The shoulder has the most mobility of any joint in the body. Even small injuries can result in significant loss of use the shoulder. One of the most common injuries to the shoulder is to the Rotator Cuff. The Rotator Cuff consists of 4 separate muscles and can be injured by overuse, repetitive smaller injuries, or a single larger injury. Most injuries will result in either weakness, stiffness, or instability of the joint. Because of the significant number of muscles around the joint, rehabilitation plays an extremely important role in getting back in the game. When surgery is needed to heal injury, minimally invasive techniques are utilized to reduce the length of disability and allow faster return to activities.
AC Joint Repair
The acromioclavicular (AC) joint is the meeting point of the acromion and clavicle bones in the shoulder area, often indicated with a visible bump in the area. AC joint injuries often occur as a result of a fall or other trauma, which may cause the acromion to move or separate from the clavicle, or cause the ligaments to be stretched or torn.
While conservative treatment is often used first for AC joint injuries, surgery may be required for injuries that are more severe or those that cause prolonged pain. Surgery for AC joint injuries may involve removing the end or restoring the position of the clavicle to relieve pain and allow the patient to resume normal functioning of the joint. Dr. Desio will decide which type of procedure is best for you after a thorough evaluation of your condition.
A labrum is a protective cuff of cartilage found in ball and socket joints like the hip and shoulder. They provide more stability, cushioning and a full range of motion for these shallow joints. A tear in the labrum, known as a labral tear, is caused by injury or overuse and can lead to pain and “catching” of the joint while moving.
While many labral tears can be treated by managing pain symptoms and undergoing physical therapy, some cases require surgical treatment. Labral repair surgery aims to repair unstable shoulders with staples, anchors or sutures. The procedure is usually performed through arthroscopy, which allows the doctor to view the tear through a small camera and perform the procedure through tiny incisions. Larger tears may require an open procedure.
Labral repair surgery is usually effective in treating labral tears and restoring full movement and strength.
Rotator Cuff Repair
The rotator cuff is the thick band of muscles and tendons that covers the top of the upper arm and holds in it place, providing stability and a full range of motion to the shoulder joint. It is made of four muscles and their associated tendons. These tendons can become partially or completely torn as a result of a rotator cuff tear. A rotator cuff tear most often occurs as a result of overuse of the muscles over a long period of time. As a result, this condition is most common in patients over the age of 40. It may also occur as a result of a traumatic injury, and involves pain when lifting or lowering their arm, muscle weakness and atrophy.
Many rotator cuff tears can be treated through nonsurgical methods that focus on relieving pain and restoring function to the shoulder. These may include:
- Use of a sling
- Anti-inflammatory medication
- Steroid injections
- Physical therapy
Surgery may be recommended for tears that cause severe pain or that do not respond to more conservative treatments. The type of surgery performed depends on the size and location of the tear, but often involves trimming torn edges or suturing the tendon back together.
Shoulder Separation Treatment
A separated shoulder is a common injury that most often affects athletes in contact sports. This injury to the acromioclavicular (AC) joint is usually the result of a fall on an outstretched hand (FOOSH), severe lateral sheering-force, or a fall on the tip of the shoulder. It is important to note that this is not the same as a shoulder dislocation: a dislocation (subluxation) of the shoulder occurs exclusively in the glenohumeral joint.
Types of Shoulder Separation
Shoulder separation injuries are classified according to their severity, with type I being the most benign and type VI being the most severe. Type I injuries consist of general trauma to the AC ligaments with no serious tears or fractures. A type II injury is tougher, as it must involve a completely severed AC ligament in addition to an acutely traumatized coracoclavicular ligament.
Type III injuries are composed of fully severed AC and coracoclavicular ligaments and formation of a permanent bump on the clavicle. The most severe types require the same makeup as a type III injury, but with additional displacement of the clavicle into various soft tissues surrounding the area.
Typically, types IV through VI all require surgery but there is controversy as to whether a type III injury would benefit significantly from surgery. Recently, it has been recommended to consider surgery as a preemptive measure against future arthritis concerns.