Orthopedic Specialties: Shoulder

R.I.C.E. (Rest, Ice, Compression, Elevation)

• Rest – Limited activity is recommended immediately after an injury or demanding activity, to allow your body time to heal. Try to avoid using or putting weight on the injured area for up to 48 hours after the injury, as these might worsen injury or delay recovery.
• Ice – An icepack, wrapped in a light towel to protect your skin from frostbite, helps reduce pain and swelling when applied to the injured area. Ice should be applied in cycles of ten minutes on, ten minutes off, as often as possible for 48 hours after injury.
• Compression – Wrapping the injured area snugly with an elastic medical bandage helps prevent further swelling. Avoid wrapping too tightly, which can cut off blood flow.
• Elevation – Keeping your injured body part raised above the level of your heart can help reduce pain, throbbing sensations, and bruising.

Bracing/Immobilization

Immobilization is the use of a brace or a sling to prevent movement of the shoulder. In the case of a fracture, immobilization may hold the bones in place while they heal. Slings and braces are also used to provide stability and support for the shoulder, often for rehabilitation immediately after surgery or for functional support for patients who have past injuries or conditions.

Physical Therapy

The use of exercise therapy, manual therapy, massage and other techniques to promote mobility and function in patients, and to facilitate recovery and rehabilitation from orthopedic injuries and conditions that limit a person’s abilities to perform activities in daily life. Physical therapists also establish fitness and wellness plans to prevent future loss of mobility.

Medication

• Nonsteroidal anti-inflammatory drugs (NSAIDs) – NSAIDs are commonly known drugs, many of which are available over the counter, such as ibuprofen and aspirin. They help relieve pain, reduce fever, and decrease inflammation by inhibiting enzymes that cause pain and swelling.
• Disease-modifying antirheumatic drugs (DMARDs) – Drugs defined by their ability to slow down the progression of rheumatoid arthritis (RA), like the commonly used methotrexate. Unlike NSAIDs and corticosteroids, DMARDs treat the underlying cause of RA rather than its symptoms of pain and swelling.

Injections

• Corticosteroid injections – Corticosteroid injections are frequently used to treat inflammatory joint and soft tissue conditions that haven’t responded to conservative management like physical therapy or NSAIDs. The body increases blood flow to an injury to help it disinfect and heal. This process is known as inflammation. Corticosteroids injected at the site of an injury decrease the blood flow to the area, thereby reducing inflammation.
• Platelet-rich plasma injections – Platelet-rich plasma (PRP) is a blood product drawn from a patient and then centrifuged to form a concentration rich in platelets, the cells that help repair damage. Once concentrated, the PRP is re-injected into specific areas of the patient’s body to accelerate or facilitate healing after conservative or operative interventions.
• Dry Needling – A technique in which an appropriately certified physical therapist inserts thin, solid needles into painful knotted tissues known as “trigger points.” The needles don’t inject medication; instead they’re used to stimulate tissue, helping increase blood flow, improve pain threshold, decrease inflammation, and decrease banding – taut tissue that can’t contract or relax properly.

Shoulder Arthroscopy

A minimally invasive surgical procedure used to visualize, diagnose, and treat problems inside the shoulder joint. Small incisions are made to allow small instruments to magnify, view and repair damaged cartilage or other soft tissues surrounding the shoulder joint. A range of procedures can be done arthroscopically, including SLAP repair, bone spur removal, and rotator cuff repair.

Post-operative Treatment: Treatment varies depending on the details of your arthroscopic procedure, but in most cases, physical therapy is recommended to achieve the best recovery. Exercises specific to your specific procedure can help restore your strength and mobility.

Recovery: After surgery, you’ll typically stay in the recovery room up to two hours before being discharged. You’ll need someone to drive you home and stay with you for at least one night. Full recovery can take several weeks.

SLAP Repair Surgery

An arthroscopic procedure that repairs an injury to the ring of cartilage around the shoulder socket called the Superior Labrum Anterior-Posterior (SLAP) tear. SLAP repair might be completed by removing the damaged portion of the labrum or stitching the labrum tear back together. Patients generally require a sling for two to four weeks after.

Post-operative Treatment: Patients generally require immobilization with a sling for two to four weeks, after which physical therapy is recommended to strengthen the joint.

Recovery: Most patients can return to normal activities within three to six months.

Mini-Open or Arthroscopic Rotator Cuff Repair

Minimally invasive procedures in which the surgeon inspects and reattaches torn tendons in the shoulder’s rotator cuff, removing bone spurs if necessary. Because these procedures are less invasive than open surgery, they can be completed without the surgeon detaching the deltoid muscle.

Post-operative Treatment: After surgery, your arm will be immobilized with a sling for four to six weeks. After immobilization, physical therapy is needed to regain full range of motion and increased shoulder strength. Therapy starts with passive exercises, in which a therapist supports your arm while moving it, followed by independent active exercises.

Recovery: Most patients return to normal activities within four to six months.

BioCartilage Procedures

BioCartilage is a mixture of cartilage cells from donor tissue and the patient’s stem cells, used to repair damage to the articular cartilage in a patient’s joint. Small holes are drilled in the damaged area of the joint to allow the bone’s cells to aid healing. Much like patching a pothole, BioCartilage is then applied to the damaged area and sealed, providing a site for the body to create new, healthy cartilage.

Post-operative Treatment: Immobilization and physical therapy may be recommended to stabilize and strengthen the shoulder following surgery.

Recovery: Full recovery and maturation of new cartilage can take six or more months.

Superior Capsular Reconstruction

An arthroscopic surgical technique that can restore shoulder function to patients with irreparable rotator cuff tears. The procedure grafts donor tissue onto the joint, which stabilizes the shoulder by functionally replacing the damaged rotator cuff.

Post-operative Treatment: sling to immobilize and support, physical therapy

Recovery: due to less invasive approach, shorter than other more invasive procedures.

Shoulder Replacement Surgery (Arthroplasty)

The replacement of damaged of arthritic joint surfaces of the bones in the shoulder joint. Total replacement removes the damaged portions of the scapula and humerus bones and replaces them with a plastic socket and highly polished metal ball attached to a stem, while partial replacement, or hemiarthroplasty, replaces just the head of the humerus with a metal ball. In reverse total shoulder replacement, the location of the socket and metal ball are switched – the metal ball is attached to the scapula bone in the shoulder and the plastic socket is attached to the end of the humerus.

As part of Ortho Rhode Island’s leadership in emerging technology, we offer outpatient shoulder replacement, an innovative, minimally invasive approach to arthroplasty that doesn’t move or cut any of the shoulder’s rotator cuff muscles, enabling patients to return home the same day as their operation.

To help achieve better outcomes, Ortho Rhode Island also employs 3D templates for shoulder arthroplasty, using state-of-the-art three-dimensional planning software to map out surgery preoperatively, allowing surgeons to tailor procedures to the anatomy of their patients, and to place components more accurately.

Post-operative Treatment: Your arm will be in a sling to support and protect your shoulder for the two to four weeks after surgery. Physical therapy is then recommended to strengthen and improve flexibility in your shoulder.

Recovery: While some patients can return home the same day, others might have to spend a few nights in the hospital following the procedure. Most patients resume normal activity after three to four months.