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Treatments

Treatments for upper extremity conditions

When rest, ultrasound, therapeutic exercise and medications to reduce inflammation are not effective, surgeons may recommend surgery. Following are just some of the surgeries orthopedic specialists perform at ProHealth Care hospitals to correct conditions of the elbow and shoulder:

Orthopedic specialists perform a variety of elbow surgeries at ProHealth Care to treat a number of conditions, including: 

  • Biceps tendonitis 
  • Dislocation 
  • Bursitis
  • Biceps tendon rupture
  • Epicondylitis
  • Fractures
Surgeries performed include:

Arthroscopy

Arthroscopy is a minimally invasive procedure where a small video camera attached to a fiber optic lens is inserted into the body to allow the surgeon to see without making a large incision. Elbow arthroscopy may relieve painful symptoms of many problems that damage the cartilage surfaces and other soft tissues surrounding the joint. Elbow arthroscopy may also be recommended to remove loose pieces of bone and cartilage, or release scar tissue that is blocking motion.

Traditional (open) elbow surgery

In open elbow surgery, the surgeon makes a large incision in the front of the elbow to directly access the joint. He or she then removes or repairs the damaged part(s).

Ligament repair and reconstruction

The biceps tendon helps bend the elbow and rotate the forearm. Injury to this tendon frequently occurs as a result of age, inactivity or over-activity, and can result in inflammation or a partial or complete tear. Patients with a biceps tendon injury may experience severe pain, bruising and weakness. Surgical treatment may include simply shaving away the torn fibers, removing the torn tendon stump and reattaching the remaining tendon, or completely reattaching torn tendons with screws and sutures.

The complexity of the shoulder joint makes it susceptible to injury and degenerative conditions. Shoulder pain can be caused by:

  • Dislocation/separation
  • Tendonitis/bursitis/impingement syndrome
  • Rotator cuff tear
  • Fracture
  • Arthritis

Many surgeries have been developed to repair the muscles, connective tissue or damaged joints that can arise from traumatic or overuse injuries to the shoulder. Techniques include:

Arthroscopy

Arthroscopy is a minimally invasive procedure where a small video camera attached to a fiber optic lens is inserted into the body to allow the surgeon to see without making a large incision. Shoulder arthroscopy may be used to remove loose pieces of bone and cartilage in the joint, or release scar tissue that is blocking motion.

Reverse shoulder replacement surgery

A conventional shoulder replacement device mimics the normal anatomy of the shoulder. A plastic "cup" is fitted into the shoulder socket, and a metal "ball" is attached to the top of the upper arm bone. In a reverse total shoulder replacement, the socket and ball are switched. The metal ball is fixed to the socket and the plastic cup is fixed to the upper end of the humerus. A reverse total shoulder replacement works better for people with cuff tear arthropathy because it relies on different muscles to move the arm. In a healthy shoulder, the rotator cuff muscles help position and power the arm during range of motion. A conventional replacement device also uses the rotator cuff muscles to function properly. In a patient with a large rotator cuff tear and cuff tear arthropathy, these muscles no longer function. The reverse total shoulder replacement relies on the deltoid muscle, instead of the rotator cuff, to power and position the arm.

Arthroscopic repair for rotator cuff tears

During arthroscopy, the surgeon inserts a small camera, called an arthroscope, into the shoulder joint. The camera displays pictures on a television screen, and the surgeon uses these images to guide miniature surgical instruments. Because the arthroscope and surgical instruments are thin, the surgeon can use very small incisions (cuts), rather than the larger incision needed for standard, open surgery.

Traditional (open) shoulder surgery

If the injury is large (significant rotator cuff tear) or complex, a traditional open surgical incision may be required. The surgeon makes the incision over the shoulder and may detach the shoulder muscle to better see and gain access to the injury. Open repair was the first technique used for torn rotator cuffs. Over the years, new technology and improved surgeon experience have led to less invasive procedures.