© 2019 by Orthopaedic Research Clinic Alaska

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The American Board of Orthopaedic Surgery

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Shoulder

Shoulder Procedures

The shoulder joint is composed of the clavicle (collarbone), the scapula (shoulder blades), and the humerus (upper arm bone), along with two joints. For the shoulder to remain mobile and healthy, the comprising bone structures, joints, muscles, and ligaments need to be functioning properly. Along with the hip joint, the shoulder is a classic “ball and socket” joint that allows basic arm functions such as rotating and hinging.

Common shoulder conditions include damaged tendons that cover the shoulder joints such as torn rotator cuffs or broken bones such as the clavicle. ORCA advocates nonoperative care whenever possible but understand that operation may be the only solution. 

 
Bankart Repair

The Bankart repair refers to an operation to repair habitual anterior shoulder dislocation. During this procedure, the surgeon sews the joint capsule to the detached glenoid labrum. The subscapularis tendon is not duplicated. Another common name for this procedure is the Bankart lesion.


The purpose of the Bankart repair is to fix the torn or overstretched labrum and capsule, which are both located in the shoulder joint. Some surgeons prefer an open procedure while others prefer to perform the Bankart repair surgically. Which type of procedure a patient undergoes depends on the circumstances and the preference of the surgeon.
 

The open repair procedure involves making an incision at the armpit within a skin crease. After performing the procedure, the surgeon will stitch the wound. While this stitch is dissolvable, it will be removed after three weeks once the wound has healed. The arthroscopic (keyhole) repair involves two or three 5 millimeter puncture wounds. Small sticking plaster strips will be placed over the world rather than stitches. The wound will be healed within five to seven days as long as the wound is kept dry.

Shoulder Arthroscopy

Shoulder arthroscopy refers to a surgical procedure that involves the use of an arthroscope, which is a small camera. The arthroscope is used to examine and repair the tissues within or surrounding the shoulder joint. The surgeon makes a small incision in the skin and inserts the arthroscope into this incision to project images to the video monitor.


The rotator cuff refers to a group of muscles and tendons that create a cuff over the joint of the shoulder. These tendons and muscles are responsible for holding the arm in the joint of the shoulder and help the shoulder move freely. Injury and overuse can cause the tendons in the rotator cuff to become torn or damaged.


Usually, patients will receive general anesthesia before the surgical procedure. General anesthesia puts the patient to sleep and makes them unable to feel any pain. Regional anesthesia is another possibility for patients undergoing shoulder arthroscopy. Regional anesthesia involves numbing the arm and shoulder so that the patient doesn’t feel any pain. The patient is also given sedative medicine so that they feel sleepy during the surgical procedure.


During the procedure, the surgeon uses the scope and video monitor to identify damage to the bones, tendons, ligaments, and cartilage in the shoulder joint and surrounding area. The surgeon will then make up to three small incisions to repair damaged tissues. Torn tissues are fixed while damaged tissues are removed entirely.

 
Debridement

Debridement refers to a procedure that is used to eliminate debris and damaged tissues within the shoulder joint. Surgeons perform this procedure with a very tiny camera called an arthroscope in order to be as minimally invasive as possible. Patients who have damaged tissue within the shoulder joint are often good candidates for the debridement procedure. Before undergoing the debridement procedure, patients must have unsuccessfully undergone conservative treatments.
 

There are a number of causes of tissue damage within the shoulder joint. Trauma or injury are two common causes of tissue damage. Osteoarthritis and other degenerative conditions also commonly cause damaged tissue in the shoulder joint. As the body gets older, wear and tear causes the tissue in the shoulder joint to deteriorate. The injuries that lead to debris in the shoulder joint can occur naturally over time. The conditions that cause tissue damage of the shoulder joint have varied symptoms. However, limited range of motion and shoulder pain both indicate the need for debridement surgery.
 

To begin the debridement procedure, the surgeon applies anesthesia to the patient and makes tiny incisions in the shoulder. Through one of the tiny incisions, the surgeon inserts a small camera. The surgeon relies on the images from the camera to provide guidance during the surgical procedure. The surgeon then uses a tool to fill the shoulder joint with fluid through one of the tiny incisions. The fluid expands the joint and grants the surgeon more space and eases when it comes to examining the damage. The surgeon then uses various tools to repair or remove all discovered damage. In the debridement process, all damaged or loose cartilage is removed. The surgeon may use a tool to file down any existing bone spurs. After the procedure, the surgeon drains the fluid from the joint, removes the tools, and closes the incisions with stitches or surgical sutures.

 
 
Biceps Tenodesis

The most common form of biceps tendon tear is the partial or complete detachment of a bicep tendon in the shoulder joint. The biceps tendon has two attachments in the shoulder. One attachment is located within the shoulder while the other attachment is located in front of the joint. If the proximal biceps tendon becomes injured, the injury almost always involves the biceps’ long head. If the long head of the biceps tendon becomes damaged, biceps tenodesis may be recommended as a treatment.


The biceps tenodesis operative procedure is generally performed to treat biceps tendonitis that involves the shoulder. The biceps tendon attaches to the labrum by passing through the joint of the shoulder. If this attachment becomes torn, this injury is called the SLAP tear of the shoulder. Inflammation, irritation, or the SLAP tear of the biceps tendon are likely culprits for individuals with biceps tendon issues.


During the procedure, the surgeon will sever the attachment to the labrum of the biceps tendon. The surgeon will then attach the biceps tendon to the patient’s humerus bone. The biceps tenodesis procedure reduces the pressure from the biceps tendon or labrum in the shoulder. The surgeon may remove a portion of the biceps tendon surgically.


Patients who suffer from severe biceps tendon symptoms like inflammation tend to undergo the biceps tenodesis procedure. These symptoms and issues can be identified via an arthroscopic examination. Most people who undergo a biceps tenodesis procedure are over 40. Patients who are younger tend to undergo other procedures, such as the SLAP repair.

 
Rotator Cuff Repair

The rotator cuff refers to an entire group of tendons and muscles that form the shoulder joint’s cuff. The purpose of these tendons and muscles is to support the shoulder joint and facilitate movement. The tendons can become torn or damaged due to injury or overuse.


Rotator cuff repair is an operative procedure intended to repair torn tendons in the shoulder. This procedure can be performed with a sizable incision or with shoulder arthroscopy, which involves incisions the size of buttonholes.
Before the surgery, the patient will receive general anesthesia. The purpose of general anesthesia is to put the patient to sleep and prevent him or her from feeling pain during the procedure. Another option is regional anesthesia, which numbs the arm and shoulder area to ensure the patient doesn’t feel pain. Patients who receive regional anesthesia will also be given medicine to make them feel sleepy during the surgery.


The three most common techniques used to fix a rotator cuff tear include open repair, arthroscopy, and mini-open repair. The surgeon will make a surgical incision and move the deltoid muscle aside to fix the torn tendon in the shoulder. Open repair surgery is preferred when tears are larger or more complex. During an arthroscopy, the surgeon will make a small incision and insert the arthroscope, which is connected to a video monitor. This permits the surgeon to use the video monitor to view the shoulder joint. the surgeon may make additional incisions to insert other instruments. During a mini-open repair, the surgeon will use an arthroscope to remove bone spurs and damaged tissue. The surgeon will then make a relatively large incision to repair the rotator cuff in the shoulder.

 
Repair of Biceps Tendon

The tendons are responsible for attaching muscles to the bones. The biceps tendons are responsible for attaching the biceps to the bones in the shoulder and elbow. Therefore, if an individual tears his or her biceps tendon at the shoulder, he or she may experience pain and lose strength in the arm.


In many cases, an individual can function with a biceps tendon tear. These individuals simply rely on conservative treatments in order to relieve or manage their symptoms. If nonsurgical treatments fail to relieve these symptoms or if the patient wants to have a full recovery of strength, the patient may undergo surgery for biceps tendon repair.
A bicep tendon tear can be partial or complete. A partial tear is when the tendon is not completely severed. On the other hand, a complete tear is when the tendon is split into two pieces. Sometimes, a torn tendon starts with fraying. Over time, the damage progresses and the tendon may tear completely.


The part of the biceps tendon most likely to be torn or damaged is the long head. This is because the long head is vulnerable when it travels to the attachment point of the socket through the shoulder joint. There are two attachments for the biceps at the shoulder. Rarely does the short head of the biceps tear. Due to the short head, many people can still move their biceps after even a complete tear of the biceps’ long head.


Patients who tear their biceps tendon may have also damaged other parts of the shoulder like the rotator cuff tendons. Rarely is surgical treatment for the biceps tendon tear of the long head needed. However, some patients (like athletes and manual laborers) want to fully recover their strength while others experience pain or cramping of the muscle. These patients may choose to undergo surgery. Patients with partial tears who are not responding well to conservative treatment may undergo surgery.


There are a number of procedures that have been developed recently to repair torn biceps tendons with few incisions. The goal of surgery is to reattach the torn tendon to the bone.

 
Repair of SLAP Lesion

The SLAP term refers to the injury of the labrum, which is located in the shoulder. The labrum is the cartilage ring that surrounds the shoulder joint’s socket. The term SLAP means the Superior Labrum Anterior and Posterior. In a SLAP injury, the superior portion of the labrum is torn or damaged. This top area is the attachment point for the biceps tendon. A SLAP tear occurs both in the back and front of the attachment point. In some cases, the biceps tendon will also be injured.
 

Injuries to the top of the labrum can be caused by repetitive shoulder motion and acute trauma. Some common causes of acute SLAP injury include a motor vehicle accident, shoulder dislocation, falling onto an outstretched arm, forceful or rapid movement of the raised arm, and the rapid pulling on the arm. People like weightlifters and throwing athletes who participate in repetitive overhead sports tend to suffer labrum tears due to repeated shoulder motion. Other SLAP tears are caused by simple wear and tear of the labrum over time. Fraying and tearing of the top of the labrum is considered a normal aging process for patients over 40. Patients under 40 tend to experience acute injury.
 

Arthroscopy is the surgical technique that is most commonly used to repair a SLAP lesion. During the procedure, the surgeon will insert an arthroscope, which is a small camera, into the shoulder joint. The camera will display images on a monitor and the surgeon will use these images to repair the injury with miniature surgical instruments. The surgeon only needs to make tiny cuts to fit the surgical instruments and arthroscope, making arthroscopy far less invasive than standard, open surgery.