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What Are The Shoulder Pain Treatment Options for Raleigh, Cary, Apex Garner and Triangle Shoulder Pain Sufferers?

A conservative, non- shoulder joint surgery approach of Physical Therapy is always best initially for shoulder pain, with goals to restore stability, strength and function of your shoulder. Physical therapy is directed at restoring the strength and control of the “dynamic stabilizers”, the rotator cuff muscles, by retraining them to provide greater reflexive control of the joint stability. This training may help compensate for the loss of support by the damaged “static stabilizers” of the joint. In many instances physical therapy can provide enough recovery to avoid surgery, depending on the type and degree of instability present. Also a key is the amount and type of future stresses the patient desires to place on the injured joint.  Physical therapy alone may not suffice to completely alleviate all shoulder pain but may need to be augmented by arthroscopic stabilization shoulder joint surgery.

What Factors Should Be Considered When Determining If Arthroscopic Stabilization Shoulder Joint Surgery Will Be Necessary?

There are multiple factors that should be considered by the surgeon before proceeding with arthroscopic stabilization shoulder joint surgery. The primary surgical consideration is the extent to which this instability limits your ability to lead a normal lifestyle. In the event this is moderately affected, then additional factors such as the length of time the shoulder has been unstable, any subsequent damage to other tissues such as nerves, muscle or the actual joint surface and also the direction in which the instability exists.

Arthroscopic Stabilization Shoulder Joint Surgery Goals
And Description

The goal of arthroscopic stabilization shoulder joint surgery is to internally tighten the static soft tissue stabilizers of the shoulder that have been damaged and stretched by previous trauma. The procedure also aims to repair any secondary damage to surrounding tissues that have experienced damage as a result of the instability.

Stabilization of the shoulder joint may be accomplished by arthroscopic stabilization shoulder joint surgery or by the open approach. The arthroscopic stabilization shoulder joint surgery is less invasive and has been reported to have a success rate of 90% for those patients that do not plan to return to contact sports. Open approach stabilization of the shoulder yields higher than 90% and is more often used for those patients returning to higher levels of sporting activities that do require contact and falling. This open approach may result in slight loss of mobility of the shoulder in specific ranges of motion.

The normal rehabilitative post-operative course for arthroscopic stabilization shoulder joint surgery may be somewhat shorter than for the open procedure but both courses may take 6 months before fully returning to desired activity levels.

You will arrive at the surgical center on the same day of your operation. Prior to the surgery, you will be contacted by the surgery center to inform you of the exact times and other pieces of important information that will be necessary to provide.

The anaesthetist will see you before your operation. You will need to discuss with the anaesthetist your medical history, current medications and any previous anaesthetic problems. Please feel free to discuss with the anaesthetist the type of anaesthetic that will be used (usually a general anaesthetic) and its possible side effects and complications.

The operation is usually performed under general anaesthesia (i.e. you are asleep).You may also have a “nerve block” on the surgical arm and shoulder which will totally numb the arm for 12 hours or longer.

The procedure may take up to 2 hours to complete. Arthroscopic portals or very small incisions are made in both the front and back of your shoulder through which repairs can be made to any torn tissue such as the labrum or rotator cuff. The capsule, which in most cases has stretched, can then be tightened using stitches or various other types of implements according to your physicians preference and the degree of laxity your shoulder demonstrates.

After surgery, you will be taken to the recovery room and given appropriate amounts of pain medicine as well as a cooling unit to further reduce inflammation and pain.

Upon discharge from the surgery center, expect to have some pain as the nerve block wears off. You will be given a prescription for pain medication as well as encouraged to ice the shoulder regularly the first week post-operatively.

A waterproof dressing will have been placed about the shoulder to allow for showering. When showering you may remove the sling taking care to leave your arm next to your body. It is not recommended that you attempt to elevate the arm at this time. The sling should be reapplied after showering.

One area that should be cared for especially is the axilla”or "armpit". Take extra care to keep this area as clean and dry as possible due to the risk of skin irritation and infection. It would be very beneficial to move around a bit as soon as you are comfortable to encourage good circulation throughout the entire body.

Plan to keep the sling in place for up to 4 weeks. The sling must remain on 24 hours a day. You may only remove the sling to shower and get dressed and on those occasions the arm needs to be kept adjacent to the body. When instructed, you will begin physical therapy exercises both at home and in-clinic during which time you may remove the sling under guidance and supervision. It is not recommended that you drive while wearing the sling or while taking pain medication.

Approximately 10 days post op you will be seen in the physicians office for dressing and suture removal as well as to insure that there are no skin issues, check that the wound is clean and that there is no infection.

Your second follow up will be approximately 4 weeks post-surgery at which time the sling may be discontinued and you will initiate a physical therapy rehabilitation program.

The Physical Therapy regimen will consist of in-clinic sessions of range of motion, joint mobilization, therapeutic heat and cold as well as progressive instruction on home exercises.

It is highly recommended that you avoid any sporting activities that can undermine the repair during the first 4-6 months after surgery. You may remain active in cardio exercises that do not involve forceful motion of the arm and shoulder during this time. Falling can also risk the healing process.

Approximately 6 months post -operatively, assuming good compliance with your rehab program, you will be released to resume your desired activities. You should plan to maintain good rehabilitation efforts during the 9-12 months after surgery and you may experience residual stiffness during this period. Any slight stiffness that remains permanently should not affect any activities that you should desire to perform..

For those patients desiring to return to high level contact sports, it is recommended that you consider a range limiting brace during the first season after surgery. These braces can be acquired through the office.

It is always important to remember that although the success rate for this procedure is 90%, there is always a chance of recurrence, especially if you participate in higher level contact sports or activities in which you can routinely fall.

For more information on how the shoulder joint surgery specialists at Cary Orthopaedics can help you, contact us today at 919-467-4992 for an appointment!

Cary Orthopaedics serves patients from Raleigh, Garner, Cary, Apex, Holly Springs, Fuquay-Varina, Clayton, Chapel Hill, and Pittsboro, NC