Surgical Procedure Information
Shoulder Replacement Surgery
Shoulder replacement surgery is a great option for patients who have pain caused by end-stage arthritis, severe fractures of the upper arm or for rotator cuff tears that cannot be replaced in a conventional manner.
In this type of surgery, the bones of the ball and socket are replaced with a combination of metal and plastic parts. These surgeries are excellent options for patients with severe pain.
In general, surgery takes about 1-2 hours, including time for anesthesia to be done. The procedure is performed under general anesthesia (meaning you are put to sleep and a breathing tube and machine are used). In most cases, patients stay overnight in the hospital for monitoring.
Risks of surgery include: Bleeding, infection, damage to blood vessels or nerves of the arm, incomplete relief of pain or return of function. In addition, it is possible that the implant fails over time and that you may need a revision surgery. This would entail having an additional surgery. These risks are extremely rare, but can happen.
Rates of failure: In general, these are robust implants, however, there can be loosening of hardware over time.
- At 10 years, 90 percent of all implants remain in place
- At 15 years, 85 percent of all implants remain in place
- At 20 years, 80 percent of all implants remain in place
Recovery differs for everyone, but typically a total recovery is around 6 months.
There are different types of shoulder replacements that can be offered based on your particular shoulder problems. Your age, integrity of the rotator cuff, amount of bone loss, and other factors are used to determine the best surgery for you. See below for more details about the different options that may be available to you.
An anatomic joint replacement mimics your normal ball and socket joint and is best reserved for patients who have an intact and functional rotator cuff and adequate socket bone stock.
This is an open procedure which involves removing the arthritic portions of your humeral head (ball) and glenoid (socket) and replacing them with metal and plastic components. In this type of shoulder replacement, the ball is replaced with a metal ball attached to a stem that is inserted into your arm bone. In addition, a plastic piece is fixed to your socket to allow a smooth surface to glide on.
Procedure Description:
A nerve block numbing medication is injected along the incision and around the surgical field. It does not make your arm go limp or numb, but helps substantially with pain control around the time of surgery.
An incision is made in the front of the shoulder (delto-pectoral incision). The incision is approximately 4-6 inches long.
Layers of muscle and other tissue are dissected (cut through) in order to reach the bones of the shoulder. This is done meticulously to avoid blood vessels and nerves encountered along the way. Bleeding is controlled as the dissection takes place.
When the bones of the shoulder are reached, the biceps tendon (which is attached to the humeral head) is cut and attached to another muscle so that the length, tension and function is preserved.
Once the shoulder joint is exposed, bone spurs are removed from the head of the humerus (ball). The arthritic head of the humerus is cut and the shaft (arm bone) is left exposed.
Metal components of different sizes are trialed until a good fit is found for your shoulder. A metal stem and glenosphere (ball) are then selected and impacted into your shoulder.
Attention is then turned to the socket, where bone spurs are again removed.
A metal baseplate is screwed into your socket, upon which a plastic spacer is attached. This will serve as a new socket for the ball to glide upon.
Once all of the components are inserted into your shoulder, the wound is meticulously closed in layers to ensure no hematoma (blood) formation and provide an appealing wound closure. In addition, the rotator cuff and muscles that were cut during the surgery are repaired.
A combination of medications including pain medications, numbing medications, antibiotic medications, anti-bleeding medications are used to help with your symptoms post-operatively. This regimen is tailored based on your medical history and pre-existing conditions.
Dressings are placed in a sterile manner to reduce the risk of infection.
Materials used during surgery
- Metal components of implants: titanium and cobalt chrome.
- Plastic components of spacer: polyethylene
- Suture: ethibond suture, vicryl suture, monocryl suture
- Wound closure device: zipline
- Adhesives: Skin glue, tegaderm
You will most likely be admitted to the hospital for an overnight stay. Your vital signs and pain will be monitored and managed as is necessary.
You will be discharged from the hospital with pain medications to help with your recovery. The regimen is tailored based on your medical history but is usually a combination of 4 medications.
You will remain in a shoulder abduction sling for 3-4 weeks after surgery. You should take your arm out of the sling to straighten and bend your elbow several times per day so it does not become stiff.
You will start physical therapy 3-4 weeks after surgery to help you regain your range of motion and begin your recovery with the goal of maximizing your function
A reverse shoulder replacement switches the anatomy of the shoulder joint. In essence, the ball is placed on the socket side, and the arm side now has the socket.
This type of shoulder replacement is used for various reasons, including for advanced arthritis, when the rotator cuff is badly torn and cannot be repaired, when there is arthritis with large amounts of bone loss, and for some types of shoulder fractures (breaks).
This is an open procedure which involves removing the arthritic portions of your humeral head (ball) and glenoid (socket) and replacing them with metal components. In this type of shoulder replacement, a metal ball is fixed to your socket and a plastic cup is attached to your upper arm bone.
Procedure Description:
A nerve block with numbing medication is injected along the incision and around the surgical field. It does not make your arm go limp or numb, but helps substantially with pain control around the time of surgery.
An incision is made in the front of the shoulder (delto-pectoral incision). The incision is approximately 4-6 inches long.
Layers of muscle and other tissue are dissected (cut through) in order to reach the bones of the shoulder. This is done meticulously to avoid blood vessels and nerves encountered along the way. Bleeding is controlled as the dissection takes place.
When the bones of the shoulder are reached, the biceps tendon (which is attached to the humeral head) is cut and attached to another muscle so that the length, tension and function is preserved.
Once the shoulder joint is exposed, bone spurs are removed from the head of the humerus (ball). The arthritic head of the humerus is cut and the shaft (arm bone) is left exposed.
Metal components of different sizes are trialed until a good fit is found for your shoulder. A metal stem is inserted down the shaft of your humerus and a plastic cup is attached on top of it. This will serve as the new “socket” for the ball to glide upon.
Attention is then turned to the socket, where bone spurs are again removed.
A metal baseplate is screwed into your socket, upon which a metal ball is attached.
Once all of the components are inserted into your shoulder, the wound is meticulously closed in layers to ensure no hematoma (blood) formation and provide an appealing wound closure. In addition, the rotator cuff and muscles that were cut during the surgery are repaired.
A combination of medications including pain medications, numbing medications, antibiotic medications, anti-bleeding medications are used to help with your symptoms post-operatively. This regimen is tailored based on your medical history and pre-existing conditions.
Dressings are placed in a sterile manner to reduce the risk of infection.
Materials used during surgery
- Metal components of implants: titanium and cobalt chrome.
- Plastic components of spacer: polyethylene
- Suture: ethibond suture, vicryl suture, monocryl suture
- Wound closure device: zipline
- Adhesives: Skin glue, tegaderm
You will most likely be admitted to the hospital for an overnight stay. Your vital signs and pain will be monitored and managed as is necessary.
You will be discharged from the hospital with pain medications to help with your recovery. The regimen is tailored based on your medical history but is usually a combination of 4 medications.
You will remain in a shoulder abduction sling for 3-4 weeks after surgery. You should take your arm out of the sling to straighten and bend your elbow several times per day so it does not become stiff.
You will start physical therapy 3-4 weeks after surgery to help you regain your range of motion and begin your recovery with the goal of maximizing your function
Similar to a total shoulder replacement, this surgery is used for patients with arthritis, but with an intact rotator cuff.
This is an open procedure which involves removing the arthritic portion of your humeral head (ball) and replacing it with a metal component. In this type of shoulder replacement, the ball is replaced with a metal ball attached to a stem that is inserted into your arm bone. In addition, the socket is smoothed out and bone spurs are removed.
Procedure Description:
A nerve block with numbing medication is injected along the incision and around the surgical field. It does not make your arm go limp or numb, but helps substantially with pain control around the time of surgery.
An incision is made in the front of the shoulder (delto-pectoral incision). The incision is approximately 4-6 inches long.
Layers of muscle and other tissue are dissected (cut through) in order to reach the bones of the shoulder. This is done meticulously to avoid blood vessels and nerves encountered along the way. Bleeding is controlled as the dissection takes place.
When the bones of the shoulder are reached, the biceps tendon (which is attached to the humeral head) is cut and attached to another muscle so that the length, tension and function is preserved.
Once the shoulder joint is exposed, bone spurs are removed from the head of the humerus (ball). The arthritic head of the humerus is cut and the shaft (arm bone) is left exposed.
Metal components of different sizes are trialed until a good fit is found for your shoulder. A metal stem and glenosphere (ball) are then selected and impacted into your shoulder.
Attention is then turned to the socket, where bone spurs are again removed.
Once all of the components are inserted into your shoulder, the wound is meticulously closed in layers to ensure no hematoma (blood) formation and provide an appealing wound closure. In addition, the rotator cuff and muscles that were cut during the surgery are repaired.
A combination of medications including pain medications, numbing medications, antibiotic medications, anti-bleeding medications are used to help with your symptoms post-operatively. This regimen is tailored based on your medical history and pre-existing conditions.
Dressings are placed in a sterile manner to reduce the risk of infection.
Materials used during surgery
- Metal components of implants: titanium and cobalt chrome.
- Suture: ethibond suture, vicryl suture, monocryl suture
- Wound closure device: zipline
- Adhesives: Skin glue, tegaderm
You will most likely be admitted to the hospital for an overnight stay. Your vital signs and pain will be monitored and managed as is necessary.
You will be discharged from the hospital with pain medications to help with your recovery. The regimen is tailored based on your medical history but is usually a combination of 4 medications.
You will remain in a shoulder abduction sling for 3-4 weeks after surgery. You should take your arm out of the sling to straighten and bend your elbow several times per day so it does not become stiff.
You will start physical therapy 3-4 weeks after surgery to help you regain your range of motion and begin your recovery with the goal of maximizing your function
Total Shoulder Replacement
Reverse Shoulder Replacement
Arthroscopic Shoulder Surgery
Shoulder Arthroscopy Overview
Arthroscopic surgery is a minimally invasive procedure used to diagnose and treat common shoulder problems including rotator cuff tears, labrum tears, biceps tenosynovitis, frozen shoulder (adhesive capsulitis), and shoulder instability problems, to name a few.
This type of surgery involves making 3-4 small “portal” incisions around the shoulder and then inserting a small video camera which magnifies the view within the shoulder joint and displays it onto a video monitor. The camera is then used to look at the inside of your shoulder in detail to diagnose any problems. Your specific surgery is then performed using various instruments that are inserted through the small portal incisions.
In general, surgery takes about 1-2 hours, including time for anesthesia to be done. This differs based on the number of things you are having done during your arthroscopy, as well as the severity of the problem(s) being fixed. The procedure is performed under general anesthesia (meaning you are put to sleep and a breathing tube and machine are used).
The surgery is an outpatient procedure, meaning you will spend some time in the recovery room following your surgery and then will go home the same day
Risks of arthroscopic shoulder surgeries include bleeding, infection, damage to blood vessels or nerves that travel down the arm, incomplete relief of pain or return of function. Though these risks are very low, they are not zero percent.
Procedure description
A nerve block with numbing medication is injected along the incision and around the surgical field. It does not make your arm go limp or numb, but helps substantially with pain control around the time of surgery.
Incisions are made and a small camera with a long lens (arthroscope) is inserted into the shoulder. This allows us to look at all structures within the shoulder joint including the rotator cuff, biceps tendon, labrum, cartilage, joint capsule, and ligaments. The problems that were identified on MRI and physical exam are located, and the shoulder is explored for any additional problems.
Depending on what the proposed procedure is, and any new problems identified, your procedure will continue to address these problems.
This is one of the most commonly performed arthroscopic shoulder surgeries and is used to diagnose and treat shoulder problems such as: rotator cuff tendonitis, biceps tendonitis, bursitis, SLAP tears, and subacromial impingement.
A biceps tenodesis is a procedure that is used to relocate the long head of the biceps tendon from its initial attachment at the top of the labrum and shoulder socket to a new location lower down on the arm near the armpit. This is a very common treatment for both biceps tendonitis and/or SLAP tear that does not respond to conservative management.
Procedure Description:
First, a diagnostic arthroscopy is performed. Please see the above section for details of this portion of the procedure.
Extensive Debridement: A motorized shaver and radiofrequency ablater device is used to remove inflammation and diseased tissue within the shoulder joint including synovitis, bursitis, and adhesions. Any labral degeneration and fraying are debrided and removed as well.
Subacromial Decompression: A motorized shaver is used to shave down bone spurs and smooth the area underneath the acromion. The tight coracoacromial ligament is released.This helps to create more space and prevent pressure on the rotator cuff muscles below (which can cause impingement). Any remaining bursal tissue is also removed during this process. This part of the procedure is vital in treating and preventing subacromial impingement.
Biceps Tenodesis: The biceps tendon is located and cut at its original attachment site through one of the portal incisions. Then, a 2 cm incision is made on the front of your humerus near your armpit. The biceps tendon that has already been cut is located through this incision. The area is dissected down to bone, and two small holes are drilled into the bone to make room for plastic anchors that will hold the biceps tendon in place. Plastic anchors with sutures attached are inserted into the previously drilled holes in your humerus bone. The attached sutures are then passed through your biceps tendon and tied tightly to secure the tendon to the humerus bone at its new attachment site. Any extra biceps tendon remaining above the new attachment site is completely removed.
Materials used during surgery
- PEEK Anchors: non-absorbable plastic
- Suture
- Wound closure: vicryl suture, monocryl suture
- Adhesives: skin glue (Dermabond), Mastisol, Tegaderm, foam tape
You will spend some time in the recovery room following surgery, and will go home shortly thereafter. Most people need at least one hour in the recovery room, some people need longer.
You will be sent home with pain medication prescriptions to help with your recovery. The regimen is tailored based on your medical history but is usually a combination of 4 medications.
You will remain in a shoulder abduction sling for 3-4 weeks after surgery. You should take your arm out of the sling to straighten and bend your elbow several times per day so it does not become stiff.
You will start physical therapy 3-4 weeks after surgery to help you regain your range of motion and begin your recovery with the goal of maximizing your function.
This arthroscopic procedure is performed for treatment of frozen shoulder and/or stiffness that is not caused by arthritis.
Procedure Description:
A radiofrequency ablater is used to remove scar tissue throughout the shoulder joint, including the anterior and posterior capsular tissue. Direct removal of scar tissue during this procedure results in immediate return of shoulder range of motion. You will need to start physical therapy as soon as possible after this procedure in order to maintain the range of motion that was restored during the procedure.
Materials used during surgery
- Wound closure: monocryl suture
- Adhesives: Mastisol, foam tape
You will spend some time in the recovery room following surgery, and will go home shortly thereafter. Most people need at least one hour in the recovery room, some people need longer.
You will be sent home with pain medication prescriptions to help with your recovery. The regimen is tailored based on your medical history but is usually a combination of 4 medications.
You will be sent home in a sling which you will need to wean out of as soon as possible. In most cases, you will need to stop wearing the sling within the first 3-5 days, you should confirm this with your surgeon following your specific procedure.
You will likely start physical therapy immediately following surgery. You may be asked to start as soon as the day after surgery in order to help you regain your range of motion and prevent onset of post-operative stiffness.
Rotator Cuff Repair
This arthroscopic surgery is used for patients who have rotator cuff tears in which a portion of the rotator cuff edge is torn from the bone. The purpose is to repair the tear and connect it back to bone where it normally attaches. This procedure generally takes 1-2 hours depending on the size and number of rotator cuff tears you have.
Procedure Description:
First, a diagnostic arthroscopy is performed. Please see the above section for details of this portion of the procedure.
Then, frayed or diseased tissue is debrided from the edge of the torn rotator cuff tendon. In very large rotator cuff tears where the tendon has retracted back, there is sometimes a great bit of debridement that needs to take place in order to free up the tendon from where it has started to scar in place in its retracted position.
Once the tendon is free, attention is turned to the attachment site at the greater tuberosity. A motorized bur is used to prepare the bony bed to receive the rotator cuff tendon. The actual rotator cuff repair is done using either anchors or bone tunnels.
Anchors: PEEK anchors made from a non-absorbable plastic are inserted into your humeral head. Strong suture threads are tightly fitted between the bone and the anchor. These suture threads are then passed through various parts of your torn rotator cuff tendon edge and tied securely to hold the tendon in place at the greater tuberosity (which is where it normally attaches). There are multiple configurations for attaching the rotator cuff back to the bone, but most commonly used is an approach called suture bridging where anchors and sutures are placed on the greater tuberosity, the rotator cuff is tied down in this location, and then sutures are passed over the remaining tendon edge and connected on the lateral side of the humerus using more anchors. This has been shown to be the best “transosseous equivalent” method.
Tunnels: This method of rotator cuff repair is a transosseous approach that utilizes bone tunnels rather than anchors to complete the repair. Tunnels are made in the humeral head, and sutures are passed through the tunnels and then through the rotator cuff. The rotator cuff is tied securely down to its attachment site.
There are some tears that involve the outside of the rotator cuff that does not attach to the bone. These “bursal sided tears” can cause pain, but do not create structural problems that affect strength. In these cases, the fraying tendon is shaved down to create a smooth tendon. Sometimes, graft is used to help heal the tear from the outside in (see below).
Graft: Sometimes, graft is needed to help supplement your rotator cuff repair. The most common graft used is a dermal allograft, meaning the graft is made of tissue taken from a cadaver and has been completely decellularized. The graft is layed down over the repair at the end of the procedure, and secured in place. This helps to reinforce the repair.
Bone marrow aspiration: This is a relatively fast procedure done in conjunction with other methods of rotator cuff repair. Bone marrow is taken from your humeral head during your arthroscopic shoulder procedure. The bone marrow aspirate is then injected back into your subacromial space at the end of your surgery to help aid in healing of the rotator cuff. Bone marrow contains factors that may help enhance the healing process. More research is still needed in this area to determine the efficacy of this treatment.
Materials used during surgery
- PEEK Anchors: non-absorbable plastic
- Sutures
- Wound closure: vicryl suture, monocryl suture
- Adhesives: skin glue (Dermabond), Mastisol, Tegaderm, foam tape
You will spend some time in the recovery room following surgery, and will go home shortly thereafter. Most people need at least one hour in the recovery room, some people need longer.
You will be sent home with pain medication prescriptions to help with your recovery. The regimen is tailored based on your medical history but is usually a combination of 4 medications.
You will remain in a shoulder abduction sling for 3-4 weeks after surgery. You should take your arm out of the sling to straighten and bend your elbow several times per day so it does not become stiff.
You will start physical therapy 3-4 weeks after surgery to help you regain your range of motion and begin your recovery with the goal of maximizing your function.
Recovery is different for everyone, but generally full recovery from a rotator cuff repair is one year.
- At 3 months, your RTC is ~20% healed
- At 6 months, your RTC is ~40% healed
- At 9 months, your RTC is ~60% healed
- At 12 months, your RTC is ~80-90% healed
Massive rotator cuff tears generally refer to completely torn and retracted rotator cuff tendons. If these tears are due to an acute injury rather than chronic tearing over time, then the tears can often be repaired using the typical arthroscopic rotator cuff repair approach (as described above).
If the tearing is chronic, resulting in complete muscle atrophy, then you may need a joint replacement surgery.
If the torn rotator cuff shows some atrophy (muscle wasting resulting in poor muscle quality/muscle turning into fat), or if the muscle quality does not look good enough for a regular repair, then you may need your rotator cuff repair surgery complemented with either a muscle tendon transfer or a superior capsular reconstruction (SCR). See below:
Tendon Transfers:
A tendon transfer is a procedure in which a muscle tendon different from the one that is being repaired is transferred to that tendon to help repair the initially torn tendon. This procedure is offered when your torn rotator cuff tendon is too badly damaged to be repaired on its own. The most commonly torn rotator cuff muscles treated with a tendon transfer are the supraspinatus, infraspinatus, and subscapularis muscles.
Lower Trapezius Tendon Transfer:
This is the most commonly used muscle to help repair badly torn supraspinatus and infraspinatus rotator cuff muscles.
Procedure Description:
First, a diagnostic arthroscopy is performed. Please see the above section for details of this portion of the procedure.
For the tendon transfer, a separate 10cm incision is made in your upper back that is in addition to the normal arthroscopic incisions. The inferior border of the trapezius (trap) muscle is dissected down and the tendon is removed from its attachment site. The portion of the trap tendon that is going to be used in your repair is completely freed up from its attachment site.
Next, the trap tendon is sutured to an achilles tendon allograft ( graft from a cadaver). This is necessary to make the tendon long enough to reach your infraspinatus. The trap tendon/allograft unit is then tunneled underneath subcutaneous tissues, underneath the deltoid muscles, and over the infraspinatus tendon.
Attention is then turned back to the arthroscopic portion of the rotator cuff repair. The attachment site at the greater tuberosity is prepared in a similar fashion as is described in the rotator cuff repair section above, and anchors with suture are placed into the posterior superior aspect of the humeral head (where the infraspinatus normally attaches).
Once the trap tendon/allograft unit is fully tunneled through and layed down over the posterior superior aspect of the humeral head, then the sutures attached to the anchors are passed through the graft and tied down to secure the grafted tendon down to the humeral head.
Materials used during surgery
- PEEK Anchors: non-absorbable plastic
- Sutures
- Allograft: Achilles tendon allograft from a cadaver
- Wound closure: vicryl suture, monocryl suture, nylon suture
- Adhesives: Mastisol, Tegaderm, foam tape
You will spend some time in the recovery room following surgery and will go home shortly thereafter. Most people need at least one hour in the recovery room, some people need longer.
You will be sent home with pain medication prescriptions to help with your recovery. The regimen is tailored based on your medical history but is usually a combination of 4 medications.
You will remain in a shoulder abduction sling for 6-8 weeks after surgery. You should take your arm out of the sling to straighten and bend your elbow several times per day so it does not become stiff.
You will start physical therapy 6-8 weeks after surgery to help you regain your range of motion and begin your recovery with the goal of maximizing your function.
Latissimus Dorsi (LD) Tendon Transfer:
This is the most commonly used muscle to help repair a badly torn subscapularis muscle (anterior rotator cuff muscle).
Procedure Description:
First, a diagnostic arthroscopy is performed. Please see the above section for details of this portion of the procedure.
For the tendon transfer, a separate incision is made that is in addition to the other arthroscopic incisions in order to reach the LD muscle. The portion of the LD muscle and tendon that is going to be used in your repair is completely freed up from its attachment site. It is then passed subcutaneously over the subscapularis muscle anteriorly. Anchors with suture are placed at the attachment site in the humerus bone, these sutures are passed through the transferred LD muscle tendon and secured tightly down to the bone.
Materials used during surgery:
- PEEK Anchors: non-absorbable plastic
- Suture
- Wound closure: vicryl suture, monocryl suture, possible Nylon suture
- Adhesives: Mastisol, Tegaderm, foam tape
You will spend some time in the recovery room following surgery, and will go home shortly thereafter. Most people need at least one hour in the recovery room, some people need longer.
You will be sent home with pain medication prescriptions to help with your recovery. The regimen is tailored based on your medical history but is usually a combination of 4 medications.
You will remain in a shoulder abduction sling for 6-8 weeks after surgery. You should take your arm out of the sling to straighten and bend your elbow several times per day so it does not become stiff.
You will start physical therapy 6-8 weeks after surgery to help you regain your range of motion and begin your recovery with the goal of maximizing your function.
Superior Capsular Reconstruction (SCR):
This is an arthroscopic procedure that is done for an irreparable supraspinatus rotator cuff tear. When this muscle is torn, the humeral head migrates superiorly due to there not being adequate muscle tendon there to hold the humeral head down in line with the socket. The procedure involves reconstructing the superior capsule with the use of graft to restore superior glenohumeral stability and improve the joint function.
Procedure Description
First, a diagnostic arthroscopy and debridement is performed. Please see the above section for details of this portion of the procedure.
Tissue is then debrided over the greater tuberosity and the superior glenoid with a motorized burr to prepare a bony bed for graft attachment. This is done in a similar way as is described in the rotator cuff repair section above. Two anchors with suture are then placed superiorly into the glenoid bone.
Attention is then turned to the graft which is prepared on a separate table during your surgery. The type of graft used most often is an Achilles tendon allograft. After measuring the defect size in your shoulder, the graft is prepared via folding the graft onto itself and sewing it to itself to fit the appropriate shape needed.
The graft is then guided arthroscopically through the shoulder portals and into the joint space. Sutures are then passed through the graft and tied with knots to secure the medial border of the graft to the superior glenoid.
Two additional anchors are then placed laterally at the greater tuberosity. The sutures from these anchors are then passed through the lateral border of the graft and then tied securely down to bone.
Sutures from the medial (glenoid) anchors are passed through the lateral row anchor and then impacted down into the lateral aspect of the greater tuberosity. This results in good medial to lateral fixation of the graft thereby reconstructing the superior capsule.In essence, the new piece of graft that has been attached to different portions of the shoulder creates a hammock that prevents the head of the humerus from travelling upwards and hitting the underside of your shoulder blade.
Materials Used
- PEEK Anchors: non-absorbable plastic
- Suture
- Allograft: Achilles tendon allograft from a cadaver
- Wound closure: vicryl suture, monocryl suture, possible Nylon suture
- Adhesives: Mastisol, Tegaderm, foam tape
You will spend some time in the recovery room following surgery, and will go home shortly thereafter. Most people need at least one hour in the recovery room, some people need longer.
You will be sent home with pain medication prescriptions to help with your recovery. The regimen is tailored based on your medical history but is usually a combination of 4 medications.
You will remain in a shoulder abduction sling for 6-8 weeks after surgery. You should take your arm out of the sling to straighten and bend your elbow several times per day so it does not become stiff.
You will start physical therapy 6-8 weeks after surgery to help you regain your range of motion and begin your recovery with the goal of maximizing your function.
Instability and Dislocation Surgery
Shoulder Instability Overview
Depending on the number of shoulder dislocations, level of shoulder instability, and the amount of bone loss associated with shoulder instability, there are a number of shoulder surgeries that are offered to help with your symptoms.
Surgeries for shoulder dislocations can focus on stabilizing the shoulder joint by fixing problems related to soft tissue injuries like labrum tears or capsule stretching or by addressing problems caused by bone loss from traumatic or repetitive dislocations.
This arthroscopic procedure is used in cases of shoulder instability or recurrent dislocations in which the joint capsule has become stretched out. Remember, the joint capsule is a series of tissues and ligaments that provide stability to the shoulder joint.
Procedure Description
First, a diagnostic arthroscopy is performed. Please see the above section for details of this portion of the procedure. We identify the area of your capsule that appears to be loose.
Next anchors are attached to the edge of your shoulder socket (glenoid). Sutures that are attached to the anchors are then passed through areas of stretched out joint capsule. The sutures are then tied tightly in order to recreate the bumper of stability the capsule usually provides.
Materials used during surgery
- PEEK Anchors: non-absorbable plastic
- Suture
- Allograft: Achilles tendon allograft from a cadaver
- Wound closure: vicryl suture, monocryl suture, possible Nylon suture
- Adhesives: Mastisol, Tegaderm, foam tape
You will spend some time in the recovery room following surgery, and will go home shortly thereafter. Most people need at least one hour in the recovery room, some people need longer.
You will be sent home with pain medication prescriptions to help with your recovery. The regimen is tailored based on your medical history but is usually a combination of 4 medications.
You will remain in a shoulder abduction sling for 6-8 weeks after surgery. You should take your arm out of the sling to straighten and bend your elbow several times per day so it does not become stiff.
You will start physical therapy 6-8 weeks after surgery to help you regain your range of motion and begin your recovery with the goal of maximizing your function.
This arthroscopic procedure is used in cases of shoulder pain and instability causing dislocations or subluxations (partial dislocations) caused by tears in the labrum. It is commonly performed in athletes and those under the age of 30.
Procedure Description:
First, a diagnostic arthroscopy is performed. Please see the above section for details of this portion of the procedure. We identify the area of your labrum that is torn.
Then, anchors are attached to the edge of your shoulder socket (glenoid). Sutures that are attached to the anchors are then passed through areas of torn labrum. The sutures are then tied down tightly to re-attach the labrum to the area of the glenoid where it once lived.
Materials used during surgery
- PEEK Anchors: non-absorbable plastic
- Suture
- Wound closure: vicryl suture, monocryl suture, possible Nylon suture
- Adhesives: Mastisol, Tegaderm, foam tape
You will spend some time in the recovery room following surgery, and will go home shortly thereafter. Most people need at least one hour in the recovery room, some people need longer.
You will be sent home with pain medication prescriptions to help with your recovery. The regimen is tailored based on your medical history but is usually a combination of 4 medications.
You will remain in a shoulder abduction sling for 6-8 weeks after surgery. You should take your arm out of the sling to straighten and bend your elbow several times per day so it does not become stiff.
You will start physical therapy 6-8 weeks after surgery to help you regain your range of motion and begin your recovery with the goal of maximizing your function.
This arthroscopic procedure is used in cases where shoulder dislocations have caused a defect (depression fracture) in the greater tuberosity of the humeral head. In these cases, there is an indentation in the humeral head that can lead to recurrent dislocations if not addressed.
Procedure Description
First, a diagnostic arthroscopy is performed. Please see the above section for details of this portion of the procedure. We identify the area of defect in the greater tuberosity of the humeral head.
Then, we drill into the area of indentation and place anchors into those holes. We then pass sutures through a portion of the rotator cuff in order to “fill” this defect and provide adequate stability.
Materials used during surgery
- PEEK Anchors: non-absorbable plastic
- Suture
- Wound closure: vicryl suture, monocryl suture, possible Nylon suture
- Adhesives: Mastisol, Tegaderm, foam tape
You will spend some time in the recovery room following surgery, and will go home shortly thereafter. Most people need at least one hour in the recovery room, some people need longer.
You will be sent home with pain medication prescriptions to help with your recovery. The regimen is tailored based on your medical history but is usually a combination of 4 medications.
You will remain in a shoulder abduction sling for 6-8 weeks after surgery. You should take your arm out of the sling to straighten and bend your elbow several times per day so it does not become stiff.
You will start physical therapy 6-8 weeks after surgery to help you regain your range of motion and begin your recovery with the goal of maximizing your function.
This arthroscopic procedure is used in cases where there is a small fracture of the shoulder socket (glenoid) in which the small portion of bone that has broken off is attached to the labrum of the shoulder. This procedure is very similar to a labral repair.
Procedure Description
First, a diagnostic arthroscopy is performed. Please see the above section for details of this portion of the procedure. We identify the area of your labrum that is torn and bone fragment is located..
Then, anchors are placed into the edge of the socket near where the break occurred. The sutures that are attached to the anchors are then passed through the labrum surrounding the broken piece of bone. The sutures are then tied, re-attaching the labrum with the bone fragment to the socket.
Materials used during surgery
- PEEK Anchors: non-absorbable plastic
- Suture
- Wound closure: vicryl suture, monocryl suture, possible Nylon suture
- Adhesives: Mastisol, Tegaderm, foam tape
You will spend some time in the recovery room following surgery, and will go home shortly thereafter. Most people need at least one hour in the recovery room, some people need longer.
You will be sent home with pain medication prescriptions to help with your recovery. The regimen is tailored based on your medical history but is usually a combination of 4 medications.
You will remain in a shoulder abduction sling for 6-8 weeks after surgery. You should take your arm out of the sling to straighten and bend your elbow several times per day so it does not become stiff.
You will start physical therapy 6-8 weeks after surgery to help you regain your range of motion and begin your recovery with the goal of maximizing your function.
This is an arthroscopic procedure used in cases where there is significant bone loss (at least 15-20%) of the shoulder socket from dislocation(s).
In this procedure, a portion of donor (human cadaver) tibia is used to augment the shoulder socket. In essence, a piece of external bone is added to your remaining shoulder socket to make up for the bone loss.
There are two major portions of this procedure. The first is the diagnostic arthroscopy, labral repair and capsular plication. The second portion of the procedure is related to preparing the bone graft, and then attaching it to the portion of the socket that has bone loss.
Procedure Description
See above sections for more detail of the arthroscopic labral repair and capsular plication. In addition to these procedures, the portion of the socket that is missing bone is smoothed out and leveled to better accept the new portion of bone.
For the bone block portion of the procedure, we first prepare the graft. We do this by precisely measuring and making angled cuts into the tibial allograft to create a bone block that is the size and shape that is ideal for attaching to your shoulder socket. We then drill two holes through the graft piece in which screws will travel through to attach it to your socket. In order to make the holes more secure, a metal piece called a “top hat” is added to each of the holes. The bone graft is then delivered into the shoulder through a small incision approximately 3 cm in length. The bone graft is then positioned adjacent to the portion of the socket which is missing bone and was previously prepared by smoothing and leveling. Using a guide that goes through the previously drilled holes in the bone graft, holes are drilled into the socket. Screws are then placed to secure the new portion of bone graft to the socket, thus giving new and improved stability to the socket.
You will spend some time in the recovery room following surgery, and will go home shortly thereafter. Most people need at least one hour in the recovery room, some people need longer.
You will be sent home with pain medication prescriptions to help with your recovery. The regimen is tailored based on your medical history but is usually a combination of 4 medications.
You will remain in a shoulder abduction sling for 6-8 weeks after surgery. You should take your arm out of the sling to straighten and bend your elbow several times per day so it does not become stiff.
You will start physical therapy 6-8 weeks after surgery to help you regain your range of motion and begin your recovery with the goal of maximizing your function.
Materials used during surgery
- PEEK Anchors: non-absorbable plastic
- Suture
- Allograft: Distal Tibia bone graft from a cadaver
- Wound closure: vicryl suture, monocryl suture, possible Nylon suture
- Adhesives: Mastisol, Tegaderm, foam tape
Fracture Surgery
Shoulder Fracture Overview
In cases where there are fractures (breaks) of the humeral head (ball) and neck of the humerus, there are a few different options depending on the way in which the shoulder breaks, and how many pieces the head of the humerus is broken into.
These are open surgeries where an incision is made in the front of the shoulder. Sometimes, x-ray is used during surgery to help ensure the fracture is re-aligned to satisfaction.
In general, surgery takes about 1-2 hours, including time for anesthesia to be done. The procedure is performed under general anesthesia (meaning you are put to sleep and a breathing tube and machine are used). In most cases, patients stay overnight in the hospital for monitoring.
Risks of surgery include: Bleeding, infection, damage to blood vessels or nerves of the arm, incomplete relief of pain or return of function. In addition, it is possible that the implants can fail over time. There is also a risk of avascular necrosis (bone death) due to blood supply to the humeral head being disrupted due to the fracture.
Recovery rates differ for everyone, but typically a total recovery is expected by 6-9 months post-operatively.
This type of surgery utilizes metal plates, screws, cerclage wires and sometimes sutures and anchors to fix and secure the fracture fragments. Indications for this surgery include displaced greater tuberosity fractures, 2-part and 3-part fractures.
Procedure Description
A nerve block with numbing medication is injected along the incision and around the surgical field. It does not make your arm go limp or numb, but helps substantially with pain control around the time of surgery.
An incision is made in the front of the shoulder (delto-pectoral incision). The incision is approximately 4-6 inches long.
Layers of muscle and other tissue are dissected (cut through) in order to reach the bones of the shoulder. This is done meticulously to avoid blood vessels and nerves encountered along the way. Bleeding is controlled as the dissection takes place.
When the broken bones of the shoulder are reached, different instruments are used to re-align the fragments as closely as possibly to your normal anatomy. Alignment is typically confirmed with an x-ray.
Once the fracture is aligned (reduced), long pins are placed through the fragments to hold them in place. An appropriate sized plate and screws are selected. The plate is then attached to the bone with screws in order to keep the fracture in alignment.
Once all of the components are inserted into your shoulder, the wound is meticulously closed in layers to ensure no hematoma (blood) formation and provide an appealing wound closure.
A combination of medications including pain medications, numbing medications, antibiotic medications, anti-bleeding medications are used to help with your symptoms post-operatively. This regimen is tailored based on your medical history and pre-existing conditions.
Dressings are placed in a sterile manner to reduce the risk of infection.
Materials used during surgery
- Metal components: titanium
- Suture: ethibond suture, vicryl suture, monocryl suture, nylon suture
- Wound closure device: zipline
- Adhesives: Skin glue, tegaderm
You will most likely be admitted to the hospital for an overnight stay. Your vital signs and pain will be monitored and managed as is necessary.
You will be discharged from the hospital with pain medications to help with your recovery. The regimen is tailored based on your medical history but is usually a combination of 4 medications.
You will remain in a shoulder abduction sling for 3-4 weeks after surgery. You should take your arm out of the sling to straighten and bend your elbow several times per day so it does not become stiff.
You will start physical therapy 3-4 weeks after surgery to help you regain your range of motion and begin your recovery with the goal of maximizing your function
This type of surgery utilizes a CAGE device (a device with metal wires that deploys into the humeral head in a circle shape) with or without use of a metal plate and screws to secure fracture fragments. Indications for this surgery include 3-part fractures and 4-part fractures of the humeral head.
Procedure Description
A nerve block with numbing medication is injected along the incision and around the surgical field. It does not make your arm go limp or numb, but helps substantially with pain control around the time of surgery.
An incision is made in the front of the shoulder (delto-pectoral incision). The incision is approximately 4-6 inches long.
Layers of muscle and other tissue are dissected (cut through) in order to reach the bones of the shoulder. This is done meticulously to avoid blood vessels and nerves encountered along the way. Bleeding is controlled as the dissection takes place.
When the broken bones of the shoulder are reached, different instruments are used to re-align the fragments as closely as possibly to your normal anatomy. Alignment is typically confirmed with an x-ray.
Once the fracture is aligned (reduced), long pins are placed through the fragments to hold them in place. The correct sized CAGE device is selected and then inserted and deployed inside the head of your humerus. Screws are then placed through the fracture and the CAGE to provide excellent fixation.
Once all of the components are inserted into your shoulder, the wound is meticulously closed in layers to ensure no hematoma (blood) formation and provide an appealing wound closure.
A combination of medications including pain medications, numbing medications, antibiotic medications, anti-bleeding medications are used to help with your symptoms post-operatively. This regimen is tailored based on your medical history and pre-existing conditions.
Dressings are placed in a sterile manner to reduce the risk of infection.
Materials used during surgery
- Metal components: titanium, nitinol (nickel titanium)
- Suture: ethibond suture, vicryl suture, monocryl suture, nylon suture
- Wound closure device: zipline
- Adhesives: Skin glue, tegaderm
You will most likely be admitted to the hospital for an overnight stay. Your vital signs and pain will be monitored and managed as is necessary.
You will be discharged from the hospital with pain medications to help with your recovery. The regimen is tailored based on your medical history but is usually a combination of 4 medications.
You will remain in a shoulder abduction sling for 3-4 weeks after surgery. You should take your arm out of the sling to straighten and bend your elbow several times per day so it does not become stiff.
You will start physical therapy 3-4 weeks after surgery to help you regain your range of motion and begin your recovery with the goal of maximizing your function
This type of surgery utilizes a reverse shoulder replacement approach in cases where fractures cannot be fixated with the above types of hardware.
See “Reverse Shoulder Replacement” section above.
This surgery is performed for patients who have breaks in their clavicle (collar bone) that require stabilization with a metal plate and screws.
Following the procedure, it is normal to have numbness along the area of the incision and just below the collar bone. It is one of the unfortunate risks of the surgery. In addition, some people can find the plate and screws uncomfortable. If it becomes necessary to remove the hardware due to discomfort, we try to wait at least 1 year before removing.
Procedure Description
A nerve block with numbing medication is injected along the incision and around the surgical field. It does not make your arm go limp or numb, but helps substantially with pain control around the time of surgery.
An incision is made along the length of the clavicle.
Layers of muscle and other tissue are dissected (cut through) in order to reach the clavicle. This is done meticulously to avoid blood vessels and nerves encountered along the way. Bleeding is controlled as the dissection takes place.
When the broken clavicle is reached, different instruments are used to re-align the fragments as closely as possibly to your normal anatomy. Alignment is typically confirmed with an x-ray.
Once alignment is confirmed, we hold the pieces in place with different tools. Sometimes, “lag screw(s)” are placed to hold the fracture pieces together.
A metal plate is selected to fit your bone and fracture pattern, and then is screwed into place on top of the bone.
Another x-ray is taken to confirm proper hardware placement.
Once all of the hardware is placed, the wound is meticulously closed in layers to ensure no hematoma (blood) formation and provide an appealing wound closure.
A combination of medications including pain medications, numbing medications, anti-bleeding medications are used to help with your symptoms post-operatively. This regimen is tailored based on your medical history and pre-existing conditions.
Dressings are placed in a sterile manner to reduce the risk of infection.
Materials used during surgery
- Metal components: titanium
- Suture: ethibond suture, vicryl suture, monocryl suture, nylon suture
- Wound closure device: zipline
- Adhesives: Skin glue, tegaderm
You will spend some time in the recovery room following surgery, and will go home shortly thereafter. Most people need at least one hour in the recovery room, some people need longer.
You will be sent home with pain medication prescriptions to help with your recovery. The regimen is tailored based on your medical history but is usually a combination of 4 medications.
You will remain in a shoulder abduction sling for 2-4 weeks after surgery. You should take your arm out of the sling to straighten and bend your elbow several times per day so it does not become stiff.
You will start physical therapy 2-4 weeks after surgery to help you regain your range of motion and begin your recovery with the goal of maximizing your function.