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Common Types Of Shoulder Surgery
Physical therapy and medications are often the first treatment for shoulder injuries. However, shoulder surgery is also an option to repair joints, rotator cuffs, or dislocations, to name a few.
The shoulder contains the most mobile joint in the body. This mobility makes the shoulder joint very vulnerable to injuries.
Often, nonsurgical options such as physical therapy and anti-inflammatory medications are the first-line treatments for shoulder issues. If these options are not effective, shoulder surgery may be considered to repair or replace joints, bones, or tendons in the shoulder area.
Surgical techniques can range from minimally invasive arthroscopic procedures to more traditional open surgeries. This article reviews the most common types of shoulder surgery.
Rotator cuff muscles are critical to your shoulder's range of motion and stability. A rotator cuff is a group of four muscles and their tendons. Although they attach as one unit to the humerus (upper arm) bone, each separate component can tear.
Rotator cuff injuries are very common.
Surgery for a complete rotator cuff tear usually involves reattaching a tendon to its original site on the upper arm bone (humerus). A partial tear may need only a minor procedure to repair the damage.
Depending on the level of damage, this surgery can be done in one of three ways:
These techniques all report similar success rates and recovery outcomes. While surgery for a torn rotator cuff is not usually a first-line treatment, you may be a good candidate for this surgery if any of these situations are true:
Learn more about rotator cuff repair here.
A SLAP tear is an injury to the ring of cartilage surrounding the socket of your shoulder joint. This injury can be caused by trauma or repetitive use.
Minimally invasive arthroscopy is usually used in SLAP repair surgery. There are several different types of SLAP tears that will require different surgical strategies. After a recovery period, most patients report improved strength and reduced pain.
Learn more about SLAP tear repair here.
Total shoulder replacement might be needed in cases of severe arthritis or a fractured shoulder joint.
The surgery involves taking out any damaged areas of the shoulder joint and replacing them with artificial parts. Often this means replacing the damaged ball and socket joint with a highly polished metal ball attached to a stem, and a plastic socket.
A shoulder hemiarthroplasty is commonly used for fractures of the humeral head. This procedure replaces just the humeral head of the shoulder joint rather than the entire ball and socket.
The specific type of shoulder replacement will depend on your injury, the quality of your bone and joint, and what your surgeon believes is best for your health needs.
Learn more about shoulder replacement surgery here.
Surgery for a shoulder dislocation may be recommended to help improve shoulder stability and tighten or repair torn or stretched tendons and ligaments. Arthroscopy is usually the recommended surgical option, as it's minimally invasive and can minimize damage to nearby tissues.
For younger athletes, shoulder dislocation surgery after a first injury may decrease the rate of future shoulder dislocations, per research published in 2019.
Learn more about arthroscopy for shoulder dislocation here.
Frozen shoulder (adhesive capsulitis) is a painful condition that limits the range of motion in your shoulder due to thickening joint tissues. Frozen shoulder is most common in women between ages 40 and 60 years old, according to the American Academy of Orthopaedic Surgeons (AAOS).
Physical therapy is the primary treatment for frozen shoulder, but surgery may be suggested if nonsurgical methods are not effective.
The goal of surgery for frozen shoulder is to stretch and release the stiffened joint capsule. This can either be done by shoulder arthroscopy or manipulation under anesthesia. These methods may also be used in combination with each other.
Per the AAOS, surgical recovery times vary from 6 weeks to 3 months, but most patients report positive long-range outcomes.
Learn more about arthroscopy for frozen shoulder here.
Your acromioclavicular (AC) joint is where the end of your collarbone and shoulder blade meet. AC joint injuries account for about 40% of all shoulder injuries and are usually due to direct trauma.
Surgery is usually only recommended if improvement is not seen via conservative methods.
AC joint surgery involves removing the damaged end portion of the collarbone and replacing torn ligaments. This can be done either arthroscopically or with open surgery. Recovery from AC joint surgery may take up to 6 months or more.
Learn more about acromioclavicular joint repair here.
Shoulder impingement is when the upper outer edge of your shoulder blade pinches or rubs against the rotator cuff beneath it. This can cause pain and irritation.
Shoulder impingement usually responds well to physical therapy and medication, but surgery may be used in severe cases. Surgery is often a minimally invasive procedure that expands the shoulder joint to relieve the pinched tissues.
Core decompression for humeral head avascular necrosis is another procedure that may be used to retain a humeral head that has been damaged due to a lack of blood supply.
Learn more about arthroscopic shoulder impingement surgery here.
The shoulder is a complex joint that's vulnerable to several types of injuries. In many cases, shoulder injuries can be resolved with a combination of physical therapy and pain management.
When these conservative methods are not effective, or in cases of severe injury, surgery may be used to repair damaged bones or tendons.
Regardless of the surgical technique used, shoulder surgeries are often effective at relieving pain and restoring shoulder function.
"This Healed My Painful Bunions — And You Won't Believe The Before And After!"
Podiatrists and foot surgeons have traditionally relied on a surgical procedure called an osteotomy to correct bunions — or the painful bony bumps that form on the joint at the base of the big toe. The procedure involves cutting bone to reshape or realign the bones of the toe, but Daniel Tucker, DPM, a podiatrist and foot surgeon, says that an osteotomy does not address the true cause of a bunion.
"There is a misconception that a bunion is simply an overgrowth of the bone when in fact it is caused by a destabilization of the joint," Dr. Tucker explains. "Osteotomy surgery doesn't stabilize the joint, which is why the procedure has a bunion recurrence rate up to 78 percent."
The solution? Dr. Tucker uses a new outpatient procedure called Lapiplasty 3D Bunion Correction, which realigns and secures the unstable joint with titanium plates at mid-foot (where the toe bone actually begins). "Lapiplasty bunion surgery fixes the root of the problem, so the rate of recurrence is only 1 percent to 3 percent," says Dr. Tucker. "Plus there is significantly less recovery time and patients are back on their feet faster."
Lapiplasty bunion surgery before (left) and after (right) showing the stabilizing plates mid-foot Wanda Martin
Case in point: Wanda Martin, 75, suffered from painful bunions for most of her adult life. As a senior Olympian and award-winning tennis player, she had considered surgery to remove them, but she dreaded the painful recovery. Even worse, she knew there was a chance they could come back.
But then she heard about Lapiplasty and decided to give it a try, and she was miraculously back on her feet in just two weeks. Read on for Wanda's incredible story – and her amazing bunion surgery before and after photos.
Wanda's story: Living with painful bunionsGrimacing with each step, Wanda Martin limped off the tennis court. The then-73-year-old had always led a very active life, even competing in the Senior Olympics. But, over the past year, the pain from her bunions had become so severe, at times she could barely walk. "I have to do something," Wanda thought. "I'm not ready to give up everything I enjoy."
Wanda had bunions on both feet for most of her life. While some people might think they are not a big deal, bunions are a progressive and extremely painful condition. They occur when unstable bones in the foot allow the big toe to drift out of alignment. The bone protrudes from the side of the foot, causing the big toe to push inward toward the other toes, making it difficult to walk without pain.
Wanda admits initially she was mostly concerned with how her bunions looked. (Click through for more on how to straighten crooked toes.)
But as years passed, the bunions grew larger and started to interfere with her life. So, she tried all sorts of protective padding and wore wide-width shoes, which helped some, but eventually, nothing worked to ease the pain. Every step was excruciating, and Wanda realized she had to find a permanent solution. (Click through for walking shoes to help sidestep foot pain)
Lapiplasty bunion surgery gave Wanda hopeResearching options, Wanda learned the standard treatment was a surgery called osteotomy, in which doctors cut into or shave down the big toe bone to realign it.
"I would need to be completely off my feet for up to eight weeks," she despaired to a friend. That was scary enough, but the most concerning part for Wanda was that the procedure didn't address why the bone was drifting out of place, so her bunions could return. Not satisfied, Wanda looked further, and she was so glad she did.
Wanda discovered that there is a new outpatient procedure covered by her insurance called the Lapiplasty 3D Bunion Correction. Lapiplasty realigns the bones in the top of the foot and corrects the cause of bunions by securing the unstable joint with titanium plates. And, remarkably, she could get back on her feet in just two weeks.
What is Lapiplasty bunion surgery like?Feeling hopeful, Wanda immediately scheduled the surgery with her doctor, Daniel Tucker, DPM, and found out that she could only do one foot at a time. So since her right foot was in much worse shape, she started with that one.
The outpatient procedure only took a couple of hours, and before Wanda left the hospital, she was given a protective boot, shown how to use it and how to change the bandages.
In the coming days, Wanda experienced some swelling and restlessness but to her relief, she wasn't in any real pain. For the first two weeks, Wanda used a knee scooter to get around and to avoid putting weight on my foot, but then to her delight, she was allowed to start walking on her own as long as s wore the boot.
Wanda's bunion surgery before and after"Within six weeks, I was thrilled to be back in my tennis shoes, driving again and resuming my volunteer activities at my church and hospital," smiles Wanda. "With traditional bunion surgery, I would still have been laid up, not being able to put any pressure on my foot for more than 2 months."
Wanda recently had the same procedure on her other foot, but even with just one foot done, she was able to live a more active life. "I go to the gym, play tennis and walk four miles a day — without pain," beams Wanda. "I'm even competing in the Senior Olympics again this fall. There's no stopping me now!"
For more stories that will help you feel great, keep reading!What Is Poor Foot Posture, and Is It Causing Your Bunions? Here's How To Retrain Your Feet
The Surprising Link Between Estrogen and Foot Pain
4 Natural Remedies for Foot Pain That Are Backed by Podiatrists
This article originally appeared in our print magazine, First For Women.
This content is not a substitute for professional medical advice or diagnosis. Always consult your physician before pursuing any treatment plan.
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What Is Hiatal Hernia Surgery?
Hiatal hernia repair is a surgical procedure used to treat a hiatal hernia. A hernia occurs when your internal tissues and organs push through a tear or weak spot in your muscles, causing a bulge or bump. A hiatal hernia occurs when the upper stomach bulges into the chest through the hiatus, a small opening in the diaphragm. As a result, the diaphragm cannot keep stomach acid from flowing into the esophagus.
Unlike other hernias, a hiatal hernia does not cause a visible bulge. However, it leads to symptoms like acid reflux and heartburn. It can also lead to severe complications.
Hiatal hernia surgery returns the stomach to the abdominal cavity. The goal is to fix the hernia and prevent it from returning.
There are two main types of hiatal hernia: sliding hernia and paraesophageal hernia. Both types involve the stomach bulging through the hiatus into the chest cavity. However, they differ in symptoms and treatment. Sliding Hernia (Type I ) About 95% of hernias are sliding hernias. About 15-20% of adults experience at least one at some point in their lives. Many sliding hernias do not cause symptoms and do not require surgical repair. A sliding hernia is a risk factor for gastroesophageal reflux disease (GERD). Your healthcare provider may recommend surgery for a sliding hernia that leads to GERD and daily symptoms. Paraesophageal Hernia (Type II) A paraesophageal hernia is much less common than a sliding hernia, but it's much more serious. This type of hernia needs to be repaired surgically because it has a high risk of incarceration, which happens when the stomach gets stuck in the chest cavity. This can lead to a loss of blood supply to the stomach (ischemia) and is considered a medical emergency. The goal of hiatal hernia surgery is to fix the hernia by moving the stomach back into the abdominal cavity. The surgeon also reinforces the area surrounding the hiatus to help prevent the stomach from slipping through it again. When You Might Need Hiatal Hernia Surgery Not everyone with a hiatal hernia needs treatment. If your hernia is not causing symptoms or any other issues, your healthcare provider will likely recommend observing it over time. Most people who undergo a hiatal hernia repair have significant symptoms that are not controlled by medication, including: Heartburn Acid reflux Nausea Bloating Feeling very full after meals Upper abdominal pain A feeling of fullness or heaviness in the upper abdomen Difficulty swallowing Dyspnea (shortness of breath) Other possible reasons for surgery include: A paraesophageal hiatal hernia with symptoms, especially with bowel obstruction or evidence of it Evidence of severe injury to the esophagus, including an ulcer (sore on the stomach or lower intestinal lining), stricture (narrowing of the esophagus), or Barrett's mucosa (damaged esophagus lining due to acid reflux) Experiencing symptoms for a long period of time Being on lifelong therapy for a defective lower esophageal sphincter (LES), a valve between the esophagus and stomach that prevents food from moving back into the esophagus A large hernia with or without symptoms, which can lead to future complications When You Might Need Emergency Surgery You might need emergency hiatal hernia surgery if your hernia is stuck or strangulated, meaning the blood supply to the hernia has been cut off. Signs of this condition include: Fever Redness in the hernia area Sudden tenderness or severe pain in the hernia area A growing hernia bulge Bowel obstruction symptoms like nausea or bloating There are two main types of hiatal hernia surgery: laparoscopic and open. Laparoscopic surgery: The surgeon uses a laparoscope (a thin telescope with a light and a camera that helps the surgeon see inside the body), which is inserted via a small incision in your abdomen. Mesh is often used to close and strengthen the abdominal wall. Some surgeons do the surgery using a robot that they control from a nearby console. Open surgery: The surgeon makes an incision in the groin to access and repair the hernia, then uses stitches and sometimes mesh to close and strengthen the abdominal wall. This type of surgery is riskier than laparoscopic surgery. Specific surgical procedures for a hiatal hernia include: Nissen fundoplication: This involves wrapping the upper portion of the stomach (fundus) around the lower esophagus to reinforce the lower esophageal sphincter and prevent the backward flow of stomach acid. The Nissen uses a 360-degree wrap, meaning the fungus is completely wrapped around the esophagus. This type of surgery can be open or laparoscopic. Partial fundoplication: This involves a partial wrapping of the fundus around the esophagus. The Dor procedure is a posterior wrap (around the back of the esophagus), and the Toupet procedure is an anterior wrap (around the front of the esophagus). Endoluminal fundoplication: This newer surgery does not require incisions. A tube with a camera is inserted into your mouth and down your esophagus. The surgeon uses this tool to insert clips where the esophagus meets the stomach. Repair surgery: This repositions the stomach back into the abdomen and closes the opening in the diaphragm to reduce herniation. Collis-Nissen gastroplasty: This lengthens the esophagus by creating a new section using part of the stomach. The surgeon then uses Nissen fundoplication to address the acid reflux. Hiatal hernia preparation, surgery, and recovery depends on your specific procedure. However, there are some general commonalities. Talk to your healthcare provider before your procedure for more information on what to expect. Before the Surgery Here are a few basic things to expect before a hiatal hernia surgery: Tests: You may need tests before the surgery, including blood tests, x-rays, and upper endoscopy (a test to look at the lining of your upper gut—including your esophagus, stomach, and upper part of the small intestine (duodenum). Paperwork: You'll complete a questionnaire and waiver before the procedure. The pre-questionnaire helps identify any potential risks that would prevent you from having the procedure, such as pregnancy. Prep: Once you are taken back for surgery, you will be asked to change into a hospital gown. Before surgery, you will wait in the pre-operative area. Your surgeon and an anesthesiologist (a medical doctor who specializes in anesthesia and pain management) will talk with you about the procedure. The medical staff may check your blood pressure, oxygen levels, and pulse. When it is time for your procedure, a healthcare provider will wheel your bed into the operating room and help you climb onto the operating table. The anesthesiologist will administer medication to help you relax and fall into a deep sleep. Hiatal hernia surgery requires general anesthesia, so you will not feel any pain or remember the surgery. The surgery generally takes 2-3 hours. During the Surgery During surgery, the surgical team will place a nasogastric (NG) tube through your nose and throat into your stomach. This tube will provide nutrition until you are ready to eat normally. For open surgery, your surgeon will make one large incision. For laparoscopic surgery, they will make 3-5 small incisions, then insert the laparoscope into one of the incisions and other surgical tools into other incisions. Your surgeon will carefully move the part of your stomach that has slipped into the chest cavity back into place. They will then repair the area of the diaphragm around the hiatus to help ensure that the stomach does not slip through it again. The surgery may include fundoplication (wrapping the upper stomach around the lower esophagus) with stitches and possibly mesh. After the Surgery Once your surgeon has completed the repair, you will be taken to the post-anesthesia care unit (PACU) to recover. You might feel groggy and disoriented when you wake up. Nurses will monitor you and administer pain medication as needed. A provider will transport you to your hospital room once the medical team has determined that you are stable and fully recovered from anesthesia. You may need to stay in the hospital for a few days, or up to about a week if you have open surgery. You will likely need to have the NG tube in place for a few days. Your medical team will remove the tube when you're able to tolerate small, frequent meals. It's common to feel bloated and have difficulty swallowing. You might experience some pain and nausea, but OTC pain relievers are usually sufficient. You might experience some chronic pain up to several months afterward. Recovery includes specific diet and movement recommendations. Diet You will start on a clear liquid diet and progress to a diet of soft or pureed foods as tolerated. You might continue this diet for about two weeks, and perhaps up to six weeks if you experience dysphagia (difficulty swallowing). This can lead to weight loss—for example, about 10-15 pounds. Post-operative diet recommendations will likely include eating small meals frequently, eating slowly, and sitting upright for up to 60 minutes after each meal. Movement Your healthcare provider will likely encourage you to start incorporating regular movement as soon as possible post-surgery. This can help reduce constipation and the risk of blood clots. You will want to avoid heavy lifting or excessive straining, which can increase pressure in the abdomen and affect the hernia repair. For example, your healthcare provider might tell you lift no more than 15 pounds for up to six weeks. Most people feel back to themselves and are able to resume their usual activities in 4-6 weeks. Like any surgery, there are risks involved in undergoing a hiatal hernia repair. These risks are rare, but they include: Pneumothorax (a collapsed lung) Injury to the stomach, intestine, or esophagus Injury to the liver or spleen Dysphasia (difficulty speaking), often due to post-surgery swelling and often resolving on its own Other general risks of surgery include: Infection Bleeding or blood clots Reaction to anesthesia There is a risk of recurrence after hiatal hernia surgery. You could develop another hiatal hernia and need to undergo surgery again in the future. Up to 50% of people who have paraesophageal hernia surgery experience a small recurrence. Possible complications of fundoplication include continued acid reflux (if the wrap is too loose) and difficulty swallowing (if the wrap is too tight). Mesh can also lead to complications, including chronic (long-term) pain. Knowing what to expect can help you to feel prepared for hiatal hernia surgery. You will need to consider the following: Location: Hiatal hernia surgery takes place in the operating room of a hospital. This is an inpatient procedure. You will need to stay in the hospital at least overnight and possibly up to about one week depending on the type of surgery. Attire: You will likely wear a hospital gown during your time in surgery and in the hospital. Wear loose, comfortable clothing to the hospital, and pack an extra outfit for going home. Leave any jewelry or valuables at home. Food and drink: You will receive general anesthesia for the surgery. Your surgeon will ask you to not eat or drink anything for a certain amount of time beforehand. Most people do not eat or drink for at least eight hours before surgery. Ask your surgeon how long you'll need to fast. Medications: Ask your surgeon if it is safe to take your regular medications and supplements before surgery. If you take any blood-thinning medications, such as aspirin, stop taking them before surgery. They can increase your risk of bleeding. Items to bring: Bring your insurance card, identification card (such as a driver's license), and any paperwork that you received from the hospital. Plan to bring any comfort items you'd like to have with you during your hospital stay. This may include a pillow, books, or a favorite pair of slippers. Emotional support: Ask your healthcare team about the hospital's visitor policy. Most hospitals allow a support person to stay in the waiting room during your surgery and accompany you to your hospital room. Cost and insurance: Call your insurance company after you make the surgical appointment. Clarify the cost of the surgery and how much you're responsible for paying. Talk with the hospital billing department about which bills to expect after surgery and how long you have to pay them. Lifestyle modifications and medications can sometimes reduce symptoms if your hiatal hernia isn't serious enough to warrant surgery. Surgery may be needed if these approaches do not improve your symptoms. Lifestyle Modifications Your healthcare provider will likely recommend lifestyle modifications if a sliding hiatal hernia starts to cause symptoms. Recommendations might include: Avoid foods that can trigger acid reflux, such as tomatoes, citrus, and spicy foods Eat smaller meals more frequently Sit upright after eating Avoid eating three hours before bedtime Elevate your head during sleep Wear loose-fitting clothing Medications Medications that help control stomach acid and acid reflux can help relieve GERD-related hiatal hernia symptoms. These include: Antacids: Over-the-counter (OTC) antacid medications that can provide temporary relief by neutralizing stomach acid H2 receptor blockers: Medications that reduce stomach acid production Proton pump inhibitors (PPIs): Medications that help reduce stomach acid production and alleviate symptoms of acid reflux and heartburn Hiatal hernia surgery is a type of surgery that is used to fix a hiatal hernia. A hiatal hernia occurs when part of the stomach slips or bulges through the hiatus into the chest cavity. A hiatal hernia may not cause symptoms at first, but you may develop symptoms over time, such as heartburn, upper abdominal pain, and trouble swallowing. The goal of hiatal hernia surgery is to return the stomach to the abdominal cavity and prevent the hernia from recurring. Most people spend a few days in the hospital after the surgery. Speak to your healthcare provider before the procedure to make sure you understand the procedure, risks, and any other important information.
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