Shoulder surgery

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Shoulder surgery
ICD-9-CM 81.80-81.83, 81.23

Shoulder surgery is a means of treating injured shoulders. Many surgeries have been developed to repair the muscles, connective tissue, or damaged joints that can arise from traumatic or overuse injuries to the shoulder.

Contents

Dislocated shoulder

A dislocated shoulder can be treated with:

In some cases, arthroscopic surgery is not enough to fix the injured shoulder. When the shoulder dislocates too many times and is worn down, the ball and socket are not lined up correctly. The socket is worn down and the ball will never sit in it the same. After many dislocations the shoulder bones will begin to wear down and chip away. When this occurs, another operation must be done.[ citation needed ]

Coracoid of left Scapula Coracoid process of left scapula - animation01.gif
Coracoid of left Scapula

The operation is called the Latarjet surgery. The procedure involves transfer of the coracoid with its attached muscles to the deficient area over the front of the glenoid. This replaces the missing bone and the transferred muscle also acts as an additional muscular strut preventing further dislocations. It is an open surgery and requires an overnight hospital stay and usually a 4-6 month recovery. [2]

The recovery depends upon many factors, including where the tear was located, how severe it was, and how good the surgical repair was.[ citation needed ]

It is believed that it takes at least four to six weeks for the labrum to re-attach itself to the scapula bone (shoulder blade), and probably another four to six weeks to get strong. The labrum is a ring of cartilage on the rim of a shallow socket in the scapula into which the head of the upper arm bone normally fits and rotates.[ citation needed ]

Once the labrum has healed to the rim of the shoulder blade, it should see stress very gradually so that it can gather strength. It is important not to re-injure it while it is healing. How much motion and strengthening of the arm is allowed after surgery also depends upon many factors, and it is up to the surgeon to let you know your limitations and how fast to progress.[ citation needed ]

Because of the variability in the injury and the type of repair done, it is difficult to predict how soon someone can to return to activities and to sports after the repair. The type of sport also is important, since contact sports have a greater chance of injuring the labrum repair. However, a vast majority of patients have full function of the shoulder after labrum repair, and most patients can return to their previous level of sports with no or few restrictions. [3]

Surgical treatment of the shoulder due to potential biceps tendonitis or a tear of the labrum otherwise known as a SLAP tear. The long head of the biceps passes through the shoulder joint and attaches to the labrum. During a biceps tenodesis procedure, the surgeon cuts the attachment of the biceps tendon from the labrum and reattaches it to the humerus bone by tacks. By doing this, pressure is relieved from the labrum significantly reducing pain. This surgery is performed to alleviate biceps inflammation and can be implemented in correspondence to a SLAP lesion surgery. Recovery is approximately 4–8 months depending on the individual and requires physical therapy. [4]

Separated shoulder

A separated shoulder can be treated with:[ citation needed ]

Sternoclavicular separation

Sternoclavicular separation can be treated.

Tendinitis, bursitis, and impingement syndrome

The rotator cuff can cause pain in many different ways including tendonitis, bursitis, calcific tendonitis, partial thickness tears, full thickness tears or mechanical impingement. [5] Tendinitis, bursitis, and impingement syndrome can be treated with tendon repairand the Mumford procedure or acromioplasty.[ citation needed ]

Rotator cuff tear

A rotator cuff tear can be treated with arthroscopic rotator cuff repair.[ citation needed ]

Fracture

A shoulder fracture can be treated with open reduction internal fixation (ORIF).

Arthritis of the shoulder (glenohumeral joint)

Arthritis of the shoulder can be treated with total shoulder replacement, hemiarthroplasty (half a replacement), or a reverse shoulder implant (for arthritis with large rotator cuff tear).

Arthritis or osteolysis of the acromioclavicular joint

Arthritis or osteolysis of the acromioclavicular joint can be treated with the Mumford procedure (open or arthroscopic).

Scapular Winging

Scapular winging due to serratus anterior muscle (long thoracic nerve) palsy can be treated with a pectoralis major transfer.

Scapular winging due to trapezius muscle (spinal accessory nerve) palsy can be treated with an Eden-Lange procedure.

Scapular winging due to facioscapulohumeral muscular dystrophy can be treated with a scapulopexy or scapulothoracic fusion.

See also

Related Research Articles

<span class="mw-page-title-main">Rotator cuff</span> Group of muscles

The rotator cuff is a group of muscles and their tendons that act to stabilize the human shoulder and allow for its extensive range of motion. Of the seven scapulohumeral muscles, four make up the rotator cuff. The four muscles are:

<span class="mw-page-title-main">Coracoid process</span> Small hook-like structure on the lateral edge of the superior anterior portion of the scapula

The coracoid process is a small hook-like structure on the lateral edge of the superior anterior portion of the scapula. Pointing laterally forward, it, together with the acromion, serves to stabilize the shoulder joint. It is palpable in the deltopectoral groove between the deltoid and pectoralis major muscles.

<span class="mw-page-title-main">Shoulder problem</span> Medical condition

Shoulder problems including pain, are one of the more common reasons for physician visits for musculoskeletal symptoms. The shoulder is the most movable joint in the body. However, it is an unstable joint because of the range of motion allowed. This instability increases the likelihood of joint injury, often leading to a degenerative process in which tissues break down and no longer function well.

<span class="mw-page-title-main">Shoulder</span> Part of the body

The human shoulder is made up of three bones: the clavicle (collarbone), the scapula, and the humerus as well as associated muscles, ligaments and tendons.

<span class="mw-page-title-main">Rotator cuff tear</span> Shoulder injury

Rotator cuff tendinopathy is a process of senescence. The pathophysiology is mucoid degeneration. Most people develop rotator cuff tendinopathy within their lifetime.

<span class="mw-page-title-main">Teres minor muscle</span> Muscle of the rotator cuff

The teres minor is a narrow, elongated muscle of the rotator cuff. The muscle originates from the lateral border and adjacent posterior surface of the corresponding right or left scapula and inserts at both the greater tubercle of the humerus and the posterior surface of the joint capsule.

<span class="mw-page-title-main">Supraspinatus muscle</span> Muscle of the upper back

The supraspinatus is a relatively small muscle of the upper back that runs from the supraspinous fossa superior portion of the scapula to the greater tubercle of the humerus. It is one of the four rotator cuff muscles and also abducts the arm at the shoulder. The spine of the scapula separates the supraspinatus muscle from the infraspinatus muscle, which originates below the spine.

<span class="mw-page-title-main">Shoulder joint</span> Synovial ball and socket joint in the shoulder

The shoulder joint is structurally classified as a synovial ball-and-socket joint and functionally as a diarthrosis and multiaxial joint. It involves an articulation between the glenoid fossa of the scapula and the head of the humerus. Due to the very loose joint capsule that gives a limited interface of the humerus and scapula, it is the most mobile joint of the human body.

<span class="mw-page-title-main">Subscapularis muscle</span> Large triangle muscle of the shoulder

The subscapularis is a large triangular muscle which fills the subscapular fossa and inserts into the lesser tubercle of the humerus and the front of the capsule of the shoulder-joint.

<span class="mw-page-title-main">Shoulder girdle</span> Set of bones which connects the arm to the axial skeleton on each side

The shoulder girdle or pectoral girdle is the set of bones in the appendicular skeleton which connects to the arm on each side. In humans it consists of the clavicle and scapula; in those species with three bones in the shoulder, it consists of the clavicle, scapula, and coracoid. Some mammalian species have only the scapula.

<span class="mw-page-title-main">SLAP tear</span> Medical condition

A SLAP tear or SLAP lesion is an injury to the superior glenoid labrum that initiates in the back of the labrum and stretches toward the front into the attachment point of the long head of the biceps tendon. SLAP is an acronym for "Superior Labrum Anterior and Posterior". SLAP lesions are commonly seen in overhead throwing athletes but middle-aged labor workers can also be affected, and they can be caused by chronic overuse or an acute stretch injury of the shoulder.

<span class="mw-page-title-main">Glenoid fossa</span> Part of the shoulder

The glenoid fossa of the scapula or the glenoid cavity is a bone part of the shoulder. The word glenoid is pronounced or and is from Greek: gléne, "socket", reflecting the shoulder joint's ball-and-socket form. It is a shallow, pyriform articular surface, which is located on the lateral angle of the scapula. It is directed laterally and forward and articulates with the head of the humerus; it is broader below than above and its vertical diameter is the longest.

<span class="mw-page-title-main">Glenoid labrum</span> Structure on the shoulder blade

The glenoid labrum is a fibrocartilaginous structure attached around the rim of the glenoid cavity on the shoulder blade. The shoulder joint is considered a ball-and-socket joint. However, in bony terms the 'socket' is quite shallow and small, covering at most only a third of the 'ball'. The socket is deepened by the glenoid labrum, stabilizing the shoulder joint.

<span class="mw-page-title-main">Separated shoulder</span> Medical condition

A separated shoulder, also known as acromioclavicular joint injury, is a common injury to the acromioclavicular joint. The AC joint is located at the outer end of the clavicle where it attaches to the acromion of the scapula. Symptoms include non-radiating pain which may make it difficult to move the shoulder. The presence of swelling or bruising and a deformity in the shoulder is also common depending on how severe the dislocation is.

<span class="mw-page-title-main">Dislocated shoulder</span> Injury

A dislocated shoulder is a condition in which the head of the humerus is detached from the glenoid fossa. Symptoms include shoulder pain and instability. Complications may include a Bankart lesion, Hill-Sachs lesion, rotator cuff tear, or injury to the axillary nerve.

<span class="mw-page-title-main">Bankart lesion</span> Medical condition

A Bankart lesion is a type of shoulder injury that occurs following a dislocated shoulder. It is an injury of the anterior (inferior) glenoid labrum of the shoulder. When this happens, a pocket at the front of the glenoid forms that allows the humeral head to dislocate into it. It is an indication for surgery and often accompanied by a Hill-Sachs lesion, damage to the posterior humeral head.

<span class="mw-page-title-main">Shoulder replacement</span>

Shoulder replacement is a surgical procedure in which all or part of the glenohumeral joint is replaced by a prosthetic implant. Such joint replacement surgery generally is conducted to relieve arthritis pain or fix severe physical joint damage.

<span class="mw-page-title-main">Shoulder impingement syndrome</span> Medical condition

Shoulder impingement syndrome is a syndrome involving tendonitis of the rotator cuff muscles as they pass through the subacromial space, the passage beneath the acromion. It is particularly associated with tendonitis of the supraspinatus muscle. This can result in pain, weakness, and loss of movement at the shoulder.

The Latarjet operation, also known as the Latarjet-Bristow procedure, is a surgical procedure used to treat recurrent shoulder dislocations, typically caused by bone loss or a fracture of the glenoid. The procedure was first described by French surgeon Dr. Michel Latarjet in 1954.

<span class="mw-page-title-main">Reverse shoulder replacement</span> Surgical procedure on the shoulder

Reverse shoulder replacement is a type of shoulder replacement in which the normal ball and socket relationship of glenohumeral joint is reversed, creating a more stable joint with a fixed fulcrum. This form of shoulder replacement is utilized in situations in which conventional shoulder replacement surgery would lead to poor outcomes and high failure rates.

References

  1. ↑ "Shoulder Scope".
  2. ↑ "Latarjet-Bristow Procedures | ShoulderDoc". www.shoulderdoc.co.uk. Retrieved 2015-05-09.
  3. ↑ "Labrum tear Johns Hopkins Orthopaedic Surgery". Archived from the original on 2011-11-20. Retrieved 2009-05-04.
  4. ↑
  5. ↑ "Rotator Cuff Pain".
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