Shoulder Treatment

Your shoulder is one of the most widely used joints in the body, and all of the wear and tear causes many injuries. If you suffer from a shoulder injury, our top priority is eliminating the cause of your pain so you can resume using your arm with comfort and strength. The orthopedic shoulder treatment specialists at the MedStar Orthopaedic Institute dedicate themselves entirely to that priority. We care for a wide range of disorders and offer shoulder treatments and surgery options to relieve everything from a sports-related injury to a degenerative disease.

Arthroscopic Rotator Cuff Repair

The rotator cuff is made of four muscles that attach to the shoulder blade (scapula) and wrap around the front, back and top of your shoulder. Together, these muscles help guide the shoulder through many motions and also lend stability to the joint. The ends of the rotator cuff muscles form tendons that attach to the arm bone (humerus).  A variety of conditions and injuries can damage the rotator cuff, cause pain and make it difficult for you to move your arm.

In many cases, rotator cuff tears can be repaired with physical therapy and cortisone injections. However, when nonsurgical treatment does not improve your symptoms, arthroscopic rotator cuff repair may be necessary.

Arthroscopic rotator cuff repair is a minimally invasive technique, which uses an arthroscope, or thin, flexible tube equipped with a small camera. Your surgeon inserts the arthroscope through a small incision in your shoulder in order to gain access to your arm bone. The camera magnifies your injury onto a screen and allows your surgeon to visualize the damage in detail. The surgeon can then repair your tissue and restore the torn cuff to its correct position at the top of your arm bone very precisely without affecting any surrounding tissue.

Following this procedure, your shoulder will need to be immobilized in order to protect the newly placed sutures from being disrupted. After one or two weeks, you will begin physical therapy, followed by active lifting with the arm after four to six weeks. It will generally take four to six months to completely recover.

Coracoid Transfer for Shoulder Instability

If you suffer from chronic shoulder instability, you may be a good candidate for coracoid transfer surgery. This type of shoulder surgery is particularly helpful for patients who have had shoulder stabilization procedures previously or who are missing bones in the front of the shoulder socket.

In this open surgery technique, also known as the Latarjet procedure, your surgeon makes an incision at the front of your shoulder. The surgeon then transfers a piece of bone from the front of your shoulder blade to the front of your shoulder socket, helping to hold the ball in the socket of your shoulder joint and providing extra protection against continual dislocation of the joint.

Following the procedure, you may need to remain in the hospital overnight, and you may meet with a physiotherapist and/or an occupational therapist to learn appropriate exercises for your arm. You will need to keep your arm in a sling for a few weeks, and your surgeon and therapists will determine when you may return to your regular activities.

Open Bankart Repair

Used to treat conditions such as shoulder dislocations or instability, open Bankart repair helps lock the ball back into the socket of the shoulder joint. In this procedure, your orthopedic surgeon will repair damaged ligaments and cartilage through an incision in the front of your shoulder.

Following the procedure, you will start on exercises that will be provided by a physical therapist. You will be able to return to many of your daily activities quickly, but you will not be able to lift heavy objects for a couple months. If you are involved in sports, you may be able to return to training after three months, but you can typically return to low-risk activities (such as swimming or jogging) about eight to 10 weeks after surgery.

You may be a good candidate for open Bankart repair if you suffer from severe shoulder instability and have not found relief from medication, physical therapy or other nonsurgical techniques. We also often use this method to help patients who have previously had unsuccessful shoulder surgery.

Shoulder Replacement Surgery

Arthritis can make it difficult and painful to perform even the simplest daily tasks. If nonsurgical treatment options are not improving your condition, shoulder replacement surgery can mean the difference between being dependent on others and an independent life at home or in the community.

Total shoulder replacement is a surgical procedure performed by an orthopedic surgeon with special training in joint replacement. It is very effective at relieving pain and improving function. During the procedure, your surgeon replaces the damaged parts of your joints with artificial parts, called a prosthesis. The treatment options are either replacement of just the head of the humerus bone (ball) or replacement of both the ball and the socket.

You will likely be able to go home between one and three days following the surgery. You will feel some pain, but medication can help to manage it. You will need to start a rehabilitation program soon after the surgery, and your surgeon or physical therapist will help to develop a program for you.

Reverse Total Shoulder Replacement

Often, you can experience shoulder arthritis along with damage to the rotator cuff, which is the group of muscles that hold your shoulder in place and allow you to move your arm in different directions. If you suffer from both conditions at the same time, a total shoulder replacement procedure may not provide sufficient relief.

An alternative is reverse total shoulder replacement. In this open surgery, your orthopedic surgeon replaces worn away cartilage and changes the position of the ball and socket joint so you can use a different set of healthy muscles to move your arm (instead of your damaged rotator cuff muscles).

During the procedure, your surgeon makes an incision either on the front or the top of your shoulder. Your surgeon then removes the damaged bone and positions the new ball and socket joint.

You will likely return home on the second or third day following surgery. You will need to wear a sling for a few weeks, as well as complete gentle range of motion exercises. Your surgeon may recommend a physical therapy program as well. Most patients are able to regain full use of their shoulder after approximately six weeks.

Infected Total Joints

If a total joint replacement becomes infected, the health of your shoulder and arm, as well as your overall health, becomes an immediate concern.

In some cases, only the skin or soft tissues around the joint are infected, and it has not spread to the artificial joint. In this case, you may be treated with intravenous (IV) or oral antibiotics. If the infection has spread to the artificial joint, you will likely require surgical treatment, such as debridement or staged surgery.

Debridement may be appropriate if the infection is caught within the first few days. During this procedure, your surgeon removes the contaminated soft tissues, cleans the implant and replaces plastic liners or spacers. After the procedure, you will receive antibiotics for approximately six weeks.

When the infection has been present for more than a few days, staged surgery is generally needed. During the first phase of this treatment, your surgeon will remove your implant, wash the joint and soft tissues, place an antibiotic spacer to maintain normal spacing and alignment, and prescribe approximately six weeks of IV antibiotics. When the infection has been cured, your surgeon will remove the antibiotic spacer, wash the joint and reimplant your shoulder.

Preventing Shoulder Injuries

Before hitting the greens, tennis court or swimming pool, consider these tips to help prevent shoulder injuries:

  • Practice proper technique. Learn and practice the proper techniques for sports that are hard on the shoulders. For example, swimmers can help save their shoulders by placing their fingers or pinkies in the water first, not their thumbs, during freestyle.
  • Ease into exercise. Warm up with light activity such as jogging in place or jumping rope for several minutes. Then stretch your shoulders and the other muscles you'll be using. Try this shoulder stretch: Lace your fingers together and then push your arms over your head with your palms facing up. Hold for 15 seconds. Repeat five to 10 times. Be certain to also stretch after you've finished exercising.
  • Strengthen the shoulder area. Building the muscles in your wrists, arms, neck, and back helps protect your shoulders.
    • When the muscles surrounding the shoulder are strong, there's less stress on the shoulder itself. Strengthening the shoulder muscles also helps to prevent injuries. To build your shoulder muscles, grasp an unopened soup can in each hand. Point your thumbs to the ground and keep your elbows straight. Raise your arms to waist level and slowly lower them, as if you were flapping your arms. Repeat five to 15 times. Do two or three sets.

Most importantly: Do not ignore symptoms or play through a shoulder injury. Doing so can aggravate the condition and cause more problems. See a doctor if symptoms persist or if your pain is severe.

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