Sarah Lewis, PharmD
What is shoulder surgery?
Shoulder surgery repairs a damaged, degenerated or diseased shoulder joint. It is a treatment for a variety of diseases and conditions in your shoulder joint. These commonly include rotator cuff tears, shoulder dislocations, and shoulder separations. Shoulder surgery can potentially help restore pain-free range of motion and full function to a damaged shoulder joint.
Your shoulder joint is formed where the upper arm bone (humerus), shoulder blade (scapula), and collarbone (clavicle) meet. Ligaments are tissues that connect these bones within your shoulder joint. A group of four muscles surround these bones to form your rotator cuff. These muscles are attached to your bones by tendons, which are tough pieces of connective tissue. Your shoulder joint also includes layers of cartilage, joint (synovial) fluid, and a bursa sac that helps cushion your joint.
Shoulder surgery is a common but major surgery with serious risks and potential complications. You may have less invasive treatment options. Consider getting a second opinion about all your treatment choices before having shoulder surgery.
Types of shoulder surgery
The types of shoulder surgery procedures include:
Arthroplasty replaces or resurfaces a diseased joint. It involves removing arthritic or damaged surfaces of bone and replacing them with artificial material or an implant called a prosthesis. It can include a partial replacement or a total replacement of your shoulder joint. Your doctor may recommend shoulder arthroplasty for degenerative diseases of the shoulder, such as osteoarthritis and rheumatoid arthritis. Some fractures of the shoulder joint may also require joint replacement.
Arthroscopy is surgery using an arthroscope. An arthroscope is a long, thin instrument that contains a small camera. It is inserted into the joint through an incision over or near the joint. The camera transmits pictures of the inside of your joint to a video screen viewed by your doctor while performing surgery. Your doctor may recommend arthroscopic shoulder surgery for shoulder dislocations, shoulder tendonitis, certain rotator cuff problems, soft tissue (muscle) repairs, frozen shoulder, and the repair of torn cartilage or ligaments.
Rotator cuff repair reattaches a torn rotator cuff. It is a treatment for a torn tendon in your shoulder joint.
Soft tissue repair treats damage to the shoulder muscles.
Other procedures that may be performed
Your doctor may perform other procedures in addition to shoulder surgery. These include:
Bone fracture or dislocation repair. Severe injuries may require surgical repair. These injuries include certain types of fractures of the collarbone, humerus, and shoulder dislocations.
Bursectomy or bursa sac repair treats a damaged bursa sac. Your bursa sac provides cushioning for your joint.
Why is shoulder surgery performed?
Your doctor may recommend shoulder surgery to treat a damaged, degenerated or diseased shoulder joint.
Your shoulder joint consists of your upper arm bone (humerus), your shoulder blade (scapula), and your collarbone (clavicle). Your tendons are strong pieces of connective tissue that attach muscles to the shoulder and arm bones. The rotator cuff is a group of muscles and tendons that surround the shoulder joint. Ligaments connect the bones of your shoulder joint and hold it together. A bursa sac lies between the bones and tendons in the shoulder to cushion the joint.
The shoulder joint can be damaged by aging, disease, overuse or injury. Your doctor may only consider shoulder surgery for you if other treatment options with less risk of complications have not worked. Ask your doctor about all your treatment options and consider getting a second opinion before deciding on shoulder surgery.
Your doctor may recommend shoulder surgery to treat:
Arthritis, shoulder inflammation caused by either osteoarthritis or rheumatoid arthritis
Bursitis, inflammation of your bursa sac
Cartilage conditions, such as loose or torn cartilage
Fracture of the upper arm bone (humerus) or the collarbone (clavicle)
Frozen shoulder, also known as adhesive capsulitis, which is stiffness of the shoulder joint
Rotator cuff tears, both partial and complete tears
Shoulder dislocation that recurs often
Shoulder separation, which is a partial or complete tear some of the shoulder ligaments
Tendonitis, or inflammation of your tendon that is not responding to more conservative treatment
Who performs shoulder surgery?
An orthopedic surgeon performs shoulder surgery. An orthopedic surgeon is a surgeon who specializes in surgical treatment of diseases and conditions of the bones and connective tissues.
How is shoulder surgery performed?
Your shoulder surgery will be performed in a hospital or outpatient surgical setting. The procedure and technique varies depending on the specific surgery, but it is generally performed using one of the following approaches:
Minimally invasive surgery involves inserting special instruments and an arthroscope through small incisions in your shoulder. This approach is also known as arthroscopy. An arthroscope is a thin, lighted instrument with a small camera. The camera transmits pictures of the inside of your body to a video screen viewed by your surgeon while performing the surgery. Minimally invasive surgery generally involves a faster recovery, less pain, and less risk of complications than open surgery. This is because it causes less damage to tissues and organs. Your surgeon will make small incisions instead of a larger one used in open surgery. Surgical tools are threaded around muscles and tissues instead of cutting through or displacing them as in open surgery.
Mini-open surgery uses newer technology and combines minimally invasive arthroscopic techniques with a smaller open procedure. The incision is one to two inches long, which is smaller than a standard open surgery incision. This technique allows more extensive repairs than are possible with minimally invasive surgery. It also causes less damage than traditional open surgery because your muscles remain attached during surgery.
Open surgery involves making a large incision in the shoulder. Open surgery allows your surgeon to directly view and access the surgical area. It generally involves a longer recovery and more pain than minimally invasive surgery. Open surgery requires a larger incision and more cutting and displacement of muscle and other tissues than minimally invasive surgery.
Your surgeon will advise you on which procedure is best for you and how long you need to stay in the hospital based on your diagnosis, age, medical history, general health, and possibly your personal preference. Learn about the different procedures and ask why your surgeon will use a particular type for you.
Types of anesthesia that may be used
Your surgeon will perform shoulder surgery using either general anesthesia or regional anesthesia.
General anesthesia is a combination of intravenous (IV) medications and gases that put you in a deep sleep. You are unaware of the procedure and will not feel any pain. You may also have a peripheral nerve block infusion in addition to general anesthesia. A peripheral nerve block infusion is an injection or continuous drip of liquid anesthetic. The anesthetic flows