Shoulder surgery

The shoulder is the most complex and unstable joint in the body and it can get injured easily. Your shoulder joint is composed of three bones: the clavicle (collarbone), the scapula (shoulder blade), and the humerus (upper arm bone). Your shoulders are the most movable joints in your body.

Changing lifestyles have brought different shoulder problems that were not common earlier. In some cases, pain in the shoulder isn’t caused by a problem in the shoulder joint, but by a problem in another area, such as the neck, that is felt in the shoulder and upper back. Shoulders can also be unstable because the ball of the upper arm is larger than the shoulder socket that holds it. To remain in a stable or normal position, the shoulder must be anchored by muscles, tendons and ligaments. Because the shoulder can be unstable, it is the site of many common problems, classified into four main areas: rotator cuff, instability, glenohumeral osteoarthritis, and fractures.

You may be referred to an orthopedic surgeon who will help you determine when or if it’s time for shoulder surgery and which type of shoulder surgery is most appropriate.

To diagnose your condition, our orthopedic surgeon will perform a thorough examination of your shoulder, analyze X-rays, and conduct physical tests. You will be asked to describe your pain, if you suffer from other joint pain, and if you have endured past injuries that may have affected your current shoulder condition. It may be helpful to keep a record of your shoulder pain to share with your surgeon. Your shoulder joints will then be tested for strength and range of motion through a series of activities. X-rays of your shoulder joint will indicate any change in size or shape, or any unusual circumstances.

Many surgeries have been developed to repair the muscles, connective tissue, or damaged joints that can arise from traumatic or overuse injuries to the shoulder.

At Medicover Hospital we provide a wide range of shoulder surgeries with the most advanced techniques and instruments:

Shoulder arthroscopy (keyhole investigation of the shoulder)

Shoulder arthroscopy is surgery that uses a tiny camera called an arthroscope to examine or repair the tissues inside or around your shoulder joint. The arthroscope is inserted through a small incision (cut) in your skin.  This allows the surgeon to see all parts of shoulder joint and facilitates the repair of some injuries. Shoulder arthroscopy is normally done as a day case procedure. Most people receive general anesthesia before this surgery. Or, you may have regional anesthesia when your arm and shoulder area will be numbed so that you do not feel any pain. If you receive regional anesthesia, you will also be given sedative medicine to make you calm and sleepy during the operation.

Shoulder replacement

Shoulder arthroplasty (TSA or TSR) is a surgery to replace the shoulder joint. The shoulder joint is where the head (ball) of the humerus meets the glenoid (socket-like end) of the scapula. The humerus is the bone of the upper arm, and the scapula is the shoulder blade. Arthroplasty is usually done in patients with shoulder problems that cause severe or constant pain. These problems include pain from arthritis of after traumas, with narrowing of the joint space or bone spur formation. They may also include non-healing broken bones, severe muscle tears, and bone thinning or softening. The patients receive regional anesthesia before this surgery.

Open shoulder surgery (bursa and collar bone)

The shoulder is a complex joint that can fail due to damage to many different components. Repair depends on the actual damage and on an assessment by a surgeon, however most shoulder surgeries are performed under general anaesthetic. Surgery can be arthroscopic or open, but again, this is a decision that should be reached between the surgeon and the patient. In open surgery, your doctor will make a small incision in the front of your shoulder. This allows your surgeon to see the acromion and rotator cuff directly. The goal of surgery is to create more space for the rotator cuff. To do this, your doctor will remove the inflamed portion of the bursa.

Benefits

Our shoulder joint is a vulnerable joint due to its wide range of motion. In some people, frequent overhead movements or trauma damage the tissues inside the shoulder resulting in pain, discomfort, immobility and weakness of the shoulder joint. If other treatment methods are not successful, these shoulder problems often require surgery that can lessen shoulder pain and improve its function.

Risks

Most patients do not experience complications from shoulder surgery. As with any surgery, however, there are some risks. These are usually minor and treatable. Potential problems include infection, excessive bleeding, blood clots, and damage to blood vessels or nerves.

Your surgeon will discuss the possible complications with you before your operation.

Patients with shoulder pain or limited shoulder function may be candidates for shoulder surgery. Most people who suffer from a shoulder injury and who have not found the relief they need through non-operative treatments may benefit from a surgical procedure. Ask your physician if shoulder surgery is a good option for you.

Ensure that you provide all the essential information to your doctor, including:

• Any medical conditions or health problems, such, asthma, diabetes, blood issues, anemia, or high blood pressure.
• All previous operations; even those not related to your current issues.
• All medications, vitamin and mineral supplements or other over-the-counter medications taken on a regular basis; include the dosage and frequency.
• All past allergies or adverse reactions that you have experienced with drugs or anesthesia. Include the name of the medication or anesthesia, when and why you were given this, and describe your reaction.
• All dietary restrictions and food allergies. This is very important as certain medications are created using, or are related to, known allergens.

The day before the surgery, you are not allowed to eat or drink after midnight. Discuss with your surgeon what to do about medications taken in the morning. An hour before surgery, you will be assessed in the preoperative area by a nurse anesthetist or anesthesiologist.

After surgery, your arm may be placed in a sling for a short period of time. This allows for early healing. As soon as your comfort allows, your surgeon will recommend you to remove the sling to begin exercise and use of the arm. Rehabilitation also plays an important role in getting you back to your daily activities. An exercise program will help you regain shoulder strength and motion. Your surgeon will develop a rehabilitation plan based on the surgical procedures you required.

If you have had a more complicated surgical repair, your surgeon may recommend a physical therapist to supervise your exercise program.

It is important that you make a strong effort at rehabilitation in order for your surgery to succeed.

Because patients have varied health conditions, complete recovery time is different for everyone. You will need physiotherapy after the surgery and should return to your own therapist. An appointment has to be made to see your doctor or therapist 4-6 weeks post-operatively, depending on the surgeon’s preference.