Shoulder Arthritis | Shoulder Arthroscopy | Shoulder Fracture | Shoulder Impingement Syndrome | Labrum Tear
About the Acromioclavicular Joint
The acromioclavicular joint (AC joint) is the joint that connects the clavicle and scapula. This joint is prone to developing degenerative changes. These degenerative changes include degeneration and tearing of the fibrocartilaginous disc that exists within the joint, in addition to the deterioration of the joint cartilage and the generation of ‘bone spurs’ which can impinge on the underlying rotator cuff.
This problem is more often seen in heavy laborers , occupations that require repetitive stress on the shoulder, weight lifters and other types of athletes as a result of excessive repetitive physical stress on the joint. The symptoms of this condition are shoulder pain and weakness. At Regional Orthopedics, this condition can be treated using a minimally invasive arthroscopic technique whereby degenerative material within the joint can be removed and the distal 1.5cm portion of the clavicle can be removed. The joint debridement and distal clavicle excision prevents further contact between the bones making up the joint, alleviating the pain. Also, removal of the bone spurs impinging on the rotator cuff relieves the pain from this condition.
The procedure is performed on an outpatient basis and complete recovery is typically a few weeks.
About the Acromioclavicular Joint
The acromioclavicular joint (AC joint) is the joint that connects the clavicle and scapula. This joint is held together by the acromioclavicular ligaments and the coracoclavicular ligaments.
The AC joint can be injured as the result of a direct blow to the top of the shoulder. This will typically occur as the result of a fall where the delivery of energy is to the ‘point’ of the shoulder, which causes a disruption of the AC/CC joint ligaments. The hallmark clinical sign of an AC separation (separated shoulder) is a deformity at the superior aspect of the shoulder. This deformity is a result of the the scapula sagging due to its lost connection to the clavicle.
At Regional Orthopedics, this injury can be repaired using a minimally invasive arthroscopic technique whereby the scapula is re-suspended from the distal clavicle using a ‘tightrope’ suture type implant. By bringing the clavicle and acromion back into a normal physical relationship and holding this physical orientation constant, the torn ligaments are able to heal. If the injury is chronic the repair can be done using a ligament graft to reconstruct the ligaments stabilizing the joint. The procedure is performed on an outpatient basis. Healing time is 6- 8 weeks for the ligaments to heal, after which normal activity can be restored.
About the Biceps Tendon
The biceps tendon originates within the shoulder and is attached to the superior glenoid rim. The biceps tendon in the shoulder serves an important stabilizing role, causing depression of the humeral head.
The biceps tendon can be torn from its attachment to the glenoid rim. This can occur as a result of a traumatic injury or degeneration. The symptoms that result are pain and shoulder weakness.
At Regional Orthopedics, the biceps tendon can be repaired back to the bone using minimally invasive arthroscopic techniques. A bioabsorbable suture anchor is engaged into the bone following pre-drilling. The suture ends are then passed through the torn portion and base of the biceps tendon, thereby allowing a repair directly to the bone surface. This procedure is performed on an ambulatory basis. Recovery time with return to normal activity is typically 6-8 weeks.
About The Rotator Cuff
The rotator cuff is composed of 4 individual muscles which are the subscapularis, supraspinatus, infraspinatus and teres minor. These muscles completely encapsulate the shoulder over an area of nearly 360 degrees. These muscles function to move the shoulder and deliver strength. These muscles are especially important for the performance of many sports. They are, however, also necessary for the adequate performance of many routine activities of living such as reaching overhead or lifting or carrying items.
A rotator cuff injury is a common shoulder problem. The rotator cuff may become injured or torn as a result of an acute injury, or more commonly is damaged from repetitive overuse, aging and/ or pre-existing impingement syndrome. Symptoms of a rotator cuff injury or tearing include shoulder pain and weakness. A rotator cuff tear can be diagnosed by MRI.
At Regional Orthopedics, we are able to repair the rotator cuff utilizing a minimally invasive arthroscopic technique through 3 or 4 small one-centimeter incisions. We perform all of our repairs arthroscopically no matter what size, and never have to open the shoulder to perform successful repair. Our preference in many cases is to perform a ‘double row’ repair creating a ‘suture bridge’ over the tendon. This technique maximizes the surface are of the tendon in contact with the bone and also exerts a compressive force at the repair interface. These features promote more complete and more reliable healing. The procedure is ambulatory and the recovery time is approximately 6 weeks.
Arthritis can affect the shoulder in the same way that it can affect the weight bearing joints such as the hip and knee. The type of arthritis may be inflammatory or degenerative. Arthritis is a condition whereby the cartilage surfaces of the joint become damaged and deteriorate over time, resulting in the loss of the cushioning material between the bones.
Symptoms associated with this condition include shoulder pain and stiffness. At Regional Orthopedics, the pain and stiffness associated with advanced arthritis can be effectively relieved with a shoulder replacement. This procedure involves resection of the deteriorated arthritic surfaces of the joint followed by the bonding of synthetic implants to these surfaces, which will allow for the restoration of painless motion.
This procedure typically requires an overnight hospital stay followed by 8 weeks of physical therapy.
Arthroscopy is a minimally invasive procedure that involves the placement of a small camera into the shoulder. The inside of the shoulder can be visualized on a monitor. Through a separate small portal, a probe can be inserted to examine the structures within the shoulder. Based on direct visualization and probing, damaged tissue can be found and a diagnosis can be made.
This is a useful procedure to establish a diagnosis related to shoulder pain, weakness or instability. In most cases these problems can be immediately addressed and corrected at that time. Arthroscopic rotator cuff repair, labrum repair, instability repair, subacromial decompression, AC joint arthroplasty, etc. can all be performed utilizing arthroscopic techniques.
The benefits of this minimally invasive procedure to the patient include a quicker recovery with less pain and less shoulder stiffness.
About Fracture Repair
Fractures of the shoulder include fractures of the clavicle, proximal humerus, glenoid and scapula. Many of these fractures can be adequately treated without surgical intervention. When surgical intervention is necessary, these fractures can often be repaired utilizing minimally invasive techniques.
The goal of surgical treatment is to restore the normal skeletal morphology and hold the bone fragments together in a rigid fashion, which will allow for rapid healing and the introduction of early motion to prevent shoulder stiffness. If the fracture significantly disrupts the humeral head or disrupts the vascularity of the head, repair is often not advisable and a shoulder replacement is the treatment of choice.
About The Subacromial Space
The subacromial space is a physical space that exists between the acromion and the rotator cuff. This space can be compromised by congenital deformity of the acromion and/or by degenerative changes of the acromion and acromioclavicular joint. These changes in the skeletal morphology of the acromiohumeral space result in physical damage to the rotator cuff from the bone ‘impinging’ on it.
The symptoms associated with this condition cause shoulder pain, pain with overhead elevation, pain at night with sleeping and shoulder weakness. At Regional Orthopedics, this condition can be treated using a minimally invasive arthroscopic technique whereby the ‘bone impingement’ on the rotator cuff can be relieved by reshaping the subacromial space.
The procedure is performed on an outpatient basis. Complete recovery with restoration of normal activity is typically a few weeks.
About The Glenoid Labrum
The glenoid labrum is a fibrocartilaginous ring that encircles the glenoid (shoulder socket). The AIGH/MGH ligament attaches to the anterior labrum and together these structures provide stability to the ball and socket joint.
The labrum is typically damaged as a result of a traumatic event. If the labrum is torn, the resulting symptoms may include shoulder pain, limited motion, joint locking, weakness and shoulder instability.
At Regional Orthopedics, we are able to repair the torn labrum utilizing a minimally invasive arthroscopic technique through 3 or 4 small one-centimeter incisions. The procedure is ambulatory and the recovery time is approximately 6 weeks.