If you’re experiencing shoulder pain or dysfunction and have exhausted non-surgical treatment options, you may be considering shoulder surgery or even a shoulder replacement. Many people who have shoulder pain are diagnosed with a problem related to the tendons, ligaments or muscles that hold the shoulder together rather than the actual shoulder bones unless a fracture is involved.
Depending on the severity of your condition, there are various surgical procedures that might be appropriate. To give patients a starting point, we’ve outlined some of the most common shoulder surgical procedures below.
Shoulder Arthroscopy is a minimally invasive technique where a surgeon inserts a tiny fiber optic camera, called an arthroscope, into the shoulder joint to evaluate damage and guide repairs. It can be used for various conditions, including:
- Rotator cuff tears
- Bone spurs
- Labral tears (tears of the cartilage rim around the socket)
- Inflammation around the rotator cuff (subacromial bursitis) or impingement
- – Frozen shoulder
Rotator Cuff Injuries and Surgery
The rotator cuff is a group of tendons and muscles that hold the shoulder bones together and allow you to raise your arm over your head. When torn, people can feel both pain and weakness, as well as limited range of motion. Rotator cuff tears can be a partial or a complete tear and can be the result of wear and tear or an injury, such as a fall. Rotator cuff surgery is performed to repair a torn or damaged rotator cuff tendon and can involve arthroscopic techniques or open surgery, depending on the size and location of the tear.
In some cases, reverse total shoulder replacement is a good option when the rotator cuff is severely damaged, making a traditional total shoulder replacement less effective. It reverses the ball-and-socket configuration of the shoulder joint to improve function.
The labrum is the ring of cartilage that lines the shoulder socket. When this cartilage is damaged, it can lead to instability and pain. Surgery may be required to reattach or repair the labrum. While this can often be done arthroscopically, there are other specific surgical procedures that may be required:
SLAP Repair. SLAP stands for “superior labrum, anterior to posterior.” A SLAP tear is a labrum tear that typically occurs on the upper part of the socket at the point where the biceps tendon attaches to the labrum. SLAP repair surgery is usually done arthroscopically, and once the procedure is underway, your surgeon will determine the best course of action depending on the nature and severity of the tear. This could include reattaching the labrum to the biceps tendon, removing the torn portion of the labrum, or releasing the biceps tendon attachment.
Bankart Repair: If the labrum is torn at the bottom of the shoulder socket, it’s called a Bankart lesion. This often accompanies an interior shoulder dislocation (when the head of the humerus comes out of the front of the socket). Some people experience these locations more than once and have overall shoulder instability. This procedure repairs the labrum tear and tightens the shoulder capsule to prevent future dislocations.
AC Joint Surgeries
The acromioclavicular, or AC, joint is where the collarbone, or clavicle, and the shoulder blade (scapula) come together. The AC joint is most often damaged by fractures, separations, or arthritis.
Acromioclavicular (AC) Joint Resection or Reconstruction is used to address the separation of the AC (typically from injury) or severe AC joint arthritis. In this procedure, the surgeon will stabilize or reconstruct the joint.
In osteoarthritis cases, a surgeon can use a procedure called Distal Clavicle Excision (Resection Arthroplasty) in which they remove a small part of the clavicle, allowing more space for movement and reducing pain.
Shoulder Replacement Surgery
Some shoulder conditions and injuries require shoulder replacement surgery, also called shoulder arthroplasty. Among the most common are rheumatoid or osteoarthritis, severe fractures, and rotator cuff tear arthropathy (a large rotator cuff tear combined with arthritis). Shoulder replacement exchanges the damaged parts of the shoulder joint for artificial components. There are three types of shoulder replacement surgery:
Total Shoulder Replacement (TSR): This is the most common type. Both the ball (humeral head) and socket (glenoid) parts of the joint are replaced.
Partial Shoulder Replacement (Hemiarthroplasty): Only the ball of the shoulder is replaced.
Reverse Total Shoulder Replacement: As mentioned above, this is typically used for patients with completely torn rotator cuffs or certain types of severe arthritis. In this surgery, the ball and socket are switched, meaning the ball is attached to the shoulder blade, and the socket is on the upper arm bone.
Patients often pursue shoulder replacement when other surgical and non-surgical procedures are not an option or are not likely to produce the best outcome. Orthopedic surgeons work closely with patients to determine when a shoulder replacement is recommended based on several key benefits:
- Pain relief: Many patients experience significant or complete pain relief post-surgery.
- Improved motion: Range of movement can be better than before surgery.
- Increased strength: Strength may improve, especially if physical therapy is adhered to post-operatively.
- Improved quality of life: Patients can return to many activities they enjoyed before the onset of shoulder pain.
As with all surgery, there are risks, and each patient should discuss and carefully consider potential complications with their surgeon. Complications may include infection, blood clots, anesthetic complications, nerve injury, ongoing pain or stiffness, and others.
Shoulder replacement surgery is typically an in-patient procedure, and patients should expect to be in the hospital for a couple of days. Once patients return home, they should anticipate wearing a sling to protect and stabilize the shoulder for several weeks and – importantly – plan to complete physical therapy for several months to restore movement and strength. Adhering to a physical therapy regimen after surgery is key for regaining strength, function, and range of motion.
Shoulder Replacement: Post-Surgery Recovery
Full recovery can take anywhere from three to six months on average, and patients should continue to work closely with their orthopedic and physical therapy teams to rebuild strength and ensure the joint is healing properly. Depending on each patient’s specific circumstances – such as age, overall health and fitness, and activity level – an orthopedic surgeon will recommend the appropriate level of post-surgery activity to protect the artificial joint and surrounding tissue both now and for the life of the joint.
Before Deciding to Have Shoulder Surgery
Before committing to any kind of surgery, it’s crucial to discuss your options with an orthopedic surgeon. They can recommend the most appropriate procedure based on a thorough evaluation of the problem, your lifestyle, and overall health. It’s also essential to find a reputable orthopedic surgeon with experience in the specific type of shoulder surgery you need. The choice of shoulder surgery depends on your specific diagnosis and the recommendation of your orthopedic surgeon, so have an open dialogue about expected outcomes and any concerns, questions, or clarifications you have. The shoulder surgeons at Advanced Orthopedic & Sports Medicine Specialists will work closely with you to ensure that you are fully informed and comfortable with the decision to proceed with surgery. Meet our surgeons and learn more about their specialties.