The biceps tendon attaches muscles to the shoulder in two separate places and helps bend the elbow and rotate the forearm, while the acromioclavicular (AC) joint involves the junction of the acromion and clavicle bones, often marked by a small bump on the shoulder.
Injury to these structures can occur as a result of age, over-activity, a fall or other type of trauma and can result in inflammation or a partial or complete tear. These injuries can cause severe pain, bruising and weakness.
Surgical treatment depends on the type and severity of the condition. Many of these procedures can be performed through arthroscopy for less scarring, less bleeding and shorter recovery times, and may include removing damaged joint ends, shaving away torn fibers or reattaching torn tendons.
Arthroscopy is a minimally invasive surgical technique that involves several small incisions into which a fiber-optic device (arthroscope) and tiny surgical instruments are inserted. Shoulder arthroscopy is often performed to confirm a diagnosis after a physical examination and other imaging procedures have been performed. Some conditions can also be treated during the same procedure by inserting a few additional instruments into the joint area.
Arthroscopy can be used to treat many conditions that affect the shoulder joint, including:
- Rotator cuff tears
- Labral tears
- Impingement syndrome
- Biceps tendonitis
- AC joint arthritis
A Bankart lesion involves a labral tear to the inferior glenohumeral ligament. This injury occurs as a result of a shoulder dislocation, the force of which can often tear the labrum, especially in younger patients.
Successful treatment of some Bankart lesions can be achieved through conservative methods such as rest, immobilization and physical therapy. More severe cases may require surgery to reattach the torn labrum to the socket of the shoulder. This procedure is usually successful for most patients, allowing them to return to regular activities with little to no incidence of recurring dislocation. Surgery to repair a Bankart lesion can often be performed through laparoscopy, and is often recommended to reduce the risk of recurring dislocations, especially in patients under the age of 30.
A shoulder dislocation or subluxation occurs when the humerus pops out of its socket, either partially or completely. As the body’s most mobile joint, able to move in many directions, the shoulder is most vulnerable to dislocation.
Dislocation causes pain and unsteadiness in the shoulder, as well as swelling, numbness, weakness and bruising. Shoulder stabilization can be performed using arthroscopic techniques that may involve reattaching loose or torn ligaments to the joint with the use of special implants called suture anchors. These anchors are used to relocate and tighten injured structures, and then disintegrate over time.
A labrum is a protective cuff of cartilage found in ball and socket joints like the hip and shoulder. They provide more stability, cushioning and a full range of motion for these shallow joints. A tear in the labrum, known as a labral tear, is caused by injury or overuse and can lead to pain and “catching” of the joint while moving.
Labral repair surgery aims to repair unstable shoulders with staples, anchors or sutures. The procedure is usually performed through arthroscopy, which allows the doctor to view the tear through a small camera and perform the procedure through tiny incisions.
The rotator cuff is a group of tendons and muscles that support the shoulder joint and allow for complete movement while keeping the ball of the arm bone in the shoulder socket. These tendons and muscles may become torn or otherwise damaged from injury or overuse and can lead to pain, weakness and inflammation. Surgery may be used to treat this often serious condition.
Rotator cuff surgery may be performed laparoscopically or through an open procedure, depending on the type and severity of the condition. Both procedures are performed under general anesthesia and aim to reattach the tendon back to the arm, along with removing any loose fragments from the shoulder area.
Rotator cuff repair surgery is usually successful in relieving shoulder pain, although full strength cannot always be restored. Recovery time depends on the type of surgery, but can take several months.
A superior labral anterior-posterior (SLAP) lesion is an injury to the labrum of the shoulder joint, the cuff of cartilage that forms a cup for the arm bone to move within, increasing shoulder stability. Patients with a SLAP lesion may experience pain with movement, limited range of motion, frequent dislocation and a catching sensation in the shoulder.
Severe SLAP lesions may require surgical repair, which often includes:
- Debridement of fraying tissue to prevent a tear
- Securing the loose labrum to the cup of the joint
- Repair or removing torn labrum tissue
- Removing labral tear and repairing biceps tendon
Surgery for SLAP lesions is performed on an outpatient basis and takes about 90 minutes. These procedures can usually be performed arthroscopically through several small incisions, into which a camera and tiny surgical instruments are inserted.