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OrthoKnox - Dr. David Hovis - Physical Therapy - Sports Medicine - Arthroscopy - Orthopedic Surgeons in Knoxville, Tennessee

Shoulder Specialist Knoxville, TN

The shoulder has the greatest range of motion of any joint in the body. To achieve such incredible motion, the bony joint itself is inherently unstable. It achieves stability by several factors that are all essentially soft tissue in nature.

Because of the shoulder's range of motion and tendency for inherent instability, there is notable stress and force that goes across these soft tissues, increasing the opportunity for injury and degeneration. Shoulder pain and injuries are common, especially among people who play sports that require overhead arm movements or perform job duties with repetitive motions.

With fellowship training in shoulder surgery, upper extremity surgery, and sports medicine, the orthopedic surgeons at OrthoKnox have earned the highest credentials as shoulder surgeons, and they have great skill in treating the many injuries and conditions of the shoulder with techniques including:

Arthroscopic Rotator Cuff Repair

Rotator cuff tears can occur from a single traumatic event or as a result of degenerative changes and the culmination of smaller traumas to the tissue. The risk of rotator cuff damage increases with age, as the shoulder tendons and muscles may show signs of degeneration. 

Arthroscopic rotator cuff surgery is a minimally invasive approach performed through small 5 mm incisions to sew and repair the torn rotator cuff down to the bone. Typically, small anchors that fixate in the bone with a variety of designs are used to anchor the suture so that it can hold the tendon to the bone. 

While surgery may be successful in pulling the tear back to its native position, only time and appropriate therapy will achieve the actual healing desired. Hence, the correct post-operative therapy regimen is crucial to getting a good result.

Arthroscopic Bankart Reconstruction

When the shoulder has a traumatic dislocation, part of the stabilizing structures of the shoulder – the capsule and labrum – are torn, and the shoulder is at risk for recurrent episodes of instability. Each time the shoulder slides out of socket it is at least a painful and disabling event, and at worst doing more traumatic damage to the articular structures of the shoulder.

Arthroscopic Bankart reconstruction is a technique used to repair the torn capsule and labrum, thereby restoring shoulder stability. Arthroscopic Bankart reconstruction reattaches the labrum and tightens ligaments. Typically this is achieved by means of small suture anchors that fixate in the bone with the suture attached in such a way to allow sewing the ligaments and labrum back to the bone. Once again, the appropriate post-operative therapy regimen is crucial to achieving good long term outcomes.

Arthroscopic Subacromial Decompression for Shoulder Impingement

Shoulder impingement syndrome is a painful condition that occurs when the tendons in the shoulder are irritated, inflamed, or degenerated from repetitive overhead motions or structural abnormalities in the shoulder.

Classically, there is a prominent area of bone on the front of the acromion of the shoulder that impinges on the rotator cuff, thereby giving the name “impingement syndrome.” In layman’s terms, we will often refer to this area of bony prominence as a “bone spur.”

With arthroscopic subacromial decompression, the impingement is relieved by shaving off the bony prominence and debriding the inflamed, irritated bursa. Symptoms of pain are relieved and more normal function is restored.

Arthroscopic Treatment of Shoulder Arthritis

Arthritis is a common disease that causes joint pain, stiffness, immobility, and swelling. Arthritis is a degeneration of the articular cartilage, followed by a flaking away or loss of the cartilage, and finally, exposed bony surfaces in the joint.

As the cartilage wears away, other changes occur as well, such as tightening of the joint capsule. Arthroscopic shoulder surgery is used to relieve pain and restore functional movement by cutting tight capsular tissue and allowing more movement.

Arthroscopic Treatment of SLAP Tears

The term SLAP (Superior Labrum Anterior and Posterior) tear refers to a tear in the labrum of the shoulder at the top or superior region that runs from anterior (front) to posterior (back). An arthroscopic SLAP repair is the reattachment of a torn superior labrum to its native or original position on the shoulder.

The labrum anchors the biceps tendon to the glenoid bone of the shoulder. Often a biceps tenodesis, or transfer of the biceps tendon away from this attachment site, is performed for a SLAP tear in order to take away the repetitive stress on the superior labrum. Arthroscopic SLAP repair or biceps tenodesis is followed by a specific rehab program to restore motion and protecting the repair site.

Total Shoulder Replacement

Total shoulder replacement, or arthroplasty, involves the replacement of the damaged articular surfaces of the joint with metal and plastic implants. The most common indication for total shoulder replacement is severe osteoarthritis or rheumatoid arthritis. Patients with this type of surgery classically spend one or two nights in the hospital and start a physical therapy program promptly after surgery.

Reverse Total Shoulder Replacement

Reverse total shoulder replacement is a highly specialized newer surgical treatment used to replace a damaged shoulder joint with a very specific and interesting design. A reverse shoulder placement truly reverses the anatomical design of the shoulder.

The ball part of the shoulder replacement is placed on the glenoid, or shoulder blade, where the socket previously was, and the socket part is placed on the humerus, or arm bone, where the ball previously was. This design allows the deltoid muscle of the shoulder to raise the arm in the absence of a rotator cuff.

This highly advanced design is used for patients with one of several different indications. One of the most common is cuff tear arthropathy, a severe form of arthritis emanating from long-standing rotator cuff deficiency. Others include fractures of the proximal humerus, revision of painful or loose primary total shoulders, and finally, irreparable rotator cuff tears, often after multiple failed attempts at rotator cuff repair.

While this is a complex and highly specialized procedure, it can also be one of the most satisfying and reproducible shoulder procedures.

Latissimus Dorsi Transfer

Transfer of the latissimus dorsi tendon is designed to restore motion and decrease pain in shoulders with chronic pain, limited movement, and irreparable rotator cuff tears.

There are several specific criteria that must be met to consider this procedure and it is clearly not for every patient with massive rotator cuff tears. In the properly chosen patient, a latissimus dorsi transfer can relieve pain and restore function in people with severe rotator cuff tears.

Biceps Tendonitis

The biceps tendon runs up the front part of the shoulder and enters the shoulder joint between two of the rotator cuff tendons. Thus the biceps is often damaged at the same time the rotator cuff is, and also biceps tendonitis may mimic rotator cuff damage. When non-operative treatment fails, a surgical procedure called biceps tenodesis can be performed arthroscopically to attach the healthy portion of the biceps to the humerus through a small drill hole.

Shoulder Resurfacing

Shoulder resurfacing relieves pain and restores function for people with arthritis and other shoulder conditions. Unlike traditional total shoulder replacement, shoulder resurfacing does not remove the bones in the joint, but instead resurfaces the bone with smooth metal. Shoulder resurfacing conserves bone and is a less-invasive procedure than total shoulder replacement.

Shoulder Fracture Surgery

Shoulder fracture surgery is individualized and depends on several factors including the location, type, and extent of fracture. Some shoulder fractures may not require surgery, but can heal by being immobilized with a sling. Significant fractures that require surgery may require surgical hardware for stabilization or surgery with reverse total shoulder replacement.

For the highest quality of orthopedic shoulder care in Knoxville, Tennessee, call OrthoKnox today at (865) 251-3030 or request an appointment online. To learn more about common shoulder conditions and procedures, visit our patient education library.

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Physicians Plaza I, Suite 209 Knoxville, TN 37934 (865) 251-3030