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Chronic shoulder pain or even an acute injury to the shoulder can cause damage to the shoulder. You may have inflammation that does not get better with medication, injections and physical therapy. You may have a diagnosed tear through diagnostic ultrasound or MRI and your surgeon has recommended surgery. Here are some things that you should know about the process of shoulder surgery.
First, how do we get to the decision of shoulder surgery? This link looks at the steps you need to take to determine a rotator cuff injury.
Do you need to have surgery?
If you have a partial rotator cuff tear proper care and rehabilitation a recovery is very possible. A full thickness tear is more likely to cause a problem, but we have seen clients over the years avoid surgery and still function quite well with a confirmed tear. There are usually limitations to certain movements that remain though. The decision to have surgery is dependent on how well you are functioning and what activities and work you need to use your shoulder for. Can you do the things you need to?
Physical Therapy is very important
Proper treatment is important to restore normal shoulder mechanics and motion whether you have surgery or decide to wait. You can have the best surgery but if your aftercare is not done well then you can have persistent problems. Here is a video of a Personal Trainer and his story of a chronic shoulder injury, rotator cuff tear diagnosis, surgery and then recovery and outcome a year later.
The need for shoulder surgery is based on damage to the shoulder and an attempt to repair the damage. If you have a torn tendon then drilling holes into the bone and fixing anchors with wires to reattach the tendon is the process during arthroscopic surgery.
Depending on what is torn or damaged will determine the type of surgery.
Subacromial Decompression/SAD
For an Impingement Syndrome a Sub-acromial Decompression or SAD is considered. This is a cleaning out and shaving of the bone to create more room for the head of the humerus. This reduces the pinching of the rotator cuff. This type of procedure is often done during a rotator cuff repair.
A torn Rotator Cuff is more commonly the supraspinatus tendon but you can have tears to the infraspinatus and subscapularis. Each tendon injury has a different post-operative recovery protocol that will be determined by your surgeon and physical therapist.
Bankart Repair
A Bankart Repair is done to repair a torn labrum. Limiting your external rotation or outward rotation of the arm is necessary during the first part of your recovery. This is because your shoulder was unstable because of this injury.
It can take months to a year to recovery from shoulder surgery. Make sure surgery is necessary. Have you had physical therapy to restore normal mechanics? Exercises alone are usually not enough. Wearing a sling is needed following shoulder surgery to help with healing and to prevent an injury of re-tearing of the rotator cuff. Here are some links to videos on wearing a sling.
Did you know that Diagnostic Ultrasound has the same sensitivity as MRI? Check out this link to find out more.
You Should Know...
A recent study in the British Journal of Sports Medicine looked at outcomes following subacromial decompression surgery and compared the success of recovery to sham SAD surgery and an exercise program. There were no significant differences between the groups except that a higher risk of harm was seen with patients undergoing SAD surgery.
“Subacromial decompression surgery provided no important benefit compared with placebo surgery or exercise therapy” BJSM, 2018
Restoring the shoulder motion and efficiency of movement to the shoulder complex, getting your shoulder to have pain free function and mobility, is the goal of any treatment. Make sure this is done first. For more on this topic check out this link.
Dry needling for shoulder pain is a great way to reduce muscle knots and improve muscle pain. Check out this link.
