Orthopedic Shoulder Surgery in Wayne & Paramus, NJThe shoulder is a unique joint that can move in a large arc of motion in nearly all directions. This motion comes at the cost of sprains and strains, as the ligaments and tendons bear the forces imparted across the joint during activities like throwing a baseball, playing volleyball or lifting a heavy object.
Do I Need Shoulder Surgery?
The first step toward solving your shoulder problem is an initial consultation where you will discuss your symptoms with Dr. DeNoble. He will perform a physical examination and, if necessary, X-rays or an MRI. Whenever possible, Dr. DeNoble prefers using non-invasive procedures such as physical therapy, injections, or medical treatments.
When therapy and other nonoperative modalities are not indicated or have not solved the problem, Dr. DeNoble may recommend surgery using the latest minimally invasive arthroscopic techniques. Arthroscopic shoulder surgery avoids traditional large incisions which take longer to heal and typically require disrupting normal muscle attachments to bone in order to access the problem deep in the shoulder.
Consulting with a hand and wrist specialist doesn’t mean you agree to have surgery; it means you can find out if surgery is the option you need to consider for an optimal treatment outcome.
What Can Shoulder Surgery Treat?
As a matter of fact, shoulder surgery is very successful, returning function and eliminating pain. Since the procedures use minimally invasive techniques, the risks of issues such as infection and unusual bleeding are relatively low. Otherwise, the risks with shoulder surgery are the same as with any other surgery.
Sprains and strains of your rotator cuff and supporting ligaments can cause several issues:
Any ongoing shoulder pain should be evaluated by an expert who can determine the exact nature of the injury or condition. Thereafter, the appropriate treatments can be prescribed to rehabilitate your ailing shoulder.
Common shoulder problems that we treat include:
Shoulder StrainsShoulder strains encompass a wide variety of shoulder injuries. A muscle or tendon in the shoulder may have been stretched or slightly torn causing pain and discomfort. Strains can usually be treated with rest, NSAIDs, and physical therapy. Each patient’s injury is unique, but a simple shoulder strain can generally be treated without advanced imaging. Our specialists will take the time to assess your shoulder pain and determine the best treatment plan for you.
Shoulder InstabilityA problem that occurs when the structures that surround the shoulder joint do not work to maintain the ball within its socket. This may be the result of laxity in surrounding structures or recurrent dislocations. This issue is very unique to each patient depending on their age and history. Shoulder instability needs to be investigated carefully to ensure we pursue the appropriate treatment course. Some patients may need something as simple as rest and physical therapy while others may need a complex surgical procedure to tighten the tissues surrounding the shoulder.
Rotator Cuff TendonitisA common problem that may develop from overhead sport, repetitive motion, or age-related degeneration. Inflammation develops within the rotator cuff tendons that surround the shoulder. This leads to pain with different shoulder motions depending on which tendons are involved. The pain may be a constant ache and can be sharp when the tendon is activated with motion or against resistance. This issue can generally be treated with rest, NSAIDs, and physical therapy. Even after therapy sessions are over it is helpful to continue strengthening and stretching exercises on your own.
Impingement SyndromeImpingement may occur when the tendons or bursa in the shoulder get impinged, or “pinched,” by the bony structures of the shoulder. This syndrome may coincide with rotator cuff tendonitis or shoulder bursitis. Pain will be worse with motion that narrows the space between the tendon/bursa and the acromion. Sometimes the cause of impingement is a bone spur which may be visible on x-ray. Generally, this can be treated nonoperatively, but at times a surgery is required. A subacromial decompression is a way to remove any underhanging bone spur of the acromion that may be placing pressure on the bursa and tendons.
Other Common Shoulder Injuries:
- Bone spurs
- Shoulder dislocations
- Stiff or “Frozen shoulder”
- Labral tears
- SLAP tears
- Shoulder fractures
“I feel truly blessed that Dr. DeNoble was on call at Chilton Hospital the evening I fell and broke my shoulder. I was immediately impressed with how he put me at ease and explained the surgery he hoped to perform with diagrams etc as well as explaining contingencies. He was optimistic and positive in his approach, which instilled a feeling of peace and confidence in me…”
Common Shoulder Surgeries
Although conservative treatments and rehabilitation are always the first choices for shoulder problems, at times shoulder surgery is necessary to either return function or to eliminate chronic pain. These are the four most common shoulder surgeries we perform.
Rotar Cuff Repair
The rotator cuff is the tendon attachment of four small muscles to the top of the arm bone. These muscles and tendons help hold the ball of the bone in the socket. Professional baseball pitchers have made rotator cuff tears famous, but they are common, particularly as we age.
They may be the result of an injury such as a fall or a sudden jerking movement. When the rotator cuff has a tear the upper end of the arm bone moves up and hits the roof of the shoulder. This causes impingement and makes it difficult to raise your arm above your head; it can even be hard to simply shake hands.
We use minimally invasive arthroscopic techniques when possible, entering through very small incisions. Small anchors with thread are placed in the bone and the tissue is tied back down to the bone.
The shoulder is a shallow joint, and this allows a greater degree of motion. It also makes the joint less stable. Soft tissue in the shoulder joint makes the socket “deeper” and helps prevent dislocation. If dislocation occurs, the labrum and lining of the shoulder joint is usually torn away from the bone. Once a dislocation has occurred, the shoulder may become looser and prone to further dislocation. At a certain point, the doctor may need to stabilize the joint.
This arthroscopic procedure involves the placement of small anchors into the bone of the shoulder socket. To begin with, we attach thread to these anchors and loop it around the lining of the shoulder joint and the labrum and tie it. This brings the tissue back to the bone, allowing it to heal.
Sometimes a patient has chronic shoulder pain but doesn’t have a torn rotator cuff. Physical therapy, cortisone injections, and pain medications haven’t proven effective. The joint needs to be “cleaned out.”
To do this, we enter arthroscopically through two or three small holes and remove any irritated and inflamed tissue, scar tissue, or bone spurs that may be impinging on healthy tissue.
Osteoarthritis can affect the shoulder. This is the “wear and tear” type of arthritis and over time can cause the protective cartilage in the shoulder to wear down to nothing. As this is occurring, the patient will have flaps of cartilage that catch and cause pain during movement. This can be cleaned out arthroscopically, but once the cartilage is basically gone the only solution is shoulder replacement.
Shoulder replacement can take different forms:
- Resurfacing Hemiarthroplasty: The cap of the ball joint is replaced with a prosthesis and the remaining bone is preserved.
- Stemmed Hemiarthroplasty: Only the ball part of the shoulder joint is replaced with a metal ball and stem.
- Total Shoulder Replacement: The entire ball and socket joint is replaced with metal and plastic, respectively.
- Reverse Total Shoulder Replacement: This method is used if the patient doesn’t have a functioning rotator cuff.
How Long Does It Take For Your Shoulder To Recover After Shoulder Surgery?
Presently, recovery from all shoulder surgeries will involve having your arm in a sling to limit movement for a period of time after your procedure. On the easy end is debridement, where patients are in a sling for two to four weeks. With stabilization, rotator cuff repairs, and replacement, patients will be in a sling for four to six weeks.
Full recovery depends on the type of surgery, the degree of damage, and the patient’s healing capacity. As with all shoulder procedures, physical therapy will be a part of your rehabilitation. With stabilization, most patients can return to full use of the shoulder in three to four months. With rotator cuff repair, typical recovery is four to six months, but the shoulder will continue to improve far longer than that. In replacements, the patient can resume most daily activities in three months, although certain sports. Heavier workouts will need to wait for up to six months.
Shoulder Surgery Alternatives
We view surgery as the last option. At first, treat shoulder injuries and chronic pain with physical therapy, cortisone injections, anti-inflammatory medications, and with a change in behaviors causing shoulder strain. But when these treatments don’t solve the problem, surgery is often the only remaining option if the patient wants to have full use of his or her shoulder again.
Frequently Asked Questions
Most shoulder pain can be treated with rest, anti-inflammatories and physical therapy. Any primary doctor or general orthopedist can prescribe these simple solutions, but a trained shoulder specialist won’t just treat your pain — they will diagnose and treat your specific problem.
At Modern Orthopaedics, our trained shoulder specialists will ask the right questions, perform specific examinations and order imaging when appropriate. They will be able to diagnose your problem and treat you whether your problem is simple or complex. Although you may not feel like your shoulder issue is “bad enough” to see a specialist, it is advantageous to have the opinion of an expert in the field when it comes to your health.
Before deciding on the treatment for your shoulder pain, our doctors will first diagnose your problem. Depending on the type and severity of your problem, the treatment options will vary.
Generally, physical therapy will be involved in the first step of treatment. You will work closely with a therapist two to three times a week to develop a routine that is tailored to your diagnosis and needs. Therapy may take some time to help, which is why a six-week trial is generally recommended before proceeding with other treatment options.
Cortisone injections are often used in orthopedics. Our doctors are conservative when it comes to using cortisone injections and reserve them for specific situations. They are most commonly used for patients who may have a stiff or frozen shoulder or shoulder arthritis. They use them less commonly for rotator cuff issues, but there are exceptions. Each patient’s situation is unique, and our doctors will work with you to ensure the highest level of care.
Surgical intervention is reserved for shoulder issues that do not respond to more conservative measures or acute injuries that need to be addressed right away. The most common shoulder surgeries performed by our doctors are done arthroscopically. This allows for smaller incisions and a quicker recovery for our patients. The length of recovery, immobilization period and rehabilitation protocol differ depending on the surgery.
If you have been diagnosed with a “rotator cuff tear,” that can mean many different things depending on the severity, location, chronicity and dysfunction it is causing. Many times, a small or partial tear can be found on an MRI, but a patient may not even have symptoms. We treat the patient and not the MRI findings. That being said, MRIs can be very helpful in diagnosing a tear, and imaging gives us the ability to visualize the location and extent of the tear. With that information, we can come up with the best treatment plan. Thankfully, most people who have a rotator cuff tear on an MRI do not need surgery, but many people do. We are here to help, whether you just need a few sessions of therapy or you need surgical intervention.
As our patient, you will have an in-depth consultation with one of our doctors. We will create an individualized treatment plan together, tailored to your problem and lifestyle. Our doctors prefer non-invasive treatments whenever possible, including physical therapy and/or injections. If your problem ultimately does require surgery, our doctors prefer the least invasive surgical techniques possible. Our goals are the same as yours: to get you back to living your best life, pain free.