Shoulder

Shoulder pain can be a debilitating problem that affects millions of people on a daily basis. When non operative measures such as anti-inflammatory medications, physical therapy and various types of injections don't provide significant relief, surgical treatment may become necessary. With advances in current surgical techniques, multiple shoulder problems can now be treated with minimally invasive arthroscopic surgery. For example, rotator cuff tears, labral tears, cartilage wear, mild arthritis, and instability can be treated arthroscopically as an outpatient with quicker recovery and less complications. For patients who require shoulder replacement, newer techniques now allow custom instrumentation and implants based on patient specific anatomy judged on a preoperative CT scan. Patients are recovering quicker and achieving improved results with these newer techniques.

The most common reason for shoulder pain is rotator cuff tendonitis and bursitis with possible underlying tears. Diagnosis is based on obtaining a thorough history and performing an extensive shoulder examination. Imaging with x-rays and MRI is usually necessary to aid in the diagnosis. Initial treatment may include anti-inflammatory medications, physical therapy, or cortisone injections. Surgical treatment is reserved for patients who have failed conservative management and would include arthroscopic rotator cuff repair with decompression of the subacromial space of the shoulder. Two to three small incisions approximately one centimeter in length would be adequate to perform the entire operation. Patients will go home the same day. In years past, this operation used to be performed with a long incision requiring splitting of the deltoid muscle causing increased pain, scar tissue, and complications such as infection. At times, these patients required an overnight stay in the hospital. The advantages and benefits of arthroscopic rotator cuff surgery are clear and have been well documented in the literature.

Sometimes patients may be suffering from a massive, irreparable rotator cuff tear and have severe underlying arthritis which is a complex problem. Standard shoulder replacement surgery would not work due to the non-functioning rotator cuff. These patients would benefit from a reverse shoulder replacement, where the ball of the arm is placed on the socket side and the socket is placed on the ball side. This allows the deltoid muscle to lengthen and act as the rotator cuff to elevate the arm. The reverse shoulder replacement is a very innovative and complex procedure with excellent results for a problem we used to not have a solution for. Now the technique has been developed even further, where patient specific instrumentation and implants are custom made to each patient. This is based on preoperative CT scanning with a specific protocol. Once the scan is performed, the surgeon and the company making the implant have a web conference where the patients shoulder is viewed in three dimensions. Here, the implants and instruments are designed according to the patient's anatomy and the surgeon's knowledge of optimum positioning. This is truly an example of being at the forefront of technology and enhancing shoulder surgery, allowing patients to benefit tremendously.

In summary, the shoulder is the most complex joint in the body which allows the greatest motion of any joint. As a result, shoulder pain is a common problem that at times requires surgical intervention. Newer techniques, including minimally invasive surgery and custom implants, have allowed patients to recover quicker with excellent results and minimal risks.