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    2019
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Types of Shoulder Surgery

Types of Shoulder Surgery

Many common shoulder problems can be done away with surgery, especially those that are recalcitrant to conservative therapy.  Shoulder surgeries can be quite diverse from minimally invasive arthroscopic procedures, where a scope and surgical instruments are inserted through keyhole incisions in your shoulder, to more traditional open surgeries using scalpel and sutures.  Each approach is different and has its pros, cons, limitations and appropriate uses.

Arthroscopy for impingement syndrome:

Operation to treat the impingement syndrome accounts for one of the most common reasons of shoulder surgery.  This condition occurs when the tendons of your rotator cuff are trapped intermittently which lead to compression during movement.  This causes severe damage to the tendons as well as the bursa which acts as a cushion inside the joint space.  Impingement syndrome is also called rotator cuff tendonitis and bursitis.  The arthroscopic procedure to correct the impingement syndrome is called subacromial decompression.  The purpose of the operation is to increase the space between rotator cuff and the acromion (top of the shoulder).

During the operation, your surgeon may remove the bursa alone or some of the undersurfaces of the acromion, this will provide space for the rotator cuff to glide without getting trapped between bones.

Arthroscopic SLAP repair:

The term SLAP stands for “Superior Labrum Anterior and Posterior.”  A SLAP tear refers to an injury to the rim of the cartilage that encircles the labrum (shoulder socket).  A SLAP tear can happen both in the anterior and the posterior portion of the labrum.  This is an importation area of the labrum as it functions as an attachment point of the biceps tendon.

Arthroscopic surgery helps to restore the labrum back to its original position at the rim of the shoulder socket.  Once reposition is done, sutures would secure the bone to the cartilage.  If the tear extends into the biceps tendon then additional surgery may be needed.

Arthroscopy for shoulder dislocation:

A shoulder dislocation injury happens when the ball of the shoulder joint comes out of the socket.  This type of injury is mainly seen among the athletes with labral damage.  In order to stabilize the shoulder after dislocation, a type of surgery known as Bankart repair is undertaken, which attaches the labrum to the joint capsule to hold the ball in place.

Apart from that the generalized laxity of the shoulder, leading to a condition known as multidirectional instability, can also cause the shoulder joint to come in and out of the socket very easily.  In such cases, surgery may be used to tighten the joint capsule.

Arthroscopy for frozen shoulder:

Frozen shoulder is the second-most common cause of shoulder injury after rotator cuff tear.  Though surgery is not generally required to treat a frozen shoulder, in rare instances surgical treatment is required.  When the capsule surrounding the shoulder joint gets tight and contracted, frozen shoulder happens.  A frozen shoulder surgery intends to loosen the contracted tissues to make way for the smooth movement of the shoulder.

Aggressive physical therapy is also required to restore the full range of motion of the shoulder post operation.

Rotator cuff repairs:

Rotator cuff repairs are one of the most common surgical procedures for the shoulder.  There are many ways to attempt a rotator cuff repair and the choice of the technique depends on the best judgment of the surgeons.  The surgery aims to identify the damaged part of the rotator cuff and to clean and reattach any torn or damaged tendons.  The surgeon will try to repair the damaged tendons without excessively stretching the remaining tissues.

The conservative approach is an open rotator cuff repair, where a surgical incision is made to detach the surrounding muscle and repair the rotator cuff directly.  The newer technique is repairing it arthroscopically, usually for smaller injuries.

Acromioclavicular (AC) joint repairs:

The acromioclavicular joint is the junction of the end of the collarbone and acromion.  Several problems can occur at the AC joint, the first being wearing out and the other one being distal clavicle osteolysis.  In both these cases, the choice is an open surgery to remove the end of the collarbone and widen the acromioclavicular joint space.

Shoulder replacement:

Shoulder replacement surgery is generally opted for advanced stages of arthritis, complex fractures and for other problems where other surgical techniques cannot bring the desired result.  In a typical shoulder replacement the ball and socket joint is replaced with an artificial ball made of metal and a socket made of plastic.

If the top part of the arm bone called humerus is broken and socket of the shoulder is still intact, a partial replacement known as hemiarthroplasty may suffice.  In a hemiarthroplasty, only the ball is replaced, leaving the socket untouched.

There is one more type of shoulder replacement called reverse shoulder replacement, as the name suggests the surgery reverses the location of the ball and the socket.  It is generally done on people who have rotator cuff arthropathy.

Biceps tendon surgery:

Biceps tendon surgery is done to correct when the long head of the biceps is the cause of shoulder problems.  It can be performed as a single surgery or in combination with rotator cuff repair.  It is done via two ways, one, sever the tendon connection inside the shoulder joint and reattach it outside of the shoulder joint.  Two, sever the tendon connection inside the shoulder joint and reattach it outside of the shoulder joint.  It is called tenotomy.

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