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Shoulder Surgery Options

Last Updated 5/9/2011 9:33:18 AM


Your shoulder is uniquely designed so that your arm can move in all kinds of directions – up, down, left, right, and all around. However, the downside of having this incredible flexibility is that the shoulder is easily susceptible to injury.

Once your shoulder becomes injured, it’s critically important to determine the extent of the problem and the appropriate treatment. Some cases can be resolved non-surgically, but others require shoulder surgery or even shoulder replacement surgery. Sometimes, delaying surgery can make the problem worse. When dealing with a shoulder injury, it’s important to consult an expert so that you can take the best course of action possible.

El Camino Hospital’s orthopedic surgeons are specially trained in the diagnosis and treatment of a wide range of shoulder injuries. Our orthopedic team, which also includes skilled nurses, physical therapists and occupational therapists, is experienced in working with patients who are recovering from a variety of shoulder injuries. Our goal is to get your arm functioning normally as soon as possible, and get you back to full activity .

We typically see patients with common injuries of the shoulder, including bursitis, rotator cuff tears, instability (dislocations), bone fractures and joint degeneration due to arthritis. For more on each of these topics, click on the links below:

Common Shoulder Injuries

Bursitis/Tendinitis/Impingement

These terms are often used to describe the same condition. They typically occur as a result of repetitive activities involving extensive shoulder movement, for example swimming. These activities cause rubbing or squeezing of the rotator cuff, a group of muscles and tendons that help control the motion of your shoulder.

Initial treatment for this condition is typically conservative. Special exercises and rehabilitation techniques can help in many cases. If these methods prove unsuccessful, medications and cortisone injections may bring some relief. Persistent pain can be treated by surgery if conservative measures do not work.

Rotator Cuff Tears

Rotator cuff tears vary in their severity, and can be either partial or full tears.

Partial rotator cuff tears can be due to trauma or inflammation. They can be related to impingement and associated with spurs at the shoulder joint. In addition to temporarily altering your activities to aid in healing, certain exercises, physical therapy and cortisone injections can help treat these tears. If non-surgical treatment doesn’t work, you may need surgery to decompress and repair the rotator cuff.

Full-thickness rotator cuff tears can be caused by heavy lifting and falls, or they can develop gradually over time. Again, non-surgical treatment can work for some, but if your pain continues, you may need shoulder surgery.

Instability

A sudden injury or shoulder overuse can cause instability in your shoulder, in which the head of the upper arm bone is forced out of the shoulder socket. Sometimes shoulder dislocations occur due to a genetic looseness of joint. The two major types of instability are a partial dislocation or a complete dislocation. Some people also have chronic shoulder instability, in which shoulder dislocations occur repeatedly.

If you have chronic and recurrent shoulder dislocations, you will most likely need shoulder surgery, either through traditional open surgery or arthroscopic shoulder surgery (minimally-invasive).

Fractured Head of the Humerus (Arm Bone)

A fractured humerus is often due to a fall or other trauma. This typically occurs in older people who have a bone condition known as osteoporosis, where their bones are weak and break easily. Some of these can be treated without surgery, but if the break is severe you may need open surgery or possibly even joint replacement surgery.

Injuries Due to Arthritis

Degenerative diseases such as osteoarthritis and rheumatoid arthritis can destroy the shoulder joint and the surrounding tissue, causing chronic pain and stiffness. These diseases can also cause degeneration and tearing of the shoulder capsule and rotator cuff. 

Different types of arthritis affect the joints in different ways. If you have osteoarthritis, your joint’s surface may have worn out over the years, causing pain. If you have rheumatoid arthritis, your joint’s inner lining is likely to be inflamed and damaged, also causing pain.

If you have so much pain in your shoulder that you can no longer move your arm normally, you may find that shoulder surgery is your best option. In some cases, your surgeon may choose to replace just the head of the bone, while in other cases the surgeon may replace the entire joint.

Surgical Techniques

Shoulders can be repaired through either arthroscopy (minimally-invasive surgery) or traditional open surgery.

Arthroscopy Shoulder Surgery (Minimally Invasive)
In arthroscopy, the surgeon uses a miniature camera (the arthroscope) to look inside the joint through tiny incisions in the skin. The images are relayed to a TV monitor, allowing the doctor to diagnose and repair the problem. Arthroscopy can be done on an outpatient basis, which means there is no hospital stay required.

Open Surgery
In some cases, traditional open surgery is needed, especially if there is extensive damage to the shoulder. Open surgery is traditionally done through larger incisions in the shoulder, and therefore does not require the use of a camera for the surgeon to see inside the joint. Open surgery is generally a more complicated procedure that may require a hospital stay of one or two days.

At El Camino Hospital, our orthopedic surgeons have developed some unique techniques that combine elements of arthroscopy along with open surgery. Because each patient and each type of shoulder injury is unique, your surgeon will assess your case individually to determine the best type of surgery for you.

Recovery from Surgery
Depending on the type of shoulder surgery and extent of repair needed, recovery can range from a few weeks to several months. Your recovery will depend on your particular lifestyle and activities – while some patients are simply looking to return to work in an office setting or return back home, others are seeking to resume more strenuous activities, such as sports.

Whatever your need, El Camino Hospital has an excellent program in place to help you recover quickly from your surgery. Our dedicated team of orthopedic nurses, physical therapists, occupational therapists and discharge planners will work closely with you to ensure the best recovery possible.

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Video: Advances in the Treatment of Shoulder Pain

Image of Dr. Colyvas discussing shoulder treatments. Click to view video.

Spend a few minutes watching this video, in which Drs. Nicholas Colyvas and Nathaniel Cohen discuss how these advances in diagnosing and treating pain in the shoulder are putting a different face on possibilities for patients.

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