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Marker Shoulder Surgery

The Shoulder
The shoulder joint has a wider range of movement than any other joint in the body. It consists of three bones: the scapula; the humerus; and the clavicle. The scapula or shoulder blade is the large triangular bone located on the backside of the upper body The humerus is also known as the upper arm bone. The clavicle or collarbone attaches the shoulder to the rib cage and holds the shoulder out from the body.

Several ligaments stabilise the shoulder joint, whilst other soft tissue helps the joint to move and flex easily. The rotator cuff is a complex of four tendons that connect the upper arm with the shoulder blade. It holds the head of the upper arm firmly into the shoulder socket when moving. The tendons connect the muscles with the bone, which moves when the muscles pull on the bone. The bursa is a pocket of lubricating fluid, which allows muscles to move freely over each other. It is located under the collarbone, between the rotator cuff muscles and the larger surrounding muscles.

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Symptoms
In the early stages of shoulder problems, pain is often experienced in the entire shoulder. As the shoulder causes discomfort with every movement, sleeping problems are likely. It is common to experience pain when reaching behind, for example, for one’s back pocket or trying to reach for something on the back seat of the car. The longer the pain is there, the more likely it is that stiffness in the entire shoulder occurs, eventually preventing normal lifting or normal mobility of the arm.

Diagnosis and Treatment
The surgeon will conduct a physical examination and may order X-rays, CT Scans or even an MRI to determine the exact cause of the problem. It may be necessary to perform a shoulder Arthroscopy to ascertain the extent of damage or to locate the problem.

Initial treatment may be a course of physiotherapy or cortisone injections to promote natural healing. the surgeon may suggest that the arm is immobilized in a sling so as to allow the damaged tendons and ligaments to heal. If the damage is considered to bad or the above methods fail to improve the condition then surgery may be considered.

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Types of Shoulder Surgery

Shoulder surgery can be used for a number of treatments:

  • Arthroscopic acromioplasty - This is an arthroscopic procedure to widen the space between the upper arm and the shoulder blade so that the rotator cuff tendons do not get stuck between them.

    Arthroscopy with shoulder instability - In case of dislocation of the shoulder, it is normal to have an arthroscopy. It is often possible to repair damage to the shoulder but sometimes a separate operation is needed.
  • Rotator Cuff Repair - Arthroscopic repair of the shoulder tendons. The goal of these procedures is to minimize the pain, restore strength and functionality.
  • Total Shoulder Replacement - Shoulder arthroplasty - With loss of cartilage the patient will suffer severe shoulder arthritis. This is quite painful, and can cause restriction of motion eventually surgical treatment is necessary.
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Shoulder Arthroscopy

After an anesthetic has been administered, your surgeon and the operating room staff will then make sure that you are correctly position on the operating table. For some shoulder surgeries you will be placed in the "beach chair" position, as if you are reclining on a beach chair.

Other types of shoulder surgery require that you lie on your side and have your arm in traction. This position is becoming more popular and is now quite

common for arthroscopic rotator cuff repairs.

Once you are in the correct position on the operating table your arm will be cleaned with special surgical soaps and the draped off from the rest of your body with sterile surgical drapes. Some of the surgical soaps that are used today create a film that adheres to the skin very well and does not wash off easily. It can often take days for this type of soap to wash off completely, but don't worry, it does not stain the skin permanently. After the shoulder has been "prepped and draped", the surgeon is then ready to begin the procedure.

Shoulder arthroscopy is performed through "portals". These are small incisions, generally about 10cm long are located over particular areas of the joint that the orthopedic surgeon will need to operate upon. Small plastic tubes, called "cannulas" are then inserted into the portals so that instruments can easily be placed in the shoulder joint. Shoulder arthroscopy itself involves inserting a specially designed video camera with a very bright fiber optic light source into the shoulder joint so that the important parts of the joint can be seen. Instruments that have been specially designed to remove inflamed tissue, attach sutures to bone, and repair tears and damaged tendons are then used to operate inside the shoulder.

Once the procedure is finished, the instruments, camera, and cannulas are removed, the wounds are closed with either suture or staples, and a sterile dressing is applied to the shoulder. The shoulder is then placed in a sling or immobilizer, the patient is moved from the operating table to a hospital bed, and then wheeled back to the recovery room.

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Recovery from Shoulder Arthroscopy?
In most cases, it will be possible to do light work within a few days. Most normal activities can be carried out within four to six weeks. Heavy labour and contact sports may be restricted for as long as six months. After surgery you will need to wear an arm sling for a few days. Full recovery from shoulder surgery typically needs a great deal of intensive physiotherapy. You will need to ask a Physiotherapist about setting a coarse of treatment for you.

Shoulder Surgery

Typical Scenario

  • Day 1 – arrival and MRSA test
  • Day 2 – consultation + preoperative x-rays, Ct Scans + blood tests
  • Day 3 – Admission to hospital + surgery (+ possible overnight depending on procedure)
  • Day 4 - Day In hospital (depending on procedure)
  • Day 8 – Post-operative check and departure

Rotator Cuff Tear

The most common symptoms of rotator cuff tears are:

  • Pain - Often the pain is felt over the outside of the shoulder and upper arm. Pain while performing overhead activities (with the arm above head height) and pain at night are also quite common. When the condition is more severe, the pain may awaken patients from sleep.
  • Decreased strength - Strength of the rotator cuff tendons can be tested by your doctor. By isolating the different tendons of the rotator cuff with special tests, your doctor can determine the extent of the tear. Depending on the severity of the rotator cuff tear, there may also be a loss of motion. Significant rotator cuff tears may affect a patients ability to raise up their arm over their head.
  • Loss of Mobility- Patients often have difficulty performing activities such as combing their hair, clasping a bra behind their back, reaching behind their back, or sleeping on the affected shoulder.
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Diagnosis of Rotator Cuff
As well as a physical diagnosis the following diagnostic tools can be used:

  • X-rays of the shoulder will be obtained if there is a concern of a rotator cuff tear. The surgeon will look for signs of a rotator cuff tear, although the rotator cuff tear itself cannot be seen on a regular x-ray. Signs of a problem within the rotator cuff include a narrowing of the space for the rotator cuff and bone spurs around the rotator cuff tendons.
  • MRI - is helpful because it can show both complete rotator cuff tears and partial rotator cuff tears. The MRI can also show evidence of shoulder bursitis and other common shoulder problems.
  • Arthrogram - once was the most commonly used test to diagnose a rotator cuff tear. In this study a dye (contrast dye) that shows up on x-ray is injected into the shoulder joint. An intact rotator cuff should contain the dye within the joint, while a rotator cuff tear will allow the dye to leak into surrounding tissues. By taking an x-ray after an injection, your doctor can see evidence of a rotator cuff tear.
  • Ultrasound - operated by a skilled technician, can be as effective detecting a rotator cuff tear as these other methods. Depending on your doctor's preference, you may undergo an ultrasound study to diagnose a rotator cuff tear.

Rotator Cuff Treatment

The first steps of rotator cuff treatment include:

  • Physiotherapy - is the most important step in the treatment of a rotator cuff injury. Strengthening the rotator cuff muscles is important to maintain normal shoulder function. A physiotherapist can show you exercises to help alleviate and prevent a recurrence of your shoulder pain.
  • Anti-Inflammatory Medications - anti-inflammatory medications can be taken regularly for a short period, and can be used to alleviate pain and when symptoms of a rotator cuff tear flare up.
  • Cortisone Injections - Cortisone injections promote rapid healing and can limit the acute inflammatory process, allowing the patient to begin therapy. It is important to participate in the therapy and exercises even if the shoulder feels better after an injection. Physiotherapy will help prevent a recurrence of symptoms. This may help to relieve pain and strengthen the muscles around the joint.
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If conventional treatments don't work?
Physiotherapy is first attempted, especially in older patients or in patients who have chronic long-term injuries. In younger patients who have an acute, traumatic injury surgery is considered early on as there is less likelihood that physiotherapy will help. Where non surgical treatment have failed then surgery must be considered.

Rotator Cuff Surgery
This is an arthroscopic procedure and takes place in a theatre under full anaesthesia. The surgery takes no more than 1 hour after which the patient is returned to the recovery area. shortly afterwards the patient will be returned to their room.

Total stay in hospital is 5 days, after surgery you will need to wear an arm sling for a few days. Full recovery from shoulder surgery typically needs a great deal of intensive physiotherapy. You will need to ask a Physiotherapist or sports traumatologist about setting a coarse of treatment for you.

Rotator cuff injuries heal slowly as the rotator cuff, like all tendons, gets little blood. All bodily tissues need blood to heal. Parts of the body that have a better blood supply heal faster than those with a poor supply of blood.

Shoulder Surgery
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Total Shoulder Replacement
Shoulder replacement surgery is an option for treatment of severe arthritis of the shoulder joint. Arthritis is a condition that affects the cartilage of the joints. As the cartilage lining wears away, the protective lining between the bones is lost--when this happens, painful bone-on-bone arthritis develops. Severe shoulder arthritis is quite painful, and can cause restriction of motion. While this may be tolerated with some medications and lifestyle adjustments, there may come a time when surgical treatment is necessary.

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Indications for a Total Shoulder Replacement
Indications for a total shoulder replacement may include:

  • Arthrosis - A shoulder prosthesis or full shoulder replacement may be indicated when elasticity of the bones has gradually disappeared; or the smooth surface has become rugged and uneven, and so mobility is greatly reduced and movement itself is painful. Also, when there is a history of bone fractures or dislocation.
  • Rheumatism - Rheumatism is a cause of deterioration of shoulder cartilage. Even at a young age, this can lead to destruction of the joint and provoke bad shoulder function leading to the requirement of a shoulder replacement.
  • Fractures - Certain types of fractures can lead to damage of small blood vessels in the shoulder joint. Because of the disruption of the blood flow in the shoulder, the shoulder is slowly damaged.
  • Avascular Necrosis - Avascular Necrosis is developed due to insufficient blood flow to the bone. The bone becomes exceptionally soft and weak, which can lead to deformation. In these cases a full shoulder replacement is the best solution.
Shoulder Surgery

An Artificial Shoulder joint

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Symptoms of severe arthritis of the shoulder

Common symptoms of shoulder arthritis include:

  • Pain with activities
  • Limited range of motion
  • Stiffness of the shoulder
  • Swelling of the joint
  • Tenderness around the joint
  • A feeling of grinding or catching within the joint
Shoulder Surgery

Worn Shoulder Joint

What is a Total Shoulder Replacement?
Total shoulder replacement surgery replaces damaged bone and cartilage with a metal and plastic implant. The shoulder joint is a ball-and-socket joint, much like the hip joint. The ball is the top of the arm bone (the humerus), and the socket is within the shoulder blade (scapula). This joint allows people an enormous range of motion at the shoulder.
When shoulder replacement surgery is performed, the ball is removed from the top of the humerus and replaced with a metal implant. This is shaped like a half-moon and attached to a stem inserted down the center of the arm bone. The socket portion of the joint is shaved clean and replaced with a plastic socket that is cemented into the scapula.

What is Total Shoulder Replacement Surgery Like?
Shoulder replacement surgery lasts about two hours and is carried out under general anesthesia. The incision for the surgery is along the front of the shoulder joint and usually about four to six inches long.
The total stay in hospital is 9 days, some physiotherapy is provided however the patient may need further physiotherapy on their return home.

After Total Shoulder Replacement Surgery
You will need to wear an arm sling for a few days. You should not attempt to use the arm except as specifically instructed by your doctor. Most physicians will begin some light physiotherapy immediately following surgery, but this may not be true in every case. Usually within two to three months, patients are able to return to most normal activities and place an emphasis on strengthening the muscles around the shoulder and maintaining range of motion.

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