Arthroscopic Shoulder Instability Procedures

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Arthroscopic Rotator Cuff Repair

A rotator cuff tear involves damage to the group of muscles and tendons that surround the shoulder joint, which are crucial for shoulder stability and movement. These muscles and tendons work together to hold the head of the upper arm bone firmly within the shallow socket of the shoulder. Rotator cuff tears can occur due to acute injury, such as from a fall or lifting something heavy abruptly, or they can develop gradually due to wear and tear over time, particularly in individuals who perform repetitive overhead activities. Symptoms typically include pain at rest and at night, particularly if lying on the affected shoulder, weakness when lifting or rotating the arm, and a crackling sensation when moving the shoulder in certain positions. Treatment for a rotator cuff tear varies depending on the severity of the tear, the patient’s activity level, and their overall health. Conservative treatments often include rest, ice application, anti-inflammatory medications, and physical therapy to strengthen the shoulder muscles and restore range of motion. Physical therapists may also utilize other techniques to reduce pain and inflammation. For more severe tears, particularly those that do not respond to conservative management, surgical options may be considered. Surgery aims to repair the torn tendons. Dr. Byck specializes in the arthroscopic technique, which involves smaller incisions and typically allows for less complications and post operative pain. Post-surgery, patients usually undergo a rehabilitation program to regain full function of the shoulder.

Shoulder Instability or dislocation

Shoulder instability occurs when the head of the humerus (upper arm bone) is not held securely within the glenoid (shoulder socket), leading to a feeling that the shoulder may slip out of place, or actually dislocating. Dislocations typically happen due to significant force that separates the shoulder joint’s normal alignment, often during sports or a traumatic injury like a fall. Common symptoms include pain, visible deformity if the shoulder is dislocated, swelling, and an inability to move the arm. Recurrent dislocations can lead to chronic instability, where the shoulder feels loose and slips in and out of the joint easily, sometimes with routine activities.

Treatment for shoulder instability and dislocations depends on the severity and frequency of the dislocations and the patient’s lifestyle and activity level. Initially, conservative management, including the RICE protocol (rest, ice, compression, and elevation), pain management, and immobilization of the shoulder to allow the joint structures to heal, is recommended. Physical therapy is crucial in strengthening the muscles around the shoulder, enhancing joint stability, and reducing the risk of recurrence. For individuals who experience chronic instability or recurrent dislocations, or for whom conservative treatment fails to restore adequate function, surgical intervention may be considered. Surgery typically involves repairing the damaged ligaments and, if necessary, addressing any associated injuries such as labral tears. It is primarily an arthroscopic procedure in which small portal incisions are utilitized to perform the labral (Bankart) reconstruction. Postoperative rehabilitation is key to regaining strength and function and typically involves a gradual increase in activities to ensure a return to pre-injury levels.

Impingement

Shoulder impingement syndrome is a common condition where the tendons of the rotator cuff muscles become irritated and inflamed as they pass through the subacromial space, the narrow passageway between the bones of the shoulder. This can lead to pain, weakness, and reduced range of motion in the shoulder. The condition often develops over time due to repetitive overhead activity, poor posture, or other underlying shoulder abnormalities, making it prevalent among athletes, painters, and construction workers. Symptoms typically include a painful arc of movement when lifting the arm, pain that worsens at night, and a feeling of weakness or stiffness in the shoulder.

Treatment for shoulder impingement typically starts with conservative approaches aimed at reducing inflammation and avoiding activities that exacerbate the condition. This may include the use of non-steroidal anti-inflammatory drugs (NSAIDs), physical therapy, and modifications of daily activities to alleviate stress on the shoulder. Physical therapy is particularly crucial, focusing on exercises that strengthen the shoulder muscles, improve posture, and restore normal shoulder biomechanics. If these measures are ineffective, more invasive treatments may be considered, such as corticosteroid injections to reduce inflammation. In cases where conservative treatments fail to relieve symptoms, surgical options like arthroscopic subacromial decompression may be recommended. This procedure involves removing the inflamed tissue (bursa) as well as a small portion of the bone that forms the top of the shoulder space, thereby increasing the space available for the rotator cuff tendons and reducing the impingement.