Shoulder Surgery

What is Shoulder Surgery?

Shoulder surgery is a surgical procedure for the treatment of a shoulder injury or shoulder condition. The procedure involves repairing a diseased, damaged, or degenerated shoulder joint in order to eliminate pain and restore normal shoulder function.

The shoulder is the most flexible joint in the body that enables a wide range of movements including forward flexion, abduction, adduction, external rotation, internal rotation, and 360-degree circumduction. This flexibility of the shoulder joint also makes it vulnerable to instability and injury. Shoulder surgery helps to overcome this vulnerability and provides a long-term or permanent solution.

Anatomy of the Shoulder Joint

The shoulder joint (glenohumeral joint) is a ball and socket joint where the head of the humerus (upper arm bone) articulates with the socket of the scapula (shoulder blade), which is called the glenoid. The two articulating surfaces of the bones are covered by a smooth tissue called articular cartilage, which allows the bones to slide over each other without friction, enabling smooth movement. The cartilage is lubricated by synovial fluid. Tendons and ligaments around the shoulder joint provide strength and stability to the joint.

Indications for Shoulder Surgery

Shoulder surgery is indicated when non-surgical treatment such as medications, injections, physical therapy, closed reduction, and manipulation has failed to provide desired results in treating shoulder conditions such as:

• Arthritis
• Fracture/trauma
• Bursitis/tendinitis
• Rotator cuff tears
• Shoulder dislocation/instability
• Shoulder impingement
• Frozen shoulder

Preparation for Shoulder Surgery

Preoperative preparation for shoulder surgery may involve the following steps:

• A thorough examination is performed by your doctor to check for any medical issues that need to be addressed prior to surgery.
• Depending on your medical history, social history, and age, you may need to undergo tests such as bloodwork and imaging to help detect any abnormalities that could compromise the safety of the procedure.
• You will be asked if you have allergies to medications, anesthesia, or latex.
• You should inform your doctor of any medications, vitamins, or supplements you are taking.
• You may need to stop taking supplements or medications such as blood thinners or anti-inflammatories for a week or two prior to surgery.
• You should refrain from alcohol or tobacco at least a few days prior to surgery.
• You should not consume solids or liquids at least 8 hours prior to surgery.
• Arrange for someone to drive you home after surgery.
• A written consent will be obtained from you after the surgical procedure has been explained in detail.

Procedure for Shoulder Surgery

Based on the shoulder condition affecting the patient, several types of shoulder surgeries can be performed to address the specific condition. Shoulder surgeries are performed under general or local anesthesia either as an open surgery or as a minimally invasive arthroscopic procedure.

In an arthroscopic procedure, tiny incisions (portals), about a half-inch in length, are made around the joint area. Through one of the incisions, an arthroscope - a small flexible tube with a light and video camera at the end - is passed into the joint. The camera attached to the arthroscope displays the images of the inside of the joint on a monitor, which allows your surgeon to view the damage and carry out the required repair.

In an open surgery, a long incision of several centimeters is made over the joint. The underlying soft tissues are carefully moved aside to expose the treatment area. Special surgical tools are used to carry out the required repair around the joint. Once the repair is complete, the instruments are removed and the incisions are closed with stitches or small sterile bandage strips.

Some of the common shoulder surgeries include:

• Total shoulder replacement: This is a surgery commonly employed for the treatment of shoulder joint arthritis or damage to the shoulder joint as a result of severe trauma or fracture. In this surgery, the damaged articulating parts of the shoulder joint are removed and replaced with artificial prostheses. Replacement of both the humeral head and the socket is called a total shoulder replacement.
• SLAP Repair: A SLAP (superior labrum anterior and posterior tear) repair is indicated to treat the torn labrum of the shoulder socket. The tear or injury may occur from repeated use of the shoulder while throwing or a fall onto the shoulder. During a SLAP repair surgery, the damaged tissue of the labrum is removed, and the torn labrum is secured to the bone of the shoulder socket with sutures.
• Rotator cuff repair: A rotator cuff is a group of tendons in the shoulder joint that provide support and enable a wide range of motion. Major injury to these tendons may result in rotator cuff tears. During rotator cuff repair surgery, the space for rotator cuff tendons will be increased and the cuff tear is repaired using suture anchors. These anchor sutures help in attaching the tendons to the shoulder bone.
• Shoulder dislocation/instability surgery: A shoulder dislocation occurs when the ball of the shoulder joint slides out of the glenoid socket. The labrum, a cuff of cartilage that encircles the shoulder socket, helps to keep the shoulder bones from dislocating. Any damage to this labrum can result in dislocation. To stabilize the shoulder after dislocation, a type of surgery known as Bankart repair is employed in which the edge of the glenoid cavity is trimmed and suture anchors are then inserted to reattach the detached labrum to the glenoid joint capsule to hold the ball in place.
• Frozen shoulder surgery: Frozen shoulder, also called adhesive capsulitis, is the second-most common cause of shoulder injury after rotator cuff tear. It is caused when the capsule encircling the shoulder joint becomes contracted and tight resulting in the formation of stiff bands of tissue called adhesions or scar tissue. During surgery, the scar tissue will be removed, and tight ligaments, if any, will be dissected to loosen the contracted tissue to enable free shoulder movement.
• Biceps tendon surgery: The biceps is a large muscle located in the front of your upper arm and runs from the shoulder to the elbow joint. The biceps muscle has two tendons, one of which attaches to the bone in the shoulder, and the other to the elbow. Biceps tendon repair is a surgical procedure to restore a biceps tendon that has been torn or ruptured by severe trauma or injury. The goal of the surgery is to re-attach the torn tendon to the bones in the shoulder and elbow and to restore normal function of the arm.

Postoperative Care and Instructions

In general, postoperative care instructions and recovery after shoulder surgery may involve the following steps:

• You will be transferred to the recovery area where your nurse will closely observe you for any allergic/anesthetic reactions and monitor your vital signs as you recover.
• You may notice some pain, swelling, and discomfort in the shoulder area. Pain and anti-inflammatory medications, as well as application of ice packs, are recommended as needed.
• Your arm may be secured with assistive devices such as a sling or a cast for the first few weeks to facilitate healing with instructions on restricted weight-bearing.
• Keep the surgical site clean and dry. Instructions on surgical site care and bathing will be provided.
• Refrain from smoking as it can negatively affect the healing process.
• Refrain from strenuous activities and lifting heavy weights for the first few months. Gradual increase in activities over a period of time is recommended.
• An individualized physical therapy protocol will be designed to help strengthen shoulder muscles and optimize shoulder function.
• You will be able to resume your normal activities in a month or two after surgery; however, return to sports may take at least 6 months or longer.
• Refrain from driving until you are fully fit and receive your doctor’s consent.
• A periodic follow-up appointment will be scheduled to monitor your progress.

Risks and Complications

Shoulder surgery is a relatively safe procedure; however, as with any surgery, some risks and complications may occur, such as the following:  

• Infection
• Bleeding
• Fever
• Increased pain or swelling
• Tingling or numbness
• Warmth, redness, or tenderness
• Damage to nerves and vessels
• Stiffness or restricted motion
• Thromboembolism or blood clots
• Anesthetic/allergic reactions