The team at Sports, Occupational and Knee Surgery strives to deliver quality care to informed patients in our comfortable and convenient offices. Our office staff and doctors work as a team here at Sports, Occupational and Knee Surgery to assist you in your treatment and recovery, whether you are an athlete with sports-related injuries or an active person suffering from joint pain. We are a premier provider of shoulder arthroscopy in San Antonio, TX.
INDICATIONS FOR SHOULDER PAIN:
Patients with athletic injuries or just wear and tear from a lifetime of activity may be candidates for shoulder arthroscopy in San Antonio. The word Arthroscopy comes from two Greek words which mean “to look inside the joint.” When a shoulder problem makes daily activities difficult or painful, your orthopedic physician can do an examination and determine which direction or procedure is best for you.
ARTHROSCOPIC SUBACROMIAL DECOMPRESSION (ASD):
This area between the arm bone (Humerus) and the shoulder bone (Acromion) can become pinched and inflamed and is sometimes called “impingement syndrome.” The pain you might experience is caused by this pinching and is typically felt on movements such as reaching or putting your arm into a jacket sleeve. The surgery is done by “key hole surgery”, usually through 2 or 3 5mm puncture wounds. You will usually be an outpatient at the hospital, depending on each individual’s health and situation. You will be encouraged to use your arm, and will be given exercises to do as soon as possible. You should be back at work between one and four weeks depending on your job. Your symptoms should be approximately 80% better after 3 months but may take a year to totally settle.
WHAT IS SHOULDER ARTHROSCOPY?
Shoulder arthroscopy is a minimally invasive surgical procedure used to diagnose and then correct problems with the shoulder joint. For these procedures, Dr. Holmes uses an arthroscope, a thin surgical tool with a camera and light on the tip, to provide visuals without needing a larger incision. The arthroscope is inserted through a small incision directly into the joint. Surgical tools are then inserted through other small incisions and the repairs are made.
Because arthroscopy allows access to the shoulder joint with very small incisions this makes for less pain and shorter recovery time for our patients.
WHAT CAUSES SHOULDER PAIN?
Most shoulder pain can be divided into four categories:
- Tendon inflammation (tendinitis, bursitis, etc) or tendon tear
Here are some descriptions of individual issues within those categories:
- Bursitis — The bursae are small, fluid-filled sacs located in joints throughout the body, including the shoulder. They provide cushion between the bones and the overlying soft tissues, and they help reduce friction between gliding muscles and the bones. In the shoulder, excessive use of the joint leads to inflammation of the bursa between the rotator cuff and the shoulder blade. This is often associated with rotator cuff tendinitis.
- Tendinitis — Tendons connect muscles to bones. Tendinitis is inflammation of the tendon. In the shoulder, this usually involves the four rotator cuff tendons and one of the biceps tendons.
- Tendon tears — Tendons can partially or completely tear as a result of acute injury or degenerative wear. In a complete tear, the tendon is pulled away from its attachment to the bone.
- Impingement — This happens when the top of the shoulder blade puts pressure on the underlying soft tissues when the arm is lifted away from the body. This leads to bursitis and tendinitis, causing pain and limiting movement.
- Instability — When the head of the upper arm bone is forced out of the shoulder socket, this is shoulder dislocation. This can be a partial or full dislocation. Once the ligaments, tendons, and muscles around the shoulder have loosened after a dislocation or from long-term overuse, dislocations can become more frequent.
- Arthritis — In the shoulder, the most common form of arthritis is osteoarthritis, colloquially known as “wear and tear” arthritis. This typically develops in middle age and the pain worsens with time.
- Fracture — Shoulder fractures commonly involve the collarbone (clavicle), upper arm bone (humerus), and shoulder blade (scapula). In older patients this is often the result of a fall. In younger patients, fractures occur in sports injuries or car accidents.
WHAT ARE SIGNS I MAY NEED SHOULDER ARTHROSCOPY?
Dr. Holmes may recommend shoulder arthroscopy if you have a painful condition that isn’t responding to more conservative treatments such as physical therapy. Since most shoulder problems are the result of injury, overuse, or age-related wear and tear, arthroscopy can be an effective way to address the problems with far easier recovery than full open surgery.
Beyond diagnosing the problem in the shoulder, Dr. Holmes uses arthroscopy for these common procedures:
- Rotator cuff repair
- Removal or repair of the labrum
- Bone spur removal
- Repair of ligaments
- Removal of inflamed tissue or loose cartilage
- Repair for recurring shoulder dislocations
IS SHOULDER SURGERY PAINFUL?
Recovery from shoulder surgery involves some pain and discomfort for several weeks after surgery. The amount of pain and the duration depend upon the extent of the repairs Dr. Holmes had to make with your surgery. You will need prescription pain medication for at least the early part of your recovery.
WHAT ARE THE BENEFITS OF HAVING SHOULDER ARTHROSCOPY?
If you’ve been having chronic pain in your shoulder it likely has started affecting your life. If you have a rotator cuff tear, for instance, just brushing your hair can be nearly impossible. In patients with frequent dislocations that have made the shoulder joint more and more loose, surgery is the only way to tighten the joint back up.
While shoulder surgery is always Dr. Holmes’s last option, if it is necessary it can allow the patient to return to activities and exercise that they likely have had to avoid. Surgery can allow the patient to rebuild strength in the shoulder, as well, helping keep things in good shape moving forward.
HOW IS SHOULDER ARTHROSCOPY PERFORMED?
Dr. Holmes often starts these surgeries by injecting fluid into the shoulder to inflate the joint. This provides better visuals so that he can clearly see all the structures in your shoulder provided by the arthroscope. Next, he usually makes a small puncture in the shoulder about the size of a button and inserts the arthroscope. Images from the arthroscope are projected on the video screen next to the operating chair, guiding Dr. Holmes.
Once he has identified the problem with your shoulder, he makes separate incisions as needed to insert the small specialized instruments necessary to make the repairs. Tasks performed may include cutting, shaving, grasping, suture passing, and knot typing. Special devices are used to anchor stitches into bone. Once your repairs are complete the small incisions are closed with stitches or steri-strips. The area is then covered with a large, soft bandage and the procedure is complete.
HOW LONG WILL MY RECOVERY BE AFTER SHOULDER ARTHROSCOPY?
Your recovery time is dependent upon the extent of your repairs during your arthroscopy. Minor repairs, such as trimming inflamed tissue or cartilage may allow the patient to return to work with a few days, and rehabilitation may only be short duration. For more complicated procedures, such as ligament repair, full recovery may take up to six months.
Rehabilitation is involved in most recoveries. We will design and give you an exercise program to help you regain shoulder strength and motion. Dr. Holmes’s extensive experience with various sports teams around San Antonio (including the Spurs) plays a role in his developing excellent rehabilitation plans for you. You may be able to perform all of the exercises on your own, or they may require a physical therapist. Again, this is unique to your procedure and situation. For the quickest, most effective end result, it’s imperative that you follow your recovery instructions to the letter.
OPTIONS FOR SHOULDER PAIN:
This is one of many solutions to shoulder problems. Rotator Cuff tears are also treated at Sports, Occupational and Knee Surgery. Dr. Peter Holmes and his staff of professionals at Sports, Occupational and Knee Surgery, San Antonio, will make sure you get the appropriate treatment and will follow you through to your full recovery.
A healthy and happy body is only a click or call away. Call Sports, Occupational and Knee Surgery today for a shoulder arthroscopy appointment at (210) 696-9000 at either our San Antonio or Shertz location.