Shoulder

Shoulder pain can be caused by trauma or injury, osteoarthritis or by wear on the shoulder joint that occurs over time. DMC Orthopaedic Surgeons and specialists use state-of-the-art procedures to treat shoulder pain, allowing you the freedom to return to your normal activities quickly and without pain.

Procedures include:

Rotator Cuff Repair

One of the most important parts of the shoulder, your rotator cuff consists of muscles and tendons that hold the shoulder in place and allow you to lift your arm and reach up. An injury to the rotator cuff, such as a tear, may happen suddenly when falling on an outstretched hand, or develop over time due to repetitive activities.

Rotator cuff degeneration and tears may also be caused by aging. Rotator cuff tears are painful, and you may not be able to raise your arm or put weight on your shoulder. Signs of a torn rotator cuff may include:

  • pain when you lift or lower your arm
  • weakness when you lift or rotate your arm
  • crackling sensation when you move your shoulder in certain positions

Experienced DMC orthopaedic surgeons can use a minimally invasive technique, arthroscopic rotator cuff repair, to effectively eliminate your pain while restoring strength and function to your shoulder. The advantages of arthroscopic rotator cuff repair are less pain, less scarring and a faster recovery.

Treatment

Surgical techniques that may be used to repair a tear of the rotator cuff include arthroscopy, open surgery, or a combination of both. The goal of rotator cuff repair surgery is to help restore the function and flexibility of the shoulder and to relieve the pain that cannot be controlled by other treatments.

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Shoulder Resurfacing

In some situations, joint resurfacing can be an alternative to total joint replacement surgery. This surgical procedure replaces only the diseased part of the joint instead of the entire joint, allowing you to retain much of your natural tissue. Shoulder resurfacing can often delay total shoulder replacement, and is a good option for younger, more active patient.
The procedure is an option for patients with:

  • osteoarthritis
  • rheumatoid arthritis
  • fractures of the head of the humerus or upper arm bone
  • mild to moderate joint wear
  • loss of cartilage
  • stiffness
  • loss of function
  • pain that does not respond to other treatments

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Total Reverse Shoulder Replacement

Called a “reverse shoulder replacement,” this procedure alters the mechanics of the shoulder by reversing the normal position of the ball and socket. Rotator cuff problems can occur due to injury or degenerative changes, resulting in tendon tears and arthritis. In cases where the tendon can’t be repaired surgically, a reverse shoulder replacement is a good alternative because it is the deltoid muscle instead of the rotator cuff that moves your shoulder. It increases your stability, restores motion and relieves pain.

Reverse total shoulder replacement may be an option for people who have:

  • completely torn rotator cuffs
  • the effects of severe arthritis (cuff tear arthropathy)
  • had a previous shoulder replacement that failed

Older people who have significant pain and little to no movement in their shoulder are the best candidates. It is ideal for patients with chronic, longstanding rotator cuff tears coupled with arthritis.

Treatment

In the healthy shoulder, the upper arm bone (humerus) ends in a ball shape. This fits into a socket formed by the shoulder blade (scapula). Together this ball and socket form the shoulder.

The Reverse Shoulder prosthesis “reverses” the way the shoulder works with an implant designed on which the socket and metal ball are switched. The ball portion attaches to the scapula and the socket attaches to the humerus. Reversing the shoulder anatomy allows your deltoid muscle to lift your arm, instead of the rotator cuff. As a result, your range of motion will greatly increase and your pain should disappear.

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Total Shoulder Replacement

If you suffer from arthritis of the shoulder joint, then total shoulder replacement surgery may be right for you. Arthritis affects the cartilage in your joints, causing it to wear away so there is no protective lining between your bones.

Total shoulder replacement surgery alleviates pain by replacing the damaged bone and cartilage with an implant. During surgery, the ball is removed from the top of the humerus (long bone in the arm or forelimb that runs from the shoulder to the elbow) and replaced with a metal implant. The socket portion of the joint is shaved clean and replaced with a plastic socket that is cemented into the shoulder blade.

If you have tried the usual treatments for shoulder arthritis, but have not been able to find adequate relief, you may be a candidate for total shoulder replacement surgery. Other reasons for surgery include:

  • osteoarthritis (degenerative joint disease)
  • rheumatoid arthritis
  • post-traumatic arthritis
  • rotator cuff tear arthropathy (a combination of severe arthritis and a massive non-reparable rotator cuff tendon tear)
  • failed previous shoulder replacement surgery

Symptoms

X-ray evidence of joint damage is one of the criteria used to decide who should have this surgery. However, symptoms of pain and decreased mobility are more important:

  • severe pain during activity
  • pain walking or getting up from a chair
  • pain that prevents movement
  • pain that prevents sleeping

Treatment

In this operation, a surgeon replaces the shoulder joint with an artificial ball for the top of the humerus and a cap (glenoid) for the scapula. The success of the operation often depends on the condition of rotator cuff muscles prior to surgery.

Physical therapy is a critical part of recovery from shoulder replacement. Patients can start passive shoulder exercises, in which someone else moves the joint for you, soon after surgery and will continue physical therapy for up to 12 weeks. There still may be some pain in the two to three months after surgery, however, it's usually a different type of pain and will go away as the recovery period continues.

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