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Complex Shoulder
Complex shoulder refers to a broad spectrum of shoulder conditions involving multiple structures, such as the rotator cuff, labrum, and joint capsule, often requiring a comprehensive approach for diagnosis and treatment. These conditions can present with intricate biomechanical challenges and may necessitate a combination of surgical interventions, rehabilitation, and ongoing management to optimize functional outcomes.
Shoulder Arthroscopy
Shoulder arthroscopy is a minimally invasive surgical procedure used to diagnose and treat problems within the shoulder joint. The procedure involves inserting a small camera, called an arthroscope, into the shoulder joint through small incisions.
Dr. Jildeh will use the arthroscope to examine the shoulder joint and surrounding tissues, including the rotator cuff, labrum, and biceps tendon. If a problem is identified, Dr. Jildeh can use specialized instruments to repair or remove damaged tissue. Common conditions that can be treated with shoulder arthroscopy include rotator cuff tears, labral tears, shoulder impingement, and shoulder instability. The procedure is typically performed on an outpatient basis, which means that most patients can go home on the same day as the surgery.
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Arthroplasty/Arthritis
• Total shoulder arthroplasty
• Reverse total shoulder arthroplasty
• Hemiarthroplasty
• Revision shoulder arthroplasty
• Shoulder resurfacing
• Comprehensive Arthroscopic Management (CAM) of mild-moderate arthritis
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• Total shoulder arthroplasty (TSA) is a surgical procedure that replaces the damaged shoulder joint with artificial components, relieving pain and improving function. This surgery is typically performed on patients with severe arthritis or irreparable rotator cuff tears.
• Reverse total shoulder arthroplasty (RTSA) is a specialized procedure in which the artificial joint components are reversed, allowing the deltoid muscle to compensate for a nonfunctional rotator cuff. This surgery is ideal for patients with complex shoulder problems like cuff tear arthropathy.
• Hemiarthroplasty involves replacing only one part of the damaged shoulder joint, typically the humeral head, preserving the natural glenoid surface. This procedure is often performed on patients with less severe arthritis or limited rotator cuff tears.
• Revision shoulder arthroplasty is a procedure performed to correct complications or improve outcomes from a previous shoulder replacement surgery. Reasons for revision may include infection, loosening of prosthetic components, or persistent pain and limited mobility.
• Shoulder resurfacing is a surgical procedure that is used to treat shoulder arthritis by replacing the damaged cartilage on the surface of the humeral head with a metal cap. This procedure is often referred to as shoulder resurfacing arthroplasty.
• Comprehensive Arthroscopic Management (CAM) of mild-moderate arthritis is a minimally invasive surgical procedure used to treat patients with mild to moderate arthritis in the shoulder joint. This procedure involves the use of an arthroscope, a small camera that is inserted into the shoulder joint through a small incision. During the procedure, Dr. Jildeh will examine the joint to assess the degree of damage to the joint surface. If necessary, he may use specialized instruments to remove any loose or damaged cartilage, bone, or tissue. Dr. Jildeh may also perform procedures such as microfracture or other cartilage restoration techniques to promote the growth of new cartilage and improve joint function. In some cases, he may also use biological agents such as platelet-rich plasma (PRP) or stem cells to aid in the healing process. CAM is a relatively new and innovative approach to the treatment of mild to moderate arthritis, and it has shown promising results in improving joint function and reducing pain. The procedure is typically performed on an outpatient basis, which means that most patients can go home on the same day as the surgery.
Rotator cuff repair
Revision rotator cuff repair
• Rotator cuff repair is a surgical procedure that is used to treat a torn rotator cuff. The rotator cuff is a group of four muscles and tendons that attach to the shoulder blade and help to lift and rotate the arm. During the procedure, Dr. Jildeh will make an incision in the shoulder to access the torn rotator cuff. He will then reattach the torn tendon to the bone using sutures or small anchors that are placed into the bone. The goal of the surgery is to restore the normal function of the rotator cuff and to relieve pain. Rotator cuff repair can be performed using either an open or arthroscopic technique. Arthroscopic surgery is a minimally invasive approach that uses a small camera and instruments to repair the rotator cuff through small incisions.
Superior capsular reconstruction
• Superior capsular reconstruction (SCR) is a surgical procedure that is used to treat massive rotator cuff tears that cannot be repaired using traditional methods. The procedure involves using a graft to replace the damaged rotator cuff tendon. During the procedure, Dr. Jildeh will make a small incision in the shoulder and use arthroscopic instruments to remove any remaining rotator cuff tissue and prepare the bone. He will then use a graft, typically taken from the patient's own body or from a donor, to create a new "superior capsule" that spans the gap between the humeral head and the glenoid socket. The goal of SCR is to restore shoulder stability and function, reduce pain, and prevent the development of arthritis. Recovery from SCR can vary depending on the extent of the surgery and the individual patient. Physical therapy is typically recommended to help restore strength and range of motion in the shoulder.
Proximal biceps (tenodesis/tenotomy)
• Proximal biceps tenodesis and tenotomy are two surgical procedures used to address problems with the long head of the biceps tendon in the shoulder. The long head of the biceps tendon runs from the top of the shoulder and attaches to the top of the upper arm bone. Proximal biceps tenodesis involves reattaching the tendon to a different location on the upper arm bone. This can be done using different methods, such as an interference screw or a suture anchor, to hold the tendon in place. The goal of this procedure is to eliminate any pain or discomfort in the shoulder caused by a damaged or inflamed biceps tendon. Proximal biceps tenotomy involves cutting the long head of the biceps tendon at its attachment to the shoulder. This procedure is typically reserved for patients who are less physically active or have pre-existing shoulder issues, as it can result in some weakness of the biceps muscle. The goal of tenotomy is also to alleviate pain and discomfort in the shoulder caused by biceps tendon problems. Both procedures can be performed arthroscopically, meaning that Dr. Jildeh will make small incisions in the shoulder and use a tiny camera and specialized instruments to perform the surgery. Recovery time can vary depending on the extent of the surgery and the individual patient.
Shoulder capsulolabral procedures
• SLAP repair
• Bankart repair
• Posterior labrum repair
• Correction of multidirectional instability
• Capsular shift
• Revision instability procedures
Shoulder capsulolabral procedures refer to surgical techniques used to repair or reconstruct the labrum, which is a rim of cartilage that surrounds the shoulder socket. The labrum helps to keep the ball of the upper arm bone securely in place in the shoulder joint. Capsulolabral procedures can address various types of shoulder instability, including anterior (front), posterior (back), and multidirectional instability. SLAP repair (Superior Labrum Anterior to Posterior) is a surgical procedure used to repair a specific type of labral tear that occurs at the top of the labrum, where the biceps tendon attaches. Bankart repair is a surgical procedure used to repair a tear in the labrum that occurs in the front of the shoulder joint. This type of tear is often associated with anterior shoulder dislocations. Posterior labrum repair is a surgical procedure used to repair a tear in the labrum that occurs in the back of the shoulder joint. This type of tear is often associated with posterior shoulder dislocations. Correction of multidirectional instability involves a combination of surgical techniques that aim to restore the normal stability of the shoulder joint. This may include capsular shift, which involves tightening the shoulder joint capsule to reduce its size, and other procedures to repair or reconstruct the labrum. Capsular shift is a surgical procedure used to tighten the shoulder joint capsule and reduce its size. This can help to address shoulder instability and prevent dislocations. Overall, shoulder capsulolabral procedures aim to restore normal stability to the shoulder joint and improve shoulder function. The specific technique used will depend on the location and type of labral tear, as well as other factors such as the patient's age, activity level, and overall health.
Latarjet and Distal Tibial Allograft procedures
• Latarjet procedure is a surgical treatment option for shoulder instability and recurrent dislocations. It involves transferring a piece of bone along with attached muscles from the scapula (shoulder blade) to the front of the shoulder socket to create a barrier that prevents the upper arm bone from slipping out of the socket. During the procedure, Dr. Jildeh makes an incision in the front of the shoulder and carefully positions coracoid bone on the front of the shoulder socket and secured in place using screws. The newly positioned bone acts as a barrier to keep the upper arm bone in the socket, preventing dislocations. The subscapularis muscle is then reattached to the coracoid bone and the incision is closed.
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The distal tibial allograft procedure may be selected in particular circumstances. This procedure involves reconstructing the patients’ glenoid to increase stability.
Impingement procedures: subacromial decompression/acromioplasty
• Subacromial decompression or acromioplasty is a surgical procedure that is done to treat shoulder impingement syndrome. Shoulder impingement syndrome occurs when the tendons of the rotator cuff muscles and the bursa (a fluid-filled sac) in the shoulder joint become compressed or pinched between the acromion (a bony projection of the shoulder blade) and the humeral head (the ball of the upper arm bone). During the procedure, the surgeon will remove the inflamed and/or damaged tissue and bone that is causing the impingement. This is done by shaving down the acromion or removing a small piece of bone from it. This procedure can be done arthroscopically, which means that the surgeon will make small incisions and use small instruments to perform the procedure.
SC Joint reconstruction/resection
• Sternoclavicular (SC) joint reconstruction is a surgical procedure performed to restore stability and function of the SC joint. The SC joint is where the clavicle (collarbone) meets the sternum (breastbone) at the front of the chest. This joint is important for shoulder and arm movement, as well as for chest expansion during breathing. The SC joint can become unstable due to trauma, degenerative changes, or other underlying conditions. In cases where conservative treatments such as rest, physical therapy, and medication do not improve the symptoms, surgery may be recommended.
AC joint reconstruction
• AC joint reconstruction is a surgical procedure performed to treat chronic pain or instability of the acromioclavicular (AC) joint, which is located where the collarbone (clavicle) meets the shoulder blade (scapula). This joint is important for shoulder function, as it allows the arm to move freely. However, injuries or degeneration of the joint can cause pain, weakness, and limited range of motion. During AC joint reconstruction, the surgeon removes the damaged or arthritic portion of the joint and replaces it with a graft or implant to restore stability and function. This can involve using the patient's own tissue, such as a tendon, or a synthetic material.
Distal clavicle resection
• Distal clavicle resection, also known as a Mumford procedure, is a surgical procedure that involves removing a small section of the collarbone (clavicle) where it meets the shoulder blade (scapula). This is usually done to alleviate pain and inflammation in the acromioclavicular joint (AC joint), which is the joint between the collarbone and shoulder blade.
Scapular bursectomy/snapping scapular correction
• Scapular bursectomy is a surgical procedure performed to treat a condition called snapping scapula syndrome. The scapula, also known as the shoulder blade, has a bursa (a fluid-filled sac) overlying it that helps to reduce friction and allow smooth movement of the scapula over the chest wall. In some individuals, the bursa can become inflamed or thickened, leading to a condition known as scapular bursitis. This can cause snapping, popping, or grinding sounds in the shoulder, known as snapping scapula syndrome. During a scapular bursectomy, Dr. Jildeh will make a small incision near the affected area of the scapula and remove the bursa. This procedure can be performed using minimally invasive techniques, such as arthroscopy, which involve smaller incisions and typically result in less pain and faster recovery time. By removing the bursa, Dr. Jildeh can help alleviate symptoms of scapular bursitis and snapping scapula syndrome, allowing for smoother and more pain-free shoulder movement.
