Until a few years ago, shoulder surgery invariably meant months of therapy, a long recuperation with limited mobility, and a permanent scar to remind patients of the ordeal. As a result, many people postponed shoulder surgery indefinitely and lived with pain and limitations, including foregoing preferred leisure activities.
Today, patients can look at shoulder replacement surgery or arthroscopy as facilitating a quick return to sports and a full spectrum of activities of daily living due to improvements in orthopaedic treatments.
Sound like a myth? Fortunately, it’s all true. Our surgeons’ toolkit now includes improved surgical techniques for shoulder replacements or torn rotator cuffs, prosthetics individually-tailored to a patient’s body and novel anesthesia options. These advances have created a sea-change in the field, so one key issue is to find a surgeon who specializes in upper-extremity surgery.
A painful shoulder condition or injury can have a severe impact on quality of life, including such common activities as eating, dressing and even typing. It’s critical to remember that the shoulder rotates through a greater range of motion than any other joint in the body. The shoulder joint is partly composed of three bones – the humerus (upper arm), scapula (shoulder blade) and clavicle (collarbone). A healthy shoulder also has cartilage and joint fluid to help lubricate the joint and avoid friction. The supporting muscles and tendons provide stability and support.
One frequent source of shoulder pain is the rotator cuff, which is part of the structure that holds the arm in the shoulder joint. It allows us to lift and rotate the arm to brush our teeth, swing a golf club or even lift an iPhone. The tendons in the rotator cuff can tear from age, overuse, traumatic injury, or a fall, which then require surgical intervention.
A rotator cuff injury or fracture was often a career-ending incident for professional athletes and painful for the general public. Fortunately, these injuries can often be repaired via arthroscopy, which means less tissue damage, far less pain and a quicker recovery.
In arthroscopy, which is minimally-invasive, orthopaedic surgeons use a pencil-sized instrument with a tiny camera at the tip called an arthroscope to examine and repair the tissues in the joint. Recovery is quicker and less painful when compared to an open procedure.
The small incisions in arthroscopy mean that swelling is curtailed. With the advent of longer lasting and safer anesthetics, little or no pain medication is needed after the surgery. Arthroscopy also avoids a lengthy scar.
After arthroscopy, many patients return to work in a week. Many return to their favorite sports after just a month in physical therapy. Additionally, improvements in anesthesia mean a post-operative recuperation without opioids.
Arthroscopy has made a vast difference in how we treat shoulder injuries. It is also used to treat shoulder dislocation, fracture or impingement syndrome, and it is used in other joints, including knees, hips, ankles, elbows and wrists.
In more severe cases, such as an irreparable rotator cuff injury or to repair a prior operation, shoulder replacement is required. Frequently, severe shoulder pain interferes with sleep. It can weaken the joint so much that holding a briefcase or gym bag with that arm is impossible.
Numerous ailments may necessitate shoulder replacement, including osteoarthritis (degenerative arthritis), chronic inflammation caused by rheumatoid arthritis, severe fractures or failure of prior replacements caused by infection, dislocation and/or excessive wear and tear. Approximately 53,000 people in the United States undergo the procedure annually, according to the Agency for Healthcare Research and Quality.
Most patients come to us at Cleveland Clinic’s Levitetz Department of Orthopaedic Surgery after failure to improve with other treatments, such as cortisone injections, physical therapy or anti-inflammatory medicine. Some patients with large rotator cuff tears or severe arthritis known as cuff tear arthropathy may benefit from a reverse shoulder replacement rather than the conventional procedure.
In a reverse total shoulder replacement, the position of the socket and metal ball in the prosthesis is switched, placing the onus on different muscles to move the arm. Reverse shoulder replacement has allowed patients who were previously impaired to experience a significant improvement in their quality of life.
It’s important to seek help from an upper-extremity surgeon, as orthopaedics has become highly specialized in the last decade, with surgeons treating one or two joints exclusively.
The shoulder is a complicated part of the body, and with increased age, more boomers are choosing shoulder replacement and other surgical interventions. With appropriate treatment and rehabilitation, surgery can restore mobility to the shoulder and help patients quickly return to their preferred activities.
