When you can't shrug it off: all about shoulder surgery

Shoulders are used in a variety of ways – for balance, for support, carrying and throwing, and hugging our loved ones. But shoulders can get damaged due to injury, inflammation, wear and tear, or infection. In this article, Mr John Scadden, leading orthopaedic surgeon, describes different types of shoulder ailments, and the surgeries that correct them..

What is a shoulder?

The shoulder is a group (a girdle) of joints of the upper torso that connects the upper arm bone (the humerus) to the clavicle and scapula via a network made of musculature, ligaments, and tendons. The shoulder joints are the sternoclavicular (SC), acromioclavicular (AC), glenohumeral – the “main” shoulder joint, in a ball-and-socket configuration – and scapulothoracic joints. The components of the shoulder allow it to be one of the most limber structures of the body, enabling a wide range of movements: abduction, adduction, flexion, extension, internal and external rotation.

When is shoulder surgery needed?

It is possible that shoulder damage can be corrected by medications, physical therapy, and letting time run its course – but some damage is so severe that it necessitates surgery to correct, repair, or replace the shoulder.  Surgery for the shoulder can address problems with the bones, the cartilage in between joints, the tendons, or the muscles.

A shoulder may need surgery because of:

• a rotator cuff tear or injury
• arthritis
• frozen shoulder (adhesive capsulitis)
• tendonitis
• fracture
• long-term pain and lack of mobility
• weakness of the shoulder
• lack of results from alternative treatments

Ailments to the shoulder can be diagnosed with physical exams, X-ray scans, MRIs, CT scans and ultrasounds.

What kind of surgery is done on the shoulders?

One of the most common surgical procedures for the shoulder is the arthroscopy. It is a minimally invasive surgery that is also used in the diagnostic process. Orthopaedic surgeons make small incisions to the shoulder to insert tools and a camera (the arthroscope), which projects an image of the interior of the shoulder that they use to examine the condition of the shoulder and look for areas of damage or that cause pain. The surgeons are then able to treat the shoulder, either during the arthroscopy or a different procedure. It is normally a short procedure, though for complex cases it can take longer than two hours, and patients can go home within the day.

Arthroscopies can treat:

• rotator cuff tears
• tendonitis
• osteoarthritis
• frozen shoulder
• bone spurs (osteophytes)
• superior labrum anterior and posterior (SLAP) tear
• dislocation

However,  as arthroscopy may not be sufficient to treat some conditions, they may require different procedures, such as open rotator cuff surgery, acromioclavicular (AC) joint repairs, or a shoulder replacement.

What happens after shoulder surgery?

It can take between a couple of weeks to a few months to heal after shoulder surgery, during which there will be some swelling and residual pain. Icing the shoulder and pain medication can help manage this, and your surgeon may recommend that a sling is worn to protect the shoulder as it heals. Any extreme pain, swelling, or seepage of the wound could be a sign of infection and should be brought to the doctor.

It is also recommended to partake in physical therapy so that the shoulder can regain strength and flexibility, with a regime of daily exercises and stretches.

Patients should be able to go back to their work or school quite soon, within a few days for a minor procedure, though they cannot participate in heavy lifting, sports, and strenuous activities for a few months. The surgeon will provide more detailed, specific instructions about how to care for the healing shoulder, how to keep it clean, the rehabilitation programme, and what the patient should avoid doing.

If you are experiencing issues with your shoulders or upper torso limbs, you can consult with Mr Scadden via his Top Doctors profile.