As a specialist in shoulder surgery, what kinds of conditions do you most commonly encounter?
Rotator-cuff problems, unstable or dislocating shoulders, arthritic conditions and fractures. Many result from traumas, such as injuries or falls, while others are degenerative, usually occurring in the older population. In addition, I see a lot of more complex and esoteric problems, such as “revision” surgery to repair previous failed procedures.
What are the latest advances in treatment?
Much progress has been made in the last decade or so in the technology and sophistication of arthroscopic surgery, or minimally invasive surgery, which allows the surgeon to work through several small incisions guided by images on a computer screen from a camera inserted into the joint. When it’s used instead of the traditional “open” procedures that involve much larger incisions cutting through muscle and other tissues, it usually means less postoperative pain and a much quicker recovery.
Today, computer navigation, long used for hip and knee replacements, is a popular choice for shoulder replacements too, and has resulted in more accurate placement of the implants and more extended implant longevity.
Another advance in the field is the increased use of “multimodal anesthesia,” a combination of regional nerve blocks, general anesthesia and long-acting local anesthetics to minimize postoperative pain.
Are shoulder replacements becoming more prevalent?
Yes, the number of replacements performed annually in the United States is increasing as the population ages, and the indications are for it to expand. I now do roughly 85 a year, for both fractures and arthritis.
A procedure called “reverse shoulder replacement” was approved by the Food and Drug Administration in 2004. It’s used to treat patients with irreparable rotator-cuff tears or an arthritic shoulder with an absent or insufficient rotator cuff. Standard shoulder-replacement surgery is performed for an osteoarthritic shoulder with an intact rotator cuff. But when the cuff is deficient or nonexistent, a reverse replacement — placing a new socket where the ball usually goes and a new ball where the socket is normally located — can do a better job. It changes the biomechanics of the shoulder so the patient no longer needs the rotator cuff for movements such as elevation, or abduction, of the arm.
What is the recovery time after shoulder surgery?
Patients having arthroscopic surgery are usually treated in an outpatient facility and go home the same day. Those having shoulder-replacement or fracture surgery usually require one night in the hospital. Either way, most must wear a sling for four to six weeks and have physical therapy for at least three months.
How are rotator-cuff injuries and dislocations treated?
For rotator-cuff problems, nonoperative measures are almost always tried first. These include medications, steroid injections and physical therapy. If these fail, surgery to reattach the torn tendons to the bone using sutures and anchors is the next option.
Instability or dislocation is common among those who play contact sports like football, hockey and rugby. In most cases, surgical repair is done arthroscopically, but sometimes, because of extensive bone loss after multiple episodes of an injury, a more invasive, or open, procedure is the best way to go.
Dr. Stephen Maurer is an orthopedic surgeon practicing at HealthAlliance Hospital in Kingston whose specialties include complex shoulder surgery along with knee and elbow conditions.
HealthAlliance Hospital: Mary’s Avenue Campus
A member of the Westchester Medical Center Health Network (WMCHealth)
105 Mary’s Avenue
Kingston, NY 12401
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