Post-operative shoulder dislocation remains a possibility, but reduces from a recurrent issue to only reappearing in approximately 10% to 15% of patients. 

After a full recovery over 90% of athletes are able to return to full activity, though some are unable to return to the same level of play as before their injury. 

In some cases of repeated shoulder dislocation involving chronic joint injury, arthroplasty, or joint replacement surgery, may be appropriate. Reverse shoulder replacement surgery is a technique that has been specifically developed to treat those with a combination of joint damage and rotator cuff injury. 

Appropriate treatment of shoulder instability can vary greatly, as in the case of some youth who are able to dislocate joints and pop them back into place without any pain. Although many doctors would not recommend they make a habit of that kind of “party trick,” it is often evidence of naturally loose joints more than a serious condition, and in some cases can be attributed to an athletic edge in certain sports like swimming or gymnastics. 

How Sauk Prairie Healthcare Treats Shoulder Injuries

The shoulder treatment experts at Sauk Prairie Healthcare can offer a range of solutions for acute and chronic pain relief. 

In the case of more significant joint injuries, your doctor might refer you to an Orthopedic surgeon to discuss options in ligament repair or reconstructive surgery. When chronic pain is returning despite conservative treatment options, a surgeon may recommend arthroscopic treatment as a long-term solution in the way of a minimally invasive surgical procedure.

Where other treatments are not appropriate or have been tried and exhausted, partial or total joint replacement may be a solution for long-term pain relief. If the rotator cuff has been so damaged that it cannot stabilize a joint replacement, a reverse total joint replacement may be an option.

Orthopedic Surgeons:

Andrew Ertl, MD
Matthew Hebert, MD
Diana Kruse, MD
Michael Lamson, MD
David Marcu, MD
Arnold Rosenthal, MD

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