Shoulder Debridement

Debridement is a procedure done arthroscopically to remove debris or the damaged tissue or cartilage from inside a joint thereby effectively repairing the injured joint. Used for treating various joints in the body, the debridement procedure is also specifically used to treat shoulder conditions. This minimally invasive procedure is perhaps the most conservative treatment options used to treat any type of injury or trauma of the shoulder joint. Debridement is ideal for injury from accident or even in the case of joint deterioration in the tissues due to old age and also in the filing down bone spurs.

Debridement is especially recommended in cases like damage from wear and tear of the shoulder joint, rotator cuff tears, or when there is limited range of motion and shoulder pain and in early glenohumeral osteoarthritis. Shoulder debridement is done after making a small incision to insert a long, slim instrument called an arthroscope. The arthroscope has a small camera with a light at the end and captures live images of the joint interior and this is broadcast on a monitor. The shoulder joint may be filled with a fluid that can make the surgeon see and repair the damage. The patient will be given anesthesia before the tissue is manipulated. After the shoulder debridement procedure, the fluid pumped into the joint is drained, tools are removed, and the incisions are closed with surgical staples or sutures. A bandage is applied to the shoulder, and the patient is given pain relievers. The stitches are usually removed in two to three weeks. The procedure is a quick one and as very little damage is done to the surrounding muscle and tissue, the recovery after shoulder debridement is fast. Most people can go home the same day after the surgery.

In the case of glenohumeral osteoarthritis, debridement is helpful when nonoperative treatment has not worked. If the humeral head and glenoid is still concentric, and if there is still a visible joint space on an axillary radiograph the procedure will work but not when there is a severe joint incongruity or large osteophytes. Arthroscopic debridement should be done before there is extensive cartilage erosion in the joint so the function of the joint can be retained. Removing bone spurs and other tissue can offer pain relief and slow down the erosion of cartilage.

Along with alleviating pain an extensive debridement shoulder surgery can also restore the range of motion in the shoulder. This operation works well for those who have a rotator cuff tear that isn’t able to be formally repaired. The operation should be accompanied by physiotherapy to help get the rest of the shoulder muscles moving to the best of their abilities. Rehabilitation is important for regaining motion, strength and function of the shoulder after arthroscopic debridement surgery. A sling may be used for comfort during the initial days after the procedure. Range of motion exercises may be started to prevent the shoulder from getting stiff and losing mobility. The rehabilitation program will slowly progress to more strengthening and control type exercises.

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Q&As on Shoulder Osteotomy

1.How much discomfort will I have after my shoulder osteotomy?

Depending on the patient, this may vary significantly. Following surgery, you will be given painkillers to take, along with advice on how to ice your shoulder to reduce any swelling that may have occurred. During your physical therapy sessions, you must move the shoulder joint to regain complete arm mobility.

You should take your pain medication 45 minutes before the beginning of treatment sessions since this might worsen your discomfort. Your need for painkillers will decrease with time.

2.Is there any chance of a blood clot after shoulder osteotomy?

Having blood clots form after shoulder surgery is relatively uncommon. Deep vein thromboses (DVTs) or blood clots are substantially more prevalent after hip or knee surgery.

TED stockings, calf compression pumps, early mobilization, and drugs like heparin, clexane, and aspirin are some standard precautions to lower the risk of blood clots developing.

The danger of blood clots developing may be decreased by taking the straightforward over-the-counter drug aspirin.

3.What are the rehabilitation stages after shoulder osteotomy?

You will be led through each step of recovery by your physical therapist, such as: 

Immobilization: Using a sling to keep your shoulder still for a few weeks while your joint recovers.

Passive exercise: Begins a few weeks following surgery and relies on the help and support of your physical therapist or special equipment to move your arm slowly.

Active exercise: Up to three months after surgery, do a functional activity that involves moving your shoulder and arm with your muscles.

Gentle stretches and weightlifting exercises may help you improve your range of motion and build endurance as you progress in your recovery. Some of these workouts are easier on your shoulder if you do them in a pool.

4.What is the significance of vertical scapular osteotomy?

The most typical congenital abnormality of the shoulder complex is a spangled shape. Surgical solutions range from removing the angle to more involved surgeries such as a subtotal scapulectomy. A relocation technique that may enhance both appearance and functionality is called a vertical scapular osteotomy (VSO).

After VSO, it is possible to descend the scapula more cosmetically with minimal risk of neurovascular issues. This procedure could be used to fix the scapular rotation.

5.What is the significance of humeral osteotomy?

The humeral osteotomy is done in order to improve the range of motion in the afflicted shoulder’s external rotation. When performed on the glenohumeral joint, osteotomy actually increases the degree to which the humeral head is dislocated posteriorly. The humeral head is displaced and sitting in a more posterior position than usual. This osteotomy has always been the recommended course of therapy for older children. The outcomes of this osteotomy have been quite pleasing, with improvements in the shoulder joint’s external rotation and abduction to a lesser extent. The deltoid muscle’s improved mechanical alignment has been linked to an improvement in abduction.

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