Tendon and Ligament Repairs and Reconstruction
Due to the complex structure of the shoulder, ligaments and tendons within the shoulder are more susceptible to injury. The shoulder structure is made of three major joints: glenohumeral joint, the acromioclavicular joint, and the sternoclavicular joint. These three structures require several crucial ligaments and tendons to maintain the shoulder’s range of motion and stability. The unique structure of the shoulder is less stable than other joints and, as such is prone to dislocation and particularly susceptible to osteoarthritis.
Damage to tendons and ligaments causes severe pain and a loss of range of motion. When ligaments and tendons tear or detach, it weakens the already fragile structure of the shoulder and, if left unattended, can cause severe, long-term injuries. Your doctor will begin using conservative treatments such as anti-inflammatory medication or physical therapy to heal the damaged tendons. If nonsurgical methods are unsuccessful, surgery will be proposed.
Your surgeon at South Florida Orthopaedics & Sports Medicine will assess the severity of the injury and determine the best course of action to treat damaged tendons or ligaments in the shoulder. Most patients will make a complete recovery and, with the help of physical therapy, regain shoulder strength and mobility.
Tendon and Ligament Structure in the Shoulder
The three main joints of the shoulder are each surrounded by ligaments and tendons that allow the smooth motion of the shoulder.
The glenohumeral joint creates the ball-and-socket structure of the shoulder. The humeral head or the ball at the top of the arm bone is placed within the glenoid or shoulder socket. There are several ligaments that surround this joint to maintain a smooth range of motion.
The scapula or shoulder blade has two large protrusions. The acromion is the larger of the two protrusions and it connects to one end of the clavicle (collarbone). This joint, which allows the lifting of the arm, is surrounded by articular cartilage while being connected and stabilized by ligaments.
The third joint is the sternoclavicular joint connecting the other end of the clavicle to the sternum and allowing the forward motion of the arm. Articular cartilage is the cartilage between the two bones prevents bone to bone rubbing and damage.
Each joint is surrounded by a complex system of ligaments and tendons that, due to frequent wear and tear, are prone to injury and susceptible to osteoarthritis. Tears and detachment of ligaments or tendons can typically be repaired with a minimally invasive procedure using a tiny arthroscopic camera. However, open shoulder surgery may be required to repair more severe damage in the shoulder.
With the help of your surgeon and physical therapist, you may experience relief from the pain and instability of a damaged shoulder tendon or ligament.
Repair and Reconstruction
When determining the treatment plan for shoulder repair or reconstruction, your surgeon will recommend either arthroscopic surgery or open shoulder surgery, depending on the severity of the injury.
Arthroscopic shoulder surgery is a minimally invasive procedure using a tiny camera and small instruments to repair small to moderate damage to the shoulder. Typically, surgery will involve anchoring newly sutured tendons or ligaments to bones to allow them to heal and naturally reattach.
Open shoulder surgery is more invasive and requires a larger incision in arm. In some cases, tendons or ligaments will need to be replaced or repaired with the use of a graft or hardware to create a more stable shoulder joint.
Both methods require significant recovery time and physical therapy in order to recreate the shoulder structure and rebuild range of motion.
Recovery and Results
All reconstruction and repair options require you to keep the arm immobile for several weeks and a physical therapy treatment plan to strengthen the injured tendon or ligament. The initial recovery and immobility will last 6 to 12 weeks. Your physical therapist will begin introducing flexibility exercises to increase range of motion four to six months following surgery. Finally, strengthening exercises and a return to normal, light activities is possible within 6 to 12 months after the procedure. Overall recovery time is dependent on the type of procedure.
A majority of patients experience pain relief and increased shoulder strength following shoulder reconstruction and repair. With the help of physical therapy and rehabilitation most patients can return to a normal active lifestyle.