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. S H O U L D E R
. A R T H R O S C O P Y : · ' . '
• :. - ~ j
. . . ' . 'S u r g e r y f o r You r S h o u l d e r P rob lem ' .:~.•
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Fixing a Problem Shoulder
J
The shoulder is your body's most flexible joint. It is designed to
let the arm move in almost any direction. But this flexibility has
a price-it makes the joint prone to injury. Ifyou have a shoulder
problem, a surgical procedure called arthroscopy can help. This
technique lets your doctor examine and treat problems in your
shoulder. Read this booklet to learn more.
The Foundation
Bones provide the foundation of the shoulder joint. The bones
fit together in a way that allows the arm to move freely.jAcromion
• The humeral head is the ball at the /~ ~Clavicletop of the humerus (arm bone). Humeral head~~
• The scapula is the shoulder blade. .~~Humerus Xhe coracoid and acromion are
two parts of the scapula.
• The glenoid is a shallow socket on
the scapula. The labrum is a ring of
cartilage around the rim of the glenoid.
• The clavicle is the collarbone.Labrum
The Connections
Soft tissues include muscles, tendons, and ligaments.
These connect the shoulder bones together, provide
stability, and move the joint.Coracoacromial
ligament
• The rotator cuff is made up of muscles
and tendons. These connect shoulder
bones and move the joint.
• The bursa is a fluid-filled sac that
cushions the rotator cuff.
• The capsule is a sheet of tough fibers
that encloses the joint. The capsule
attaches to the labrum.
• The coracoacromialligament connects
the acromion to the coracoid.
Bursa
tendons
2
This booklet is not intended as a substitute for professional medical care.Onlyyour doctor can diagnose and treat a medical problem.
©2005The StayWellCompany. www.krames.com 800-333-3032All rights reserved. Lithographed in Canada. Last reviewed November 2009.
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Arthroscopy: Looking Inside Your Joint
Arthroscopy allows your doctor to see and work inside your shoulder
joint through small incisions. A long, thin, lighted instrument called
an arthroscope is used. During surgery, the arthroscope sends live
video images from inside the joint to a monitor. Using these images,
the doctor can diagnose and treat your shoulder problem. Because
arthroscopy uses much smaller incisions, recovery is often shorter
and less painful than recovery after open surgery.
Your Orthopaedic Evaluation
Your doctor will ask you about your
symptoms and the history of yourshoulder problem. Your shoulder will
be examined. And diagnostic tests,
such as an x-ray or an MRI, may be
done. These help your doctor find
the cause-of your shoulder problem.
I - ~!
l
fIt~~
• Infection
• Damage to nerves orblood vessels
Risks and possible complications of arthroscopy include:
• Stiffness or ongoing pain
inyour shoulder
• Bleeding or blood clots
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Treating Your Shoulder Problems with Arthroscopy
You will be told how to prepare for your surgery and when you
should arrive at the hospital or surgery center. Just before surgery!
a doctor will talk to you about the anesthesia that will be used to
keep you free of pain during surgery. You may be asked by several
people to confirm which shoulder is being operated on. This is for
your safety. Below are common shoulder problems and how they are
treated during arthroscopy.
Repeated ove rhead m ovem en ts canin flam e yo ur ro tato r cu ff and b ursa,
A b one spu r m ay also fo rm . T his cause s
pain and pro blem s w ith ce rtain arm
m o vem en ts. Im pingem en t is also
cal led bursi ti s o r t end in it is .
Torn Rotator Cuff
A ro tato r cu ff can te ar due to a sudden
in ju ry o r fro m overuse . T his c an c au se
pain , w eakne ss, and lo ss o f no rm al
sh ou ld er m o ve m en t.
4
During su rge ry , an in flam ed bu rsa m ay b e rem oved . Bone m ayb e trim m ed . A nd the co raco acro m ialligam en t m ay b e de tached .
T he se steps m ake m o re ro om , re liev ing pre ssu re and allo wing
the arm to move m o re fre ely .
---,.-------------~- ..~-
D uring su rge ry , to rn ro tato r cu ff tendons m ay b e tr im m ed . The
tendons are then re attached to th e hum erus, Th is is do n e w ith
su tu re s, an ch ors, o r su rg ical tack s.
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Stretched Capsule
A stretch ed capsu le w ill rem ain lo o se.
A lo o se capsu le can't ho ld the jo in t
fir m ly in p la ce . T he b o ne s o f th e jo in t
m ay feel like they m o ve to o m u ch.
D u rin g a rth ro sco p y, a str etch ed ca psu le is fo ld ed o ve r itse lf
and su tu red in place. (This is do ne fro m inside the capsu le.)
This tightens the capsu le, help ing m ake the sho u lder jo in t
m o re sta ble .
.torn Labrum
The labru m m ay tear o ff the r im o f the
gleno id. This can cau se the jo in t to
catch o r feel like it's slipp ing o u t o f
p la ce . The s ho u l de r may e ven d is lo c ate .
A to rn labru m is repaired by reattaching it to the gleno id. This
is o ften do ne w ith specia l ancho rs pu t in to the gleno id bo ne.
Su tu res attached to the ancho rs are tied to ho ld the labru m
in p la ce. The jo in t then feels m o re stable.
Arthritis and Loose Bodies
A rthr itis is dam age to jo in t car tilage
w ith age and u se. In ju ry o r d isease can
a lso cau se it. W ear and tear m ay also
lead to lo o se bo dies (p ieces o f bo ne
o r car tilage ) o r bo ne spu rs in a j o in t.
L oo se b od yremo ved car tilage
Du ring su rgery, bo ne spu rs are rem oved. Ro ugh par ts o f
the jo in t are sm oo thed. Any lo ose bo dy is rem oved fro m the
jo in t. Bo ne m ay also be scraped o r shaved to pro mo te new
car tila ge g row th .
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After Arthroscopy
After your arthroscopy, you will recover in the hospital or
surgery center for a few hours. In some cases, you may
stay overnight. When you are able to go home, you will beinstructed how to relieve any pain and how to care for your
shoulder as it heals. To help with healing, a program of
physical therapy (PT) may be prescribed.
In the Recovery Room
After surgery, you'll be taken
to a recovery area to rest.
You'll have a bandage to
protect your incisions, and
a sling to hold your arm in
place. Nurses will give you
medications to help relieve
pain. Adevice is sometimes
used to deliver pain medica-
tion directly into the joint.
In some cases, cold packs ora cooling unit may be used
to reduce swelling in your
shoulder.
Going Home
Before leaving the hospital
or surgery center, be sure
to know how to care for your
shoulder at home. Ask any
questions you have. Also
know who to contact ifyou
have questions later. When
you are ready to leave the
hospital or surgery center,
an adult family member
or friend will need to driveyou home.
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Y o u w ill wear a sling to help rest the sho u lder while it heals.
Be prepared to have so meo ne else dr ive yo u
ho me fro m yo ur su rgery.
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Your Home Recovery
At home, follow any instructions you've been given. Your doctor
may want to see you during the first weeks after arthroscopy to
check your healing. When you're ready, PT may be prescribed.
Relieving Pain
• Take prescribed pain medications
as directed. Don't wait for pain to get
bad before you take them.
• Ice your shoulder 3 times a day for
20 minutes at a time. Use an ice
machine (if given one) or a bag of
ice or frozen peas. Put a thin cloth
between your skin and the ice source.
• Wear your sling as directed.
Call your doctor if you have:
• Fever over lOPF (38.3°C)
• Bleeding from an incision
• Increased shoulder pain
or swelling
• A red or oozing incision
• Numbness or tingling that
doesn't go away 24 hours
after surgery
Physical Therapy
Physical therapy is a program of guidedexercise that will help you regain movement
and strength in your shoulder. This program
is tailored to your shoulder pro blem and
the surgery done to treat it. You will start
PT when your doctor feels you are ready,
often shortly after surgery.
Icin g yo u r sh ou lder after su r ge ry h elp s
p reven t swe lling .
Physica l therapy can help yo u regain fu ll u se o f yo u r sho u lder .
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Your Surgical Checklist
Use this checklist to remind you what to do before and after
your surgery. Ask your doctor or nurse to fil l in the blanks.
He or she can also write down any special instructions.
Before Surgery
o Tell your doctor what medications,
supplements, or herbal remedies
you take. Ask if you should stop
taking any of them before surgery.
o Stop taking aspirin, ibuprofen,
or other medications as directed___ days before surgery.
o Confirm what time you should
arrive at the hospital or surgery
center. Arrange for an adult
family member or friend to give
you a ride to and from surgery.
o Don't eat or drink anything aftermidnight, the night before your
surgery.
Consultant:
A. Shabi Khan. MD. Orthopaedic Surgery
Contributions by:
David Bartlett , MD, Orthopaedic Surgery
Edward V. Craig, MD, Orthopaedic Surgery
Jack A. Michalsld, MD. Orthopaedic Surgery
Roger E. Pack. MPT, OCS, Physical Therapy
Craig Tifford, MD, Orthopaedic Surgery
Michael A. Wirth, MD, Orthopaedic Surgery
After Surgery
o Use ice as instructed to reduce
swelling and pain.
o Take care of your incisions as
directed. You can begin bathing
again in days.
o See your doctor for a follow-up
visit on this date: _
o Wear your sling as directed
for days/weeks.
o Do physical therapy exercises
as prescribed.
o Ask your doctor what activitiesyou should avoid:
Take o u r P atient S ur vey. H elp u s
help o the r pat ients. P lease v is it
www.kramesurvey.com to p ro videy ou r feedb ack o n th is bo o klet.
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