Shoulder Surgery

Shoulder injuries are one of the most common type of sports related injuries. They can occur at any age and can be caused by traumatic injury as well as repetitive use injuries. Treatment for the more common injuries such as rotator cuff injury or tears, impingement, and dislocation or separation can include a range of options from physical therapy and medication management to surgery.

Many shoulder surgeries can be performed arthroscopically, through small incisions that lessen pain, improve recovery time, and improve the patient experience. However, in some cases of extensive damage, shoulder replacement surgery may also be required.

The primary indication for a total should replacement is pain that will not respond to non-operative treatment. The primary goal of the total should replacement surgery is to alleviate pain. Second goals include improving motion, strength and function.

Our orthopedic surgeons perform the following types of shoulder surgeries:

• Arthroscopic shoulder surgery
• Total shoulder replacement
• Reverse shoulder replacement
• Shoulder revision surgery

Patients with bone-on-bone osteoarthritis and intact rotator cuff tendons are generally good candidates for Total Shoulder Arthroplasty (TSA), a conventional total shoulder replacement procedure. TSA replaces joint surfaces with a highly polished metal ball attached to a stem and plastic socket (components are available in a variety of sizes).

If the bone is healthy, your surgeon may choose to use a non-cemented or press-fitted humeral component. If the bone is soft, the humeral component may need to be implanted with bone cement. In most cases, an all-plastic glenoid component is implanted with bone cement. Implanting a glenoid component is not advisable in cases when there is good cartilage, the glenoid bone is several deficient or the rotator cuff tendons are irreparably torn.

Reverse total shoulder replacement was initially developed in Europe in the 1980s. In 2004, this surgical procedure was FDA-approved for use in the United States. rTSA is effective for those suffering from completely torn rotator cuffs, severe arthritis and/or a previously failed total shoulder replacement procedure. For individuals suffering from these issues, a conventional TSA may not alleviate all of the pain and may not enable total rotation or arm movement past a 90-degree angle.

With the rTSA procedure, the anatomy or structure of the healthy shoulder is reversed. The implant is designed so that the ball portion is attached to the shoulder blade (scapula) and the socket is placed at the upper end of the humerus.

Ralph T. Heap, MD
Timothy Kavanaugh, MD