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Information for Patients About Shoulder Surgery

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Information for Patients About Shoulder Surgery Information for Patients about Shoulder Surgery Clinical Professor Allan Wang FRACS PhD FAOrthA Shoulder and Upper Limb Surgeon www.allanwangorthopaedics.com.au MURDOCH SUBIACO Murdoch Orthopaedic Clinic St John of God Subiaco Clinic St John of God Murdoch Clinic Suite 302, 25 McCourt St Suite 10, 100 Murdoch Drive Subiaco WA 6008 Murdoch WA 6150 Telephone: 08 6332 6390 Page | 2 Information for Patients about Shoulder Surgery Introduction e hae put this information boolet together to eduate our atients about their shoulder condition treatment otions and ost-surgial care Please ee this boolet for future referene It is not a detailed soure of information and you may also ish to refer to our ebsite www.allanwangorthopaedics.com.au for animated ideos of surgial roedures If you reuire further information or hae onerns regarding your treatment lease ontat the offie to disuss ith r ang or his staff Contents Pages 1. Shoulder natomy 3 2. Shoulder Imingement and otator Cuff endon isorders 4 3. Shoulder oint Instability and abrum ears 7 4. Post eratie Instrutions a. romiolasty eision 10 b. otator uff Reair 12 Bankart abrum Reair 5. roen Shoulder dhesie asulitis 17 6. Total Shoulder Joint elaement 19 Page | 3 Shoulder Anatomy Bone and oints of the houlder Important uscle Groups of the Shoulder Page | 4 Shoulder mpingement and otator uff Tendon isorders What is Impingement Syndrome? The moement o the houlder ont deendent on the urroundn mule and tendon - the rotator cu comlex. he rotator u comre o our tendon Suranatu tendon the mot reuently damaed tendon ecaue hen the arm eleated the tendon can ru mne aant the underurae o the aromon one at the to o the shoulder. (Fig 1) The uaromal ura hh urround the rotator u tendon an alo ecome swollen and nlamed urt). Figure 1: Tendonitis Eleaton o the arm can caue the ura to mne aant the aromon a ell (Fig 2) Imnement more lely the aromon one ha a donard ure or ha a spur. Surs rom an arthrt aromolaular A Jont may alo ontrute to ymtom What causes Impingement Syndrome? otator cu tendon damae and urt can reult rom a udden traumat nury uch a a all or heay ltn Figure 2: Bursa swelling and mpingement Deenerate endon damae may alo ocur loly rom reette atty and oerue, or a art o the an roess. Tendon damae are rom tendon rayn to artal tear to ull thcness tear and multle tendon tear can ocur. (Fig 3) Symptoms from Impingement Syndrome ou ll note an especally reahn oerhead and at nht lyn on the nured houlder. eaness and lo o houlder moement may occur Thee ymtom are alled the mnement Syndrome. Figure 3: otator uff tear Page | 5 What treatment is available? In mld cae your houlder ymtom ll mroe th ret, ant-nlammatory talet, ome hyotheray and one or to cortone necton. hen ymtom are hron or are more eere, your dotor ll order houlder -ray and an ultraound or RI an I there a one ur on the aromon urery oten necessary to remoe the one ur aromolaty to reent onon tendon mnement and urther tendon damae. I there a tear n the rotator u tendon urgery uually reured, a the tendon cannot heal y tel and the tendon tear may enlarge n uture. arer or multle tendon tear ll reure more etenive urery and ocaonally the tendon damae may not e ully rearale. What happens at Surgery? At urery an arthrooy is erormed thru mall eyhole Long Head of non The all and ocet ont is neted. A rayed or Bicep Tendon torn rotator cu tendon tear can be conrmed (Fig 4) I damae to other truture dented eg. icep tendon and lenod larum they may need urgical attenton as ell. Rotator u Bicepstendon tear Labrum A artal tear or uluaton o the long head of Biceps tendon ute a common arthroo ndn and maye Figure contrutn to an h iceps tendon damae treated y releae (tenotomy) or urgical rear (tenodesis). Aromion Tenotomy may lead to a hane n the biceps mule contour in the upper arm (“popeye muscle”). However as the e ormed y to tendon the other hal o e omenate ell ater tenotomy enode Imnement an oton n youner and more ate atent thouh early recoery wll e loer than tenotomy. endon ear Acromioplasty ± AC Excision Figure he arthrooe then laed n the uaromal spae. Acromioplast Aromiolasty he thened lament and nlamed bursa are debrided. y (Fig 5) Any spurs on the underside o the aromon are haed aay and the acromon lattened (acromioplasty). (Fig 6) Th allo learane or the underlyn rotator u learane tendon to lde moothly thout mnement If the AC joint i arthrt, the end o the clale and t one urs are alo haed AC excision). endon Tear I a mall tendon tear noted – a debridement and trmmn o the tear oten ufficent Figure Page | 6 Rotator Cuff Repair Surgery endon Tear a larer or ull thicness tenon tear is note surical repair is perorme with sutures an small resorale anchors passe into the one. (Fig 7) Humerus Figure maller rotator cu tears are repaire arthroscopically with minimal sin scarrin. (Fig 8) Figure arer rotator cu tears reuire a sin incision on the sie o the arm. are an lonstanin tenon tears may not e ully repairale or may not heal well ater surery. etearin o the cu tenon may occur. ccasionally urther surery is reuire. ore recent surical avances inclue usin a collaen patch to reinorce the rotator cu repair or aition o rowth actors (platelet rich plasma) which may improve tenon healin. Page | 7 Page | 7 Shouullddeerr JJooiinntt IInnssttaabbiilliittyy a anndd L Laabbrruumm T Teeaarsrs Anatomy The shoulder joint is a ball and socket joint held Bicep tendon Bicep tendon Coracoid together by tendons, capsular ligaments and a Coracoid fibrous cartilage which deepens the socket called the labrum. What is Shoulder Instability? Wrenching or jarring injuries can cause the shoulder joint to dislocate, sublux (partially dislocate) or feel unstable with painful clicking or a loose sensation. Treatment includes wearing a shoulder brace, followed by physiotherapy and modifying sports or work activities. Further investigations including x rays and MRI scans will show the extent of damage to bone and soft FiFgiugurer e1 :1 N: Noromrmala Sl hSohuoludledre Ar nAantaotmomy y tissue structures. BBaannkkaarrtt T Teeaarr II thethe shouldershoulder has has dislocated dislocated a acommon common type type o o damage damage is isan an anterioranterior labrum labrum tear tear with with separation separation rom rom the the glenoid glenoid socet socet anartanart tear tear I I physio physio isn’t isn’t helping helping or or you you wish wish to to remain remain very very active,active, your your shoulder shoulder is is at at ris ris or or recurrent recurrent dislocation dislocation B aBnaknakrat rt LabrumLabrum lalabbrruumm rreeppaairi r susurgrgeeryr y maymay bebe necessarynecessary This This is iseyhole eyhole GlenoidGlenoid arthroscopicarthroscopic surgery surgery Figure 2 The ANTTEERRIIOORR labrumlabrum isis repairedrepaired toto thethe edgeedge oo thethe socet socet glenoid glenoid with with bone bone anchors anchors and the capsularcapsular ligamentsligaments areare tightenedtightened with with sutures sutures The The posterior posterior labrum labrum can can also also tear, tear, causing posteriorposterior shouldershoulder painpain andand clicingclicing PPOOSTSTEERRIOIORR anart anart arthroscopic arthroscopic repair repair or or debridement cleanclean upup maymay be be reuired reuired ith severe oror multiplemultiple dislocations,dislocations, bonebone damagedamage occurs occurs The The edge edge o o the the glenoid glenoid bone bone socet maymay ractureracture oror erode,erode, oror thethe humeralhumeral head head may may be be damaged damaged ill ill Sach Sach lesion lesion which which puts the shouldershoulder ointoint atat greater greater riss riss or or re re inury inury Page | 8 SLAP Tear nother common type o damage is the SUPERIOR labrum tear or SL tear Superior Labrum tear rom nterior to osterior SL tears can be traumatic or degenerative The biceps tendon attaches to the superior labrum and SLAP tears usually don’t heal well without surgery. SLAP tears can be debrided or can also be repaired arthroscopically with suture anchors nother surgical treatment or SL tears is detachment o the biceps tendon rom the superior labrum thereby reducing the stress on the SL inury The bicep tendon can then be repaired outside the shoulder oint with suture anchors (tenodesis) or let to reattach spontaneously urther down the arm tenotomy Biceps tendon Superior Labrum Figure : Bankart Tear Figure : Arthroscopic Bankart Figure : SLAP Tear repair with suture anchors Multidirectional Instability Some patients will have generalied looseness o their oints ingers, neecaps, anles etc and may develop pain, a loose sensation and lac o conidence in using their shoulder The instability may be in one or more directions hysiotherapy and taping oten restore stability or these patients ccasionally surgical tightening o oint laity is reuired Open Surgery ter severe or multiple dislocations, other oint damage can occur otator cu tendons may tear and may also reuire surgical repair Joint suraces are scued and subected to abnormal shear orces and chondral damage and arthritis can develop one damage or ractures may need screw iation In the presence o bone damage, multiple dislocation, previous ailed surgery with scarred and poor uality labrum and capsule tissue, oint hyperlaity and young patients playing contact sport, arthroscopic anart repair may not be appropriate one grat surgery rom the pelvis or transerring o the bony Figure : Latajet epair coracoid to reconstruct the anterior glenoid damage may be reuired Lataet procedure This is an open surgical procedure, not eyhole surgery Two screws usually i the coracoid to reinorce the glenoid (Fig 6) Page | 9 After Surgery A sling is worn ull time or our to si wees.
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