Shoulder Arthroscopy

Shoulder arthroscopy (also known as a “shoulder scope”) is a surgical procedure where a small camera (the arthroscope) is placed inside the shoulder joint to allow complete visualization of the joint and minimally invasive treatment of shoulder problems. Small surgical instruments are placed through tiny skin incisions and are visualized on a TV screen. Shoulder arthroscopy has been continually improved since it’s inception over 30 years ago and has been established as a cornerstone of modern shoulder surgery. Although some conditions of the shoulder cannot be treated with arthroscopy (severe instability, advanced arthritis), repair of a torn rotator cuff, labrum, or the biceps tendon is facilitated and simplified in the hands of a well-trained arthroscopy surgeon. Patients can benefit from less tissue damage, smaller incisions, decreased recovery time, and less scarring from arthroscopic techniques.

Shoulder Replacement

What Is A Shoulder Replacement?

Shoulder replacement, or Total Shoulder Arthroplasty (TSA), is replacing a worn, arthritic shoulder joint with an artificial joint made of metal and plastic parts. Different types of shoulder replacements exist, depending on the condition of the shoulder. These include a total shoulder arthroplasty, reverse total shoulder arthroplasty, and rarely a hemi-arthroplasty (replacing only the ball part of the shoulder joint).

How Do I Know If I Need A Shoulder Replacement?

Shoulder replacement, similar to a knee or hip replacement, was developed to treat end-stage (severe) shoulder arthritis. Arthritis literally means “inflamed joint,” and it can be caused by many different disease processes such as osteoarthritis, rheumatoid arthritis, and post-traumatic (after an injury) arthritis. The most common form is osteoarthritis. The main symptom of an arthritic shoulder is aching pain that is usually worse after periods of rest (stiff in the morning, painful when first using the shoulder). Stiffness is also common complaint and sign of shoulder arthritis. The first-line treatment of shoulder arthritis is modification of your activities and the use of anti-inflammatory medications (ibuprofen, aleve). If the pain in the shoulder is interfering with your quality of life and ability to remain active and healthy despite these treatments, consultation with an orthopedic surgeon regarding a shoulder replacement may be helpful for you to get a better understanding of the procedure.

How Is A Shoulder Replacement Done?

Shoulder replacement is a relatively major surgery, and requires an overnight stay in the hospital. It involves making a 10-12cm incision over the front of the shoulder with removal of the worn out ball and socket of the shoulder joint. These are replaced with a plastic socket (glenoid) and metal ball (humeral head). After perfect positioning of the components is confirmed, the incision is closed and you are brought to recovery. Therapy and motion are started immediately on the day of surgery.

How Long Is The Recovery After A Shoulder Replacement?

Most patients go home the day after surgery and begin physical therapy immediately. The arm can be used for light lifting (coffee cup, getting dressed), but strengthening and certain motions are reserved for 6-8 weeks after surgery. Most patients are very satisfied with the pain relief a shoulder replacement provides. In general, patients should avoid heavy lifting (more than 20-30 lbs) after a shoulder replacement, and should be careful to avoid heavy impact activities. Getting back to surfing, paddling, and swimming should be okay after a shoulder replacement.

SLAP Tears

What Is A SLAP Tear?

The term “SLAP tear” is an acronym for Superior Labrum Anterior to Posterior tear. It refers to a large family of tears to the labrum (thickened cartilage and ligaments) on the upper part of the shoulder joint. Many different types of SLAP tears have been described and they can be associated with other injuries to the shoulder including biceps tendon tears and shoulder dislocations.

How Does A SLAP Tear Occur?

The cause of a SLAP tear depends on multiple factors. It can occur as part of normal wear and tear of the shoulder, or can be caused by a discrete traumatic event like a fall or forceful pulling injury to the arm and shoulder (like trying to catch a heavy falling object).

What Are Some Symptoms Of A SLAP Tear?

Shoulder pain is the most common complaint, and symptoms can worsen with overhead activity or heavy lifting. If the SLAP tear involves the biceps tendon attachment, symptoms similar to a tear of the biceps tendon can also be experienced. In addition, mechanical clicking, catching, and locking of the shoulder can occur if a loose piece of torn labrum interferes with motion in the shoulder joint.

How Are SLAP Tears Treated?

This depends on a few factors, most importantly age, the way the shoulder was injured, and the appearance of the SLAP tear during surgery. In general, SLAP tears in patients over the age of 40 are usually normal changes seen in the labrum as we age. Most often these do not require treatment; however, if surgery is ultimately required, the SLAP tear is “cleaned up” and a biceps tenodesis is often performed. SLAP tears in younger individuals or in patients who had a definite traumatic event that caused the tear may be a candidate for repair. The tear is repaired arthroscopically through three small (1cm) incisions with suture anchors and specialized tools.

What Is The Recovery Like After A SLAP Repair?

Most patients will require 5-6 weeks in a sling with gentle motion activities a few times per day. After this, physical therapy is started to work on regaining motion, and strengthening can usually begin by 2 ½ to 3 months. The biggest concern following a SLAP repair is continued pain and stiffness, and many of our rehabilitation routines are aimed at limiting these complications.

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