Shoulder

Sports & Spine Orthopedic Care

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ANATOMY OF THE SHOULDER

Soft tissue:Several ligamets make up the shoulder’s stabilizing joint capsule. Other soft tissue helps the joint flex and move with ease.Biceps tendon:The biceps tendon attaches the biceps muscle to the bone at the top of the shoulder socket. It sits in a groove at the front of the humerus.Coracoacromial ligament:The coracoacromial ligament is a bridge ligament attaching the acromion bone end to the coracoid process. Bursa:Between the rotator cuff muscles and the larger surrounding muscles lies the bursa. This is pocket of lubricating fluid allow muscles to move freely over each other.Rotator cuff:The rotator cuff muscles and tendons raise and lower the arm from the side. The rotator cuff also helps stabilize the shoulder joint by holding the humeral head in the socket.Labrum:The labrum, a ring of fibrous cartilage, surrounds the glenoid in the scapula. It helps attach the head of the humerus to the scapula.


ARTHROSCOPIC BANKART REPAIROverview:This arthroscopic procedure is used to repair a detached labrum. The labrum is a thick band of cartilage attached to the glenoid bone. It lines the shoulder socket and helps keep the ball of the humerus in place. 1. Arthroscope Inserted:Small incisions are made in the front and back of the shoulder. The surgeon inserts a small video camera (called an arthroscope) to view inside the joint. Small instruments are inserted to perform the procedure.2. Area cleaned:The surgeon cleans the area around the detached labrum, removing any loose particles or rough edges.3. Anchors placed:The surgeon drills a few small holes in the bone near the detached labrum. Anchors are placed in the holes. These anchors are used to hold sutures in place around the glenoid.4. Labrum Re-Attached:The surgeon attaches the sutures to the labrum and pulls the sutures tightly against the anchors, reattaching the labrum to the glenoid.End of Procedure:The incisions can be closed with small bandages. After surgery, the arm is usually placed in a sling. Physical therapy will be needed to regain full range of motion and increased shoulder strength. Over time, the labrum will naturally reattach itself to the glenoid socket.

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ARTHROSOCOPIC ROTATOR CUFF REPAIROverview:This surgical procedure is used to inspect and reattach torn tendon in the shoulder’s rotator cuff. The initial part of the surgery is performed arthrosocopically through small tubes. In some cases, open surgery may be needed to repair large tears.1. Joint inspected:The surgeon inserts a small video camera called an arthrosocope through tiny incisions in the shoulder to inpect the damaged joint. 2.Joint debrided:The surgeon removes any loose fragments of tendon or other debris from the damaged cuff tendon in the joint. This procedure, called debriderment, is usually performed arthrosocopically. Afterwards, the surgeon inpects the tissue damage in the joint and determines if more surgery is needed.Acromion smoothed:If bone spurs have formed on the bottom of the acromion, the surgeon uses a rasp-like tool to smooth the area. This is called subacromial decompression, or smoothing, and will keep the acromion from pinching down on the supraspinatus tendon. It is usually done arthroscopically.5 Rotator cuff Inspected: If no tear is found in the rotator cuff area, the procedure may end here. If the surgeon finds a torn rotator cuff tendon, the type of repair needed is based on the size and severity of the tear. Small to mooderate tears may be repaired arthrosocopically. Open surgery may be needed to repair large tears. First, the torn end of the tendon is cleaned up. Next, an area on the humerous is cleared.Anchors placed: The surgeon uses a drill or sharp tool to create one or more small holes in the bone. Anchors are then placed into the holes.The anchors hold stitches in place on the arm bone.Tendon sutured:The tear in the tendon is stitched togther. The sutures are pulled tightly against the anchors, reattaching the tendon to the humerus End of procedure:After surgery, the arm is usually placed in a sling. Physical therapy will be needed to region full range of motion and increased shoulder strength. Over time, the tendon will naturally reattach itself to the humerus bone.


SLAP REPAIR

Overview:This arthroscopic procedure is performed to repair a tear of the biceps tendon at the point where it connect to the labrum, a ring of cartilage that surrounds the shoulder socket. A tear at this point is called a SLAP (Superior Labrum Anterior-Posterior) tear. SLAP repair is performed under general and regional anesthesia, and patients usually leave the hospital the same day.Accessing the joint:The patient is positioned, and the shoulder is cleaned and sterilized. The surgeon creates a few small incisions in the shoulder. An arthrosocopic camera is inserted through one of the incisons. The others will be used as access points for other arthrosocopic tools. Implanting the anchors: After any loose bits of tissue are removed, the surgeon drills a small hole into the gleniod bone where the labrum has torn away. A tiny anchor tied to a suture is implanted in the glenoid bone. Some tears may be repaired with just one anchor, others require multiple anhors.Reparing the labrum:The surgeon ties the sutures around the torn labrum, reattaching it firmly to the glenoid. If the tendon cannot be repaired, it is released.End of procedure and Aftercare:The intruments are removed and the incisions are closed and bandaged. Patients generally require a sling for two to four weeks after the procedure. Physical therapy will be required to strengthen the joint. Most patients can regain normal activities within three to six months.


TOTAL SHOULDER REPLACEMENT

Overview :This surgery replaces the damaged or diseased head of the humerus (also called the ball) and cartilage from the shoulder joint with a metal and plastic joint.1. Humerus head removed: First the surgeon removes the head of the humerus.2. Glenoid reshaped:The surgeon then smooths and reshapes the shoulder socket (which is called the glenoid) 3.Palastic component attached:The plastic glenoid component is pressed into place with bone cement.4.Bone hollowed out: The surgeon hollows out the upper portion of the humerus to receive the implant.5.Metal stem implanted:The metal stem is implanted in the humerus. It may be secured with bone cement. 6.Metal head attached:A metal ball is placed onto the stem.End of procedure:The surgeon joins the repaired humerus and glenoid components to form the new shoulder joint.


ROTATOR CUFF iNJURIES

OverviewThe rotator cuff is a group of muscles and tendons that cover the head of the humerus and hold it in the shoulder socket. When rotator cuff tendons become damaged, the shoulder can become stiff, sore or lose mobility. Injuries are often caused by direct damage, such as a traumatic fall or repetitive overhead motions. It can also develop because of indirect causes such as impingement or shoulder imbalance. Impingement: Impingement occurs when the space under the acromion is so small that the supraspinatus tendon and bursa (a type of lubricating tissue) pinch whenever the arm is raised forward. If impingement happens respetitively, the bursa and suspraspinatus tendon may become swollen. This is called chronic impingement syndrome.Joint imbalance:Joint imbalance occurs when the rotator cuff tendons or shoulder muscles are stretched or weakened from misuse, allowing the unstable joint to slide forward. Imbalance can often result from overhead arm motions that are common in many sports, such as serving in tennis and throwing in baseball. The damage:Whatever the cause, over time the tendon tissue breaks down. Eventually, the tendon may tear away from its attachment to the humerus bone.Symptoms:Rotator cuff tears may cause pain in the shoulder that worsens when the arm is lifted. Sometimes, a grinding or popping sound is heard when the arm is moved. Severve tears may make it impossible to lift the arm at all. The level of pain associated with this injury is dependent on the type of tear and the patient (some patients feel more pain than others). The pain can even interrupt sleep.Treatment:Treatment will very depending on the amount of damage. Partial tears may be treated with non-surgical techniques. These can include rest, physical therapy and injections of steroid or other medications that promote healing. In cases of complete tears or partial tears that do not respond to non-surgical treatments, surgery may be required.


SHOULDER ARTHRITISOverview:Arthritis (also called osteoarthritis or degenerative arthritis) involves the swelling and damage of the joint. The condition causes pain and stiffness and limits shoulder joint movement. Cause of degeneration include increased age, everyday use of the joint, repective overhead movements, injuries such as fractures or chronic rotator cuff tears,or infection.Damaged Cartilage:Cartilage is a smooth protective joint tissue that cushions joints and allows them to move freely. Cartilage may deteriorate over time. As it loses its cushioning ability, heavy use or injury may increase its deterioration.Cartilage loss:Eventually, as cartilage wears away completely, bone rubs aganist bone.Bone spurs:This damage promotes painful new bone growth along the edges of the joint. These lumpy areas of bone, called bone spurs or osteophites, develop slowly over many years.Symptoms:Arthritis sufferers may feel as if their shoulder is stiff or their arm motions are limited. Severe arthritis may be painful at all times,even at rest.Treatment:Arthritis may be treated with cortisone injections, non-steroidal anti-inflammatory medications, use of a splint or brace, exercise and modification of daily activities. In some cases,surgery may be needed. Total shoulder replacement is commomly used to repair the glenohumeral joint. Resection arthoplasty, in which the surgeon removes part of the clavicle to free it from the acromion, is commonly used to repair the AC joint.


SHOULDER IMPINGEMENT SYNDROME

Overview:This condition occurs when the tendons of the rotator cuff, along with the subacromial bursa, become compressed against a bony scapula protrusion called the acromion. As these tissues continually rub against bone, they become irritated and inflamed.Causes:This condition is typically caused by excessive use of the shoulder. Occupations such as painting or constrution, which require repetitive overhead motions, are common culprits. Symptoms:Symptoms can include tenderness, swelling ,reduced range of motion, and weakness in the shoulder. Minor pain may be present even when the shoulder is at rest. Sudden, sharp pain may be felt when the arm is used.Treatment:Treatment option may include rest, anti-inflammatory medications, cortisone injections and physical therapy. If those methods do not relieve the symptoms, surgery may be needed to create space in the shoulder joint.


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Shoulder