8 Types of Shoulder Surgeries

Rotator Cuff Repairs

The most common surgery on the shoulder is a rotator cuff repair. Individuals may need this surgery if they experienced an injury, had a fall, or have inflammation or a tear that isn't getting any better with non-invasive treatment options.

Surgery

The goal of the surgery is to identify the damaged part of the rotator cuff and to clean and reattach any torn or damaged tendons.

Once the healthy tissue is found, the surgeon will use different techniques to restore the tendon without stretching the remaining tissues:

• The traditional approach, called an open rotator cuff repair, involves a surgical incision several inches long to detach the surrounding muscle and repair the rotator cuff directly.
• A newer minimally-invasive technique may be performed for smaller injuries.
• There is also a hybrid version, called a mini-open rotator cuff repair, which can be used if the damage is severe. This involves the placement of anchors in the shoulder bone. The tendons can be securely reattached to these with sutures.

There may be circumstances when a repair is not possible. Extensive separations known as massive rotator cuff tears are difficult to restore as the tissues can retract like a rubber band and experience rapid cell death (atrophy).

Recovery

Recovery can take several months and you may be asked to wear a sling or immobilizer once home. You will also be given specific instructions detailing:

• How to care for the surgical site, including how to keep the area clean and dry
• When to call your healthcare provider, for example, if you have a fever or chills
• Pain relief options
• A specific rehabilitation exercise program to follow
  

Outcomes

The success rate for this particular shoulder surgery is about 90%, with most individuals reporting decreased pain and increased joint functioning six months after surgery.

Risks

Risks associated with a rotator cuff repair include:

• Pain and stiffness that persists post-surgery
• Infection
• Blood clots, specifically in the legs or lungs
• Not recovering your full range of motion
  

Arthroscopy for Impingement Syndrome

Also called rotator cuff tendonitis or bursitis, impingement syndrome occurs when the tendons of your rotator cuff are trapped and compressed during movement.

This may be due to an injury, but can also occur simply due to the shape of an individual's bones. Over time, this causes damage to the tendons, as well as the cushions inside the joint space, known as bursa.

Surgery

The arthroscopic procedure used to correct impingement is known as a subacromial decompression. The aim of the surgery is to increase the space between the rotator cuff and the top of the shoulder, known as the acromion.

When performing subacromial decompression, your surgeon may remove the bursa alone or some of the undersurfaces of the acromion. Doing so creates space for the rotator cuff to glide without getting pinched between bone.

This surgical procedure may be performed alone or as part of a rotator cuff surgery. 

Recovery

The recovery process depends on whether the procedure is performed alone or as part of another surgery. If done alone, individuals will need to wear a sling and start rehabilitation exercises, likely within a few weeks. In general, recovery time can take around four months.

If it is part of another surgery, the recovery process can take longer. There may also be more movement restrictions in place.

Outcomes

Research notes that the outcomes of this shoulder surgery are "good" or "very good," with many individuals experiencing total pain relief.

Risks

Risks include surgical errors or a misdiagnosis, which can both lead to long-term symptoms. Rare complications include infection, as well as pain and stiffness in the shoulder.

Arthroscopic SLAP Repair

A superior labrum anterior and posterior (SLAP) tear is an injury to the rim of cartilage that encircles the shoulder socket known as the labrum. This can occur from an injury, repeated trauma, or wear-and-tear arthritis.

As its full name explains, a SLAP tear affects both the front (anterior) and back (posterior) of the labrum. This portion of the labrum is especially important as it serves as the attachment point for the biceps tendon.

Surgery

Arthroscopic surgery may be used to restore the labrum back to its position at the rim of the shoulder socket. Once repositioned, sutures, or stitches, are used to secure the bone to the cartilage.

More surgery may be needed if the damage extends into the biceps tendon.

Recovery

Average recovery time is about three months, but will depend on how severe the tear was. In general, it can take up to six weeks for the labrum to reattach properly to the bone. After that, your healthcare provider will recommend ways to slowly begin strengthening your arm.

Outcomes

The majority of individuals recover full range of motion after the surgery. Even athletes tend to be able to return to their sport without any restrictions once they've fully recovered.

Risks

Risks associated with this surgery include:

• Shoulder instability that persists after recovery
• Nerve damage
• Shoulder stiffness

Arthroscopy for Shoulder Dislocation

A shoulder dislocation injury occurs when the ball of the shoulder joint comes out of the socket. In young athletes, the damage most commonly occurs at the labrum.

This can happen if an individual experiences an injury that occurs due to a sudden force or with repetitive strain. In a very small amount of individuals, the shoulder can dislocate on its own without an injury.

Surgery

To stabilize the shoulder after dislocation, a type of surgery known as a Bankart repair can attach the labrum to the joint capsule to hold the ball in place.

In individuals with a condition known as multidirectional instability, the shoulder joint comes in and out of the socket very easily, so surgery is used to tighten the joint capsule.

Repeated dislocations can lead to severe shoulder damage and require major surgery to keep the joint in place. While there are several different ways to achieve this, the procedures typically involve repositioning bone around the shoulder so the ball is held more securely.

Recovery

The recovery period typically takes about two to five months, even with an accelerated rehabilitation program. Recovery typically involves immobilization for at least a month, followed by strength training.

Outcomes

Research suggests that about 92% of individuals who have Bankart repair surgery report feeling satisfied with their results.

About 71% of individuals report that they feel able to return to their typical level of work, and between 49% to 90% of individuals feel as if they were able to return to their pre-surgery level of athletic performance.

Risks

Risks associated with shoulder dislocation surgery include:

• Nerve damage
• Infection
• Osteoarthritis, as a long-term complication
• Recurring shoulder instability

Arthroscopy for Frozen Shoulder

Frozen shoulder is the second most common cause of shoulder injury next to a rotator cuff tear. When a frozen shoulder occurs, the capsule surrounding the shoulder joint becomes tight and contracted.

Frozen shoulder tends to impact individuals between the ages of 40 and 60. It most often occurs in assigned females.

While the exact cause is not known, frozen shoulder is associated with certain conditions, such as diabetes and cardiac disease. It may also occur after having an arm immobilized after a surgery.

Surgery

While often treated with non-surgical means, there are rare instances in which surgical treatment is required.

The goal of surgery is to loosen the contracted tissue to allow the shoulder to move more freely. This is done by cutting the capsule all the way around the ball of the shoulder.

It can be a challenging procedure to do, as the space inside the joint becomes extremely tight. Another challenge is that once the capsule is cut, the body responds by making new scar tissue.

Recovery

Recovery can take up to three months, and physical therapy will be required to help restore the shoulder's range of motion.

Outcomes

Outcomes tend to be good after surgery. Most individuals report reduced or no pain, as well as improved range of motion.

Risks

Risks may include:

• Recurring frozen shoulder
• Range of motion may not be fully restored
• Shoulder stiffness or pain

Acromioclavicular (AC) Joint Repairs

The acromioclavicular joint, commonly known as the AC joint, is the junction of the end of the clavicle, or collarbone, and acromion. There are several problems that can occur at the AC joint.

The first is that it can wear out. This can occur as a result of arthritis, usually at the site of previous injury. It can also deteriorate due to a repetitive use injury, such as weightlifting (a condition referred to as distal clavicle osteolysis).

Surgery

If either of these conditions occurs, open surgery may be performed to remove the end of the collarbone and widen the AC joint space. In some cases, hardware such as plates or screws will be placed during the procedure.

Instability can also occur at the AC joint, causing progressive damage to the ligaments that connect the clavicle to the end of the shoulder blade. This can eventually lead to shoulder separation.

While shoulder separation can be treated without surgery, severe cases may require surgery to repair or reconstruct ligaments that support the end of the clavicle.

Recovery

Recovery can take around three months and may include wearing a sling, as well as participating in physical therapy.

Outcomes

Research suggests that the majority of individuals undergoing surgery for AC joint repair report good or excellent outcomes, noting joint stability and strength improvement.

Risks

Risks depend on the specific surgery technique used, but may include:

• Long-term shoulder dysfunction
• Hardware issues, such as failure or associated pain
• Inflammation
• Infection
• Frozen shoulder

Shoulder Replacement

Shoulder replacement surgery is typically reserved for advanced arthritis of the shoulder joint, but can also be used for complex fractures and other problems that cannot be repaired with other techniques.

Surgery

A typical shoulder replacement will replace the ball-and-socket joint with an artificial ball made of metal and a socket made of plastic. 

In cases where only the top part of the arm bone (humerus) is broken or the socket of the arthritic shoulder is still intact, a partial replacement, known as hemiarthroplasty, may suffice. Hemiarthroplasty just replaces the ball of the shoulder, leaving the socket untouched.

Reverse shoulder replacement is another option. This surgery reverses the location of the ball-and-socket so that the replaced ball goes where the socket was, and the replaced socket goes where the ball was.

The surgery can provide an advantage for people with a rotator cuff tear arthropathy, in which both the labrum and rotator cuff are severely damaged.

Recovery

The recovery process may take a few months and you may stay in the hospital for a several days after your procedure. You will need to wear a sling during the recovery process.

Cold therapy and physical therapy are recommended for several weeks. You will also be given pain management options.

Outcomes

In general, individuals who have a shoulder replacement surgery report feeling good about their results and tend to experience improved range of motion and pain relief.

However, it is fairly common to experience a dull pain if the arm is used often or when the weather changes.

Risks

Risks are rare, but may include:

• Infection
• Nerve damage
• Artery damage
• The replacement feeling loose
• Dislocation

Biceps Tendon Surgery

The bicep is a muscle on the front of your arm. At the top end is a tendon called the long head of the bicep. This tendon attaches the muscle to the shoulder by traveling through the rotator cuff and attaching itself to the labrum. This makes the long head of the bicep a common target for shoulder problems.

Biceps tendon damage can occur from an injury, such as a fall or lifting something, but can also happen from long-term overuse.

Surgery

Biceps tendon surgery can be performed alone or as part of a rotator cuff repair. There are generally two approaches used:

• One is to sever, or cut, the tendon connection inside the shoulder joint and reattach it outside of the shoulder joint.
• The other, called a tenotomy, severs the tendon without reattaching it. Interestingly enough, this doesn't impact the bicep's strength or function. In fact, there are numerous professional athletes who have had a tenotomy and returned to their competitive careers.

Recovery

The recovery process can take around four months. During this time, your arm will be immobilized with a sling and a rehabilitation plan will be put in place to help strengthen your shoulder.

Outcomes

In general, the surgery can help restore the muscle's appearance and strength, as well as range of motion. However, complications are not uncommon.

Risks

Risks include:

• Nerve damage
• Bone presence in soft tissue, where it normally shouldn't be
• Infection
• The tendon tearing again