Shoulder surgery is recommended when non-surgical treatments fail to manage pain or restore mobility lost due to injury, chronic instability, or degenerative joint conditions like severe arthritis. The goal of these procedures is to alleviate discomfort and improve the mechanical function of the joint. The surgical approach selected is determined by the specific condition and the extent of the damage, falling into three major types: arthroscopic procedures, open surgical procedures, and shoulder joint replacement.
Arthroscopic Procedures
Arthroscopic surgery represents a minimally invasive approach, often preferred for its lower impact on surrounding tissues and quicker recovery times. The technique involves making several small incisions, typically less than a centimeter each, through which a thin camera called an arthroscope is inserted into the joint space. This device transmits real-time images to a monitor, allowing the surgeon to navigate and perform repairs using specialized, pencil-sized instruments.
This method is commonly used to address soft-tissue injuries where the structural integrity of the joint needs to be restored. Rotator cuff tears are frequently repaired arthroscopically by reattaching the torn tendon to the bone. Shoulder impingement syndrome can be corrected by performing a subacromial decompression, which involves removing inflamed bursa or shaving a small portion of the acromion bone.
Arthroscopy is also the standard for treating labral tears, which involve the ring of cartilage surrounding the shoulder socket. Procedures like a Bankart repair for instability following a dislocation, or a Superior Labrum Anterior to Posterior (SLAP) repair, reattach the torn labrum to the glenoid using small sutures or anchors. The minimal disruption to the muscle and skin layers means less postoperative pain and scarring for the patient.
Open Surgical Procedures
Open surgery involves a single, larger incision—often several inches in length—to provide the surgeon with direct visualization and access to the shoulder joint. This traditional approach is reserved for situations where the damage is too extensive or complex for a minimally invasive technique, or when a stronger, more durable repair is required. The larger incision allows for the manipulation of severe fractures and the use of specialized hardware.
Complex fractures, such as those involving the proximal humerus or the scapula, require an open procedure for internal fixation, where metal plates and screws are used to stabilize the bone fragments. Severe cases of shoulder instability or chronic dislocations may also necessitate an open approach to reconstruct or transfer bone and soft tissue.
A procedure known as the Latarjet operation, for instance, involves transferring a section of bone from the coracoid process to the front of the glenoid socket to provide a physical block against future dislocations. While recovery times are generally longer than those following arthroscopy, open surgery remains the most effective option for addressing major anatomical disruptions.
Shoulder Joint Replacement
Shoulder joint replacement, or arthroplasty, is functionally distinct from the repair procedures because it involves replacing damaged bone and cartilage with prosthetic implants. It is recommended for patients suffering from severe osteoarthritis, rheumatoid arthritis, or irreparable damage from complex fractures. The choice of implant configuration depends on the condition of the patient’s rotator cuff tendons, which are the primary movers and stabilizers of the joint.
Total Shoulder Arthroplasty (TSA)
One common type is the Total Shoulder Arthroplasty (TSA). In this procedure, a metal ball is affixed to the top of the humerus (upper arm bone), and a plastic socket is cemented into the glenoid (shoulder socket) to replicate the joint’s natural anatomy. This method is effective for relieving pain and restoring function in patients with severe arthritis who still have a functional and intact rotator cuff.
Hemiarthroplasty
A second option is Hemiarthroplasty, or partial shoulder replacement, where only the ball portion of the joint (the humeral head) is replaced with a metal implant. The natural glenoid socket is left intact. This procedure is chosen when the humeral head is severely damaged, such as by a complex fracture, but the socket cartilage remains relatively healthy.
Reverse Total Shoulder Arthroplasty (RTSA)
The third and most specialized type is the Reverse Total Shoulder Arthroplasty (RTSA), designed specifically for individuals with severe rotator cuff tear arthropathy. In a reverse replacement, the positions of the ball and socket are switched: the socket is placed on the humerus, and the metal ball is fixed to the shoulder blade. This reversal allows the powerful deltoid muscle, rather than the non-functional rotator cuff, to power arm movement.