Cartilage of the Shoulder
Cartilage is a very special surface which allows our joints to flex and extend (bend and straighten out) with minimal resistance. When this extremely low friction surface is healthy, our joints move smoothly without pain. However when injured and the surface is jagged and gnarled, the movement is associated with cracking, pain, swelling or occasional locking-up of the joint.
There are two types of cartilage: Labral and Articular (Surface) cartilage.
Labral cartilage is similar to the meniscus of the knee; it surrounds the glenoid and increases the depth of the shoulder socket, hence increasing stability. Labral injury may occur with overuse or with a single rapid event, such as throwing incorrectly. The location and size of the tear will determine the probability that the injury may:
- Remain asymptomatic.
- Require arthroscopic surgery to “clean up and smooth off” the surface.
- Require arthroscopic repair (suturing or stitching up) of the cartilage to increase stability.
Articular (Surface) cartilage covers the ends of the bones (humeral head and glenoid). The injuries to the articular cartilage present as a spectrum from simple softening of the surface, to rough, irregular surface changes, to actual loss of the cartilage and exposure of the underlying bone. At this end of the spectrum, it is no longer termed “wear and tear” but rather “bone-on-bone” arthritis of the joint. Injuries to the articular cartilage may take place gradually over time or quickly, due to direct trauma such as a fall. Subluxation or frank dislocation of the shoulder joint can lead to an acceleration of this injury process. Articular (surface) cartilage treatment options include:
- Non-surgical programs where emphasis is placed on:
a. Stretching and strengthening.
b. Beginning low-impact activities.
c. Occasional medications, such as Aspirin, Tylenol, or Ibuprofen.
Injections
a. Steroids
b. Visco-lubricants - Arthroscopic surgery to “clean up” and mechanically smooth and polish the surface cartilage. When indicated, the surface is treated to encourage the growth of new cartilage. In spite of extensive research in this field, the new material still does not have the near perfect mechanical properties of the original cartilage surface.
Arthroscopic Shoulder Surgery
The surgical treatment of cartilage problems is most frequently carried out on an “out-patient” basis. Patient-specific education is utilized to prepare the individual for the procedure and the rehabilitation program that follows. A brief summary of the steps include:
Pre-operative Evaluation
You will arrive approximately 60-90 minutes before surgery
The procedure may require 60-90 minutes in the operating room and then another 60 minutes in the recovery room
Most patients will leave to go home 2-3 hours after the completion of the procedure.
Risks and complications are similar to other surgeries. These include, but are not limited to bleeding, infection, stiffness and recurring shoulder problems.
Home Exercise Program
The best recovery depends on restoring your shoulder function. The appropriate stretching and strengthening program is important whether or not you have surgery.