Springfield, Pa. – Shoulder injuries can happen to anyone — from the big-league baseball pitcher who tears his rotator cuff during a big game, to the weekend handyman who injures the joint falling from a ladder, to the construction worker whose repetitive motions with a hammer result in the wear and tear of his shoulder cartilage.

Those who require surgery on the joint were once faced with a daunting open procedure under general anesthesia, followed by months of rehabilitation and the possibility of only a partial return to the activities they enjoyed.

Today, at the hospitals of Crozer-Keystone Health System, orthopedic surgeons can now perform sophisticated shoulder procedures — including rotator cuff repairs, shoulder replacement surgery and repairs of the labrum and other shoulder structures — through arthroscopic surgery or other minimally invasive surgical procedures, allowing patients to heal more quickly with less pain and, in most cases, a short hospital stay.

During an arthroscopic surgical procedure, a surgeon inserts a thin tube with a light source (called an arthroscope) into the joint through a small incision in the skin. The tube allows the surgeon to see the inside of the joint and use small instruments (inserted through additional incisions) to work on the joint.

At Crozer-Keystone, orthopedic surgeons are now using arthroscopic and minimally invasive surgical techniques to perform these procedures:

Arthroscopic Rotator Cuff Repair

The rotator cuff is a group of four tendons and related muscles that allow you to raise and rotate your arm. When one or more of these muscles tear, it can cause pain and weakness for the patient.

In an arthroscopic rotator cuff repair, the surgeon uses devices called suture anchors, made of metal or bio-absorbable materials, to “tie” the torn tissues back to the bone.

“Previously, rotator cuff repairs involved making a large incision in the skin and another in the deltoid (shoulder) muscle and affixing the torn tendon to the bone, which resulted in considerable post-operative pain and a long recovery time,” says Jack Kazanjian, M.D., an orthopedic surgeon at Delaware County Memorial Hospital and physician for the Crozer-Keystone Human Motion Institute. “With arthroscopic rotator cuff repair surgery, we are able to visualize the tendon better and perform the repair without taking down the deltoid, which results in a shorter, more comfortable recovery time and a more cosmetically appealing incision site. Patients are able to have the procedure performed on an outpatient basis and go home the same day, and the amount of stiffness they feel after surgery is lessened.”

Patients suffering from rotator cuff injuries — which may or may not include tendon tears — will first undergo a full evaluation of their injury. Surgeons will consider the results of MRI scans of the joint, as well as an evaluation of the person’s occupation, degree of shoulder weakness and method of injury. Not all patients will be candidates for surgical repair of the rotator cuff, and may benefit instead from non-surgical treatments such as physical therapy, injections and rest.

Impingement Surgery

Surgeons can now detect and repair rotator cuff injuries before they become tears by relieving impingement syndrome through arthroscopic surgery.

Impingement syndrome occurs when the rotator cuff tendon is injured and responds by swelling. Because they are surrounded by bone and have no way to expand, the pressure within the tendon increases, which results in compression and loss of blood flow in the small blood vessels. The tendon begins to fray, causing pain and increasing the probability of a rotator cuff tear.

“Impingement syndrome results in instabilities that cause pain in the shoulder,” says James McGlynn, M.D., an orthopedic surgeon at Crozer-Chester Medical Center and physician for the Crozer-Keystone Human Motion Institute. “Advancements in arthroscopic technology have made it possible for us to repair the condition in an outpatient setting, using a small incision and decreasing the amount of post-operative pain experienced by the patient.”

Like those who undergo open procedures, patients who undergo arthroscopic impingement repair will need several weeks of physical therapy, starting with passive techniques and advancing to active techniques approximately six weeks later.

“Patients no longer have to go to big-city hospitals to find these cutting-edge, quality arthroscopic surgical techniques,” McGlynn says. “We offer the same quality of care right here in Delaware County, and complement that care with an excellent cadre of physical therapists who are well-versed in shoulder rehabilitation techniques. Many people who undergo these techniques find that they can return to their normal activities within a reasonable amount of time.”

Minimally Invasive Shoulder Replacement

Crozer-Keystone orthopedic surgeons are also performing minimally invasive shoulder replacement procedures, using state-of-the-art implants and techniques to heal various shoulder injuries.

According to Dean Trevlyn, M.D., an orthopedic surgeon at Delaware County Memorial Hospital and physician for the Crozer-Keystone Human Motion Institute, each minimally invasive shoulder replacement procedure falls into one of four categories:  

1. Traditional “ball and socket” surgery, which involves replacing the ends of the damaged upper arm bone (humerus) and shoulder bone (scapula) with prostheses made of metal or plastic that resemble a ball and socket. 
2. “Ball only” surgery, in which the end of the humerus is replaced with a prosthesis.
3. Surface arthroplasty, a procedure in which bone spurs on the humerus are sawed off and replaced with a metal or plastic cap, which will eventually grow into the bone.
4. Reverse total shoulder replacement, a procedure in which the end of the scapula is replaced with a rounded prosthesis and the end of the humerus is replaced with a cup-shaped prosthesis. The procedure is becoming common for people who develop rotator cuff tears that cannot be repaired and allows the patient to use different muscles to regain mobility in the affected shoulder.

“Minimally invasive procedures are some of the most amazing advances in shoulder surgery to come around in quite some time,” Trevlyn says. “Patients who have had shoulder conditions for years are suddenly able to lift their arms again — it can totally change their lives. And with minimally invasive techniques, the procedures result in a short hospital stay, less pain and a more comfortable recovery than traditional open techniques.”

Patients who undergo shoulder replacement surgery typically need only regional anesthesia and are able to begin rehabilitation exercises the same day.

To learn more about arthroscopic shoulder surgery, or to schedule an evaluation with a Crozer-Keystone orthopedic surgeon, call the Crozer-Keystone Human Motion Institute at 1-877-CK-MOTION (1-877-256-6846) or go to http://ckhshmi.crozer.org and click on the Request An Appointment link, complete the secure online form, and press submit.

The Crozer-Keystone Human Motion Institute is part of the Crozer-Keystone Health System. We’re 5 hospitals, 2,600 doctors and nurses, and 7,100 caring people with 1 vision. Crozer-Keystone. Something to feel good about.