Definition and Overview

Shoulder joint reconstruction is a surgical procedure performed on patients whose shoulders have become unstable. Aside from restoring the function of the shoulder, the procedure also aims to help prevent recurrent dislocations, which is a common problem when the shoulder joint has become loose and unstable. A dislocation, which can be either partial or complete, occurs when the head of the bone of the upper arm (humerus) moves out of position or is forced out of its socket. A partial dislocation is also known as a subluxation.

A shoulder joint can become loose and unstable when the structures around the joint, namely the ligaments and cartilage, become overstretched. The shoulder joint, which is made up of the ball and socket, is highly moveable, making it prone to overuse. It can also get damaged due to injuries, such as a Bankart injury, or illness, such as osteoarthritis.

Problems with the shoulder joint and rotator cuff may initially be treated with rest, prescription medications, and physical therapy. There are also closed reduction techniques that aim to resolve the problem without requiring patients to undergo surgery. However, in severe cases, a shoulder replacement surgery may become necessary, especially if previous conservative treatment methods have already failed.

Who Should Undergo and Expected Results

Shoulder joint reconstruction is performed on patients who suffer from shoulder instability either due to injury or disease. Injuries that result in shoulder instability may include stretching the arm too far or too quickly, or falling down on an outstretched hand. An injury to the shoulder may also occur due to repetitive movements, usually in relation to sports such as basketball, volleyball, and weightlifting. They are also associated with arthritis and osteoarthritis.

Shoulder instability is one of the most common causes of shoulder pain among middle-aged individuals. It is often accompanied by a torn rotator cuff (or any other rotator cuff injury) or by a Bankart tear.

The rotator cuff refers to the group of tendons in the shoulder joint. Its role is to support and enable the arm’s full range of motion. However, this rotary movement also makes it vulnerable to dislocation. Also, when the rotator cuff is overused and overstrained, it may succumb to a rotator cuff tear or injury.

A Bankart tear, on the other hand, affects the labrum, which is a ring of cartilage that surrounds the socket.

These conditions may cause the following symptoms:

  • Severe pain

  • Arm weakness

  • Crackling sensation when moving the shoulder

  • Stiffness

  • Swelling

  • Limited range of motion

  • Loss of movement and function

  • Tenderness

  • Recurrent dislocations

  • Lack of arm and shoulder strength

  • Loss of sensation

  • Frozen shoulder syndrome

A shoulder replacement surgery, or surgery to reconstruct the shoulder joint, is often prescribed when other non-surgical treatment methods have failed to bring any lasting benefit. The surgery may replace the entire shoulder joint in what is called a total shoulder replacement. However, shoulder surgery may also focus only on a specific part of the shoulder. For example, only the rotator cuff can be replaced. In such cases, the procedure is called a rotator cuff surgery.

Either way, the purpose of shoulder surgery or reverse shoulder replacement is to reconstruct the shoulder joint so the patient can regain full mobility of the shoulder joint without experiencing any pain.

How is the Procedure Performed?

Shoulder replacement surgery to reconstruct the shoulder joint may be performed in two ways:

  • Open surgery

  • Arthroscopic surgery

Open surgery refers to a procedure wherein a large incision is made over the shoulder so the surgeon can gain access to the shoulder joint. As an invasive procedure, this type of surgery makes the patient vulnerable to risks and complications associated with an open procedure such as infection and bleeding. Thus, after the procedure, patients are required to stay in the hospital for at least one night for close monitoring.

Arthroscopic surgery, on the other hand, is a less invasive option wherein the surgeon makes small incisions and passes a small fiber-optic device through them. The device, which is called an arthroscope, is equipped with a small illuminated lens that transmits images of the inside of the shoulder to a nearby screen. This way, the surgeon can perform the surgery from the outside and without opening up the entire shoulder. There are different types of arthroscopic surgery, such as reverse total shoulder arthroplasty, also known as a reverse shoulder replacement surgery.

Due to the absence of a large incision in an arthroscopic procedure, patients are less prone to complications. The procedure is also performed on an outpatient basis, which makes the shoulder surgery less expensive for patients.

However, despite the availability of arthroscopic surgery, some injuries and conditions may still require an open shoulder surgery.

Following shoulder replacement to reconstruct a shoulder joint, patients have to go through a recovery period, which is longer for open surgery and shorter for arthroscopic surgery. The affected arm may need to be kept in a sling for a month or two, depending on the type of procedure used, in order to protect the shoulder from untoward movements while it is healing. The doctor will also give specific instructions about caring for the shoulder and arm during this period. Some of these instructions include the following:

  • Avoid heavy lifting for the first six weeks after the procedure

  • Avoid driving

  • Use a pillow under the shoulder when lying down in bed

Patients may also begin a rehabilitation program to build the strength of the shoulder joint.

Possible Risks and Complications

It is normal for patients to experience some pain and swelling after a shoulder replacement surgery or rotator cuff surgery, regardless of which method is used. Patients can apply an ice pack to the surgical site and take pain relievers to manage the symptoms, which are expected to improve after a couple of weeks. However, if symptoms don’t improve, or other symptoms arise, the patient is advised to consult a doctor.

Signs that could indicate a complication include:

  • Fever

  • Increased pain and swelling

  • Tenderness

  • Warmth in the incision site

  • Abnormal bleeding

  • Tingling and numbness of the arm, hands, or the fingers

These symptoms may point to an infection, in which case the incision needs to be promptly examined by the doctor so appropriate treatment can be given.

Aside from infection, patients are also at risk of:

  • Bleeding

  • Stiffness

  • Restricted movement

  • Nerve injury

  • Blood vessel injury

  • Failure of the procedure

  • Side effects of anaesthesia

However, the risk of complications following a shoulder replacement surgery to reconstruct the shoulder joint is very small. The procedure has a high success rate and a low complication rate.

References:

  • Magarey M, Jones M. “Clinical diagnosis and management of minor shoulder instability.” Australian Journal of Physiotherapy. http://www.sciencedirect.com/science/article/pii/S0004951414605705

  • Hayes K, Callanan M, et al. “Shoulder instability: Management and rehabilitation.” Journal of Orthopedic and Sports Physical Therapy. 2002. 32(10):497-509. http://www.jospt.org/doi/abs/10.2519/jospt.2002.32.10.497?code=jospt-site

  • Berliner JL, Regalado-Magdos A, et al. “Biomechanics of reverse total shoulder arthroplasty.” Journal of Shoulder and Elbow Surgery. 2015. 24(1): 150-160. http://www.jshoulderelbow.org/article/S1058-2746(14)00450-9/abstract

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