Dr. Gold's Orthopedic Surgery Blog

Surgeon and Author, Dr. Stuart Gold,
Blogs About Orthopedic Care

About Dr. Stuart Gold, MD

Archive for the 'Shoulder Surgery' Category

The Facts About Shoulder Surgery Scar Tissue

Thursday, July 14th, 2011

A great question I often receive from patients is “What is shoulder surgery scar tissue?” That said, here are some facts and thoughts about this unique form of tissue…

A frozen shoulder (adhesive capsulitis) is the result of the body’s attempt to heal damaged tissue. The body does not always regenerate healthy tissue after an injury, and occasionally creates fibrous tissue. Scar tissue is thicker, denser and has less blood supplying than normal tissue. This limits its functionality and most importantly its elasticity.

Scar tissue (adhesive capsulitis) in the shoulder can result from previous surgeries and injury (strains) but in some cases  there may not be a specific reason . If the lining of the joint becomes inflamed, the body can generate scar tissue to protect itself. This restricts movement and can cause pain. Previous injuries that failed to heal completely can also cause scar tissue to form in the shoulder. Sometimes, the reason for the formation of scar tissue in the shoulder may be related to a medical condition, most commonly diabetes .

The first step in treatment is NSAID’s ( advil, aleve, etc.)  Physical therapy is crucial in regaining motion.

A combination of stretching and strengthening with a large dose of patience can resolve the problem in may instances. Recovery is a slow process and the earlier it begins the easier it is.

Intervention is sometimes required if scar tissue is causing the patient problems. Manipulation under anesthesia is a procedure performed while the patient is asleep. It involves forcing the patient’s shoulder to move through a full range of motion. The intent is to stretch the scar tissue or break it up so that the shoulder is free to move. Extensive rehabilitation is typically required following the procedure. Although not a surgical procedure, the patient must be placed under a general anesthetic because of the pain that the manipulation can cause.

Often, the surgeon can perform arthroscopy to release the joint capsule or remove the scar tissue. The surgeon will insert a small camera that transmits images to a monitor. Then, using smaller instruments than in traditional surgery, he operates through tiny incisions, using the monitor to guide his movements. On occasion, if the scar tissue is extensive or if the arthroscopy does not achieve the desired results, traditional open surgery may be necessary to remove all damaged tissue.

Because scar tissue can result from surgery such as a rotator cuff repair, it is important that patients follow any exercise or physical therapy program the surgeon prescribes. In addition to strength-building activities, the physician will want the patient to perform stretching and range-of-motion exercises. Without proper movement, scar tissue can become excessive or form in the wrong place. This can cause pain and stiffness in the joint that may hinder the patient’s normal activities. After shoulder surgery, holding the formation of scar tissue to a minimum or preventing it from becoming inflexible can be an important part of future joint mobility.

Until next time,
Stuart

 

What Should Patients Know About Arthroscopic Shoulder Surgery?

Thursday, July 14th, 2011

A good portion of patient face arthroscopic shoulder surgery. That said, I am often asked, “Can you explain what is arthroscopic shoulder surgery?” and “How is it performed?” If these questions apply to you, I’d encourage you to read on…

Arthroscopic surgery, also known as minimally invasive surgery, allows physicians to examine and treat damages to a joint. By using a miniature camera and tools, the surgeon can perform his work through a much smaller incision, reducing scarring, recovery time and pain for the patient. Unlike open shoulder surgery in which the joint and connecting muscle tissue must often be subjected to trauma, arthroscopy allows the surgeon to restrict his work to the area in need of repair.

Arthroscopic shoulder surgery can be performed to correct a wide variety of injuries and diseases. One of the most common procedures is to repair a torn rotator cuff. Until recently, many surgeons reserved arthroscopic surgery for only small tears and repaired larger tears with open surgery. Advances in techniques, however, now permit even large tears to be repaired arthroscopically. Results for the procedure so far appear equivalent to traditional open surgery.

Arthroscopy is frequently used to repair a dislocated shoulder or other condition that results in instability of the joint. Superior labral  anterior to posterior tears (SLAP), are common among athletes whose sports require them to throw, such as baseball pitchers. In the past, a SLAP tear could end a pitcher’s career. New arthroscopic techniques, however, allow a greater percentage of athletes suffering such injuries to return to their sports.

Complications resulting from arthroscopic shoulder surgery are rare but possible. Like all surgery, there is a risk of infection. Some patients can develop blood clots or excessive bleeding or swelling. It is also possible for nerves or blood vessels to be damaged during the procedure. Occasionally the surgeon may discover that the problem cannot be adequately corrected through arthroscopic surgery and there may need to perform a traditional open surgery, or a ‘mini’ open procedure.

Each patient’s surgery is unique, but most arthroscopic surgeries can be performed on an outpatient basis or with no more than an overnight stay in the hospital. Pain is variable and depends on the type of procedure performed as well on the patient’s pain thresh hold. With smaller procedures (debridements and decompressions)  patients can often resume many activities within days of the arthroscopy. With more complex procedures as instability and rotator cuff surgeries, return to activity is much slower. Physical therapy or specific exercises may be ordered to speed the patient’s rehabilitation.

I hope that helps you learn more about arthroscopic shoulder surgery.

Until next time,
Stuart

 

Alternatives to Shoulder Surgery For Patients To Consider

Thursday, May 26th, 2011

Prior to any surgery, I encourage patients and my colleagues to consider their alternatives. That said, here is some additional information about alternatives to shoulder surgery that might help you through this process…

Alternatives To Shoulder Joint Surgery For Pain & Arthritis

Numerous conditions can cause shoulder pain and restricted movement. Arthritis, bursitis and tendonitis are common ailments. Fractures, especially those involving the collarbone or the upper arm, can have a significant impact on shoulder mobility. The cartilage may become worn or torn. A tear in the rotator cuff can also occur, resulting in severe pain and dramatic reductions in mobility. At times, surgery may be indicated for any of these shoulder problems. However, physicians often prefer to try non-surgical treatments prior to operating.

  • The doctor may order non-prescription medications, such as ibuprofen or aspirin, to reduce pain and inflammation. Prescription pain relievers and muscle relaxers may follow if the patient receives no relief from over-the-counter medications. The physician may also opt for steroids, injected into various locations of the shoulder, to help alleviate symptoms and accelerate the recovery.
  • Physical therapy may be beneficial for some patients. Depending on the nature of the injury, the physician may give the patient a series of exercises to perform at home. More severe cases may require a formal course of physical therapy.
  • It may be necessary for the patient to modify his or her activities. If the patient can identify certain movements or stresses that precede the onset of symptoms, avoiding such activities may reduce the pain and inflammation. In some cases, avoiding the activity for a period of time can allow the injury to heal without further intervention.

Another procedure of relatively recent origin involves the injection of an irritant to stimulate the growth of tendon and ligament tissue. The technique uses the bodies own healing system to trigger an inflammatory response that can sometimes result in growth that is thicker and stronger than the natural tissue. However, the procedure cannot heal bone or cartilage. On average, most patients need three to six injections to achieve results, but it is possible that many more injections will be required. This method has yet to be proven in long-term studies.

I hope this helps you better understand the alternatives to shoulder surgery including shoulder replacement.

Until next time,
Stuart