Shoulder Procedures

In special cases where a patient has both advanced shoulder arthritis as well as a major rotator cuff tear, a reverse total shoulder replacement may be needed.  This surgery is also used in cases involving a complicated shoulder fracture.  In a reverse total shoulder, the normal position of the ball and the socket are “reversed” in that the surgeon places a metal ball onto the socket and then places a cup or socket onto the arm bone in place of the ball.  By changing the biomechanics of the shoulder, this technique enables the patient to move the arm without the need for a normal rotator cuff.  This technique is often viewed as a “last resort” for patients with major shoulder problems.  Dr. Bushnell has lectured on the state, national, and international level about reverse total shoulder replacements, and has extensive experience in the indications and use of this technique.

For more information about Reverse Total Shoulder Replacement, please visit:

Reverse Total Shoulder Replacement
Reverse Total Shoulder Replacement (Video)

The labrum, or the cartilage o-ring of the shoulder socket, can sometimes tear as a result of overuse or acute injury such as a shoulder dislocation.  When the labrum is torn, it often requires surgical repair to re-establish the sealant effect on the shoulder, decrease pain, and restore function.  Repair of the labrum can be performed using shoulder arthroscopy or open shoulder surgery.  Typically, 2 or 3 suture anchors are placed into the shoulder socket, or glenoid, and used to tie the labrum down.  Sometimes a biceps tenodesis will also be performed to prevent continued pressure on the labrum as it tries to heal.  Most patients recover in about 4 months from arthroscopic labral repair, and can enjoy a full return to normal function, work, and athletic participation.  Dr. Bushnell has extensive experience in labral repair surgery.

For more information about shoulder labral repair, please visit:

Glenoid labral tear (AAOS Orthoinfo)

A total shoulder replacement involves removing the ball and the socket that are worn out because of arthritis or injury, and then replacing them with a metal ball and a plastic socket.  This operation has become increasingly more popular over the last decade in the United States, as more patients suffer from arthritis and the technology and surgical techniques for shoulder replacement have improved significantly.  Dr. Bushnell is an expert at shoulder replacement surgery, and has performed both minimally-invasive total shoulder replacement as well as outpatient total shoulder replacement surgeries.  He has lectured at the state, national, and international level about shoulder replacement surgery and has published articles about shoulder arthritis and replacement in the medical literature.

For more information about Shoulder Replacement, please visit:

Shoulder Joint Replacement

Shoulder Replacement (Video)

Arthritis can cause painful breakdown of the acromioclavicular joint – the part of the shoulder where the acromion, or the shoulder blade, and the clavicle, or the collar bone.  The arthritis can also cause the formation of bone spurs, which can irritate the rotator cuff and even cause a rotator cuff tear.  Treatment may involve medication, therapy, and even an injection.  Some cases, however, ultimately improve only with surgery.  Unlike many other joints, the acromioclavicular joint does not require reconstruction or replacement.  Instead, it can usually be treated with simple excision of the end of the clavicle (the “distal” clavicle).  Excision can be performed using shoulder arthroscopy or open surgery.  Dr. Bushnell has performed hundreds of distal clavicle excisions for arthritis with excellent results.

For more information about Distal Clavicle Excision, please visit:

Shoulder Arthroscopy (AAOS OrthoInfo)

Shoulder Problems and Injuries (WebMD)

Fractures of the shoulder can cause significant pain, disability, and loss of function – especially if not diagnosed and managed appropriately.

The proximal humerus, or the upper part of the arm bone at the shoulder, is the most common site of fracture.  Although sometimes fractures in this area will heal without intervention, many cases require surgical repair or even  a shoulder replacement or reverse shoulder replacement.  Surgery on the shoulder may be needed to enable use of the arm for holding a walker or a cane – especially if the patient has also suffered a hip fracture or knee fracture at the same time.  In isolation, shoulder fracture repair may only require one night in the hospital or possibly even occur on an outpatient basis.

Another common site of shoulder fracture is the clavicle, or the collar bone.  Clavicle fractures often heal on their own, but may leave a large “bump” at the fracture site as the body lays down extensive amounts of callus, or healing bone.  If the pieces of the clavicle are significantly displaced or shortened, surgery can restore the alignment and positioning of the bone.  Clavicle fracture repair usually involves the placement of a plate and multiple screws.

Dr. Bushnell performs several shoulder fracture surgeries every year, and he has lectured about shoulder fractures at the national level.  Some of his latest research also involves complex shoulder fractures and their treatment.

For more information about Shoulder Fracture Repair, please visit:

Shoulder Injuries Overview (WebMD)
Shoulder Fractures (AAOS Orthoinfo)
Clavicle Fractures (AAOS Orthoinfo)

When the biceps tendon at the shoulder suffers from partial tearing or tendinitis, or if the labrum tear of the shoulder, a biceps tenodesis may be indicated.  In this procedure, the biceps tendon is reattached to the humerus (arm bone) through a small incision and using suture anchors to secure the tendon down to the bone.  Usually, this procedure is performed through the same incision used to insert the scope and/or various instruments as part of a shoulder arthroscopy procedure.  When a tenodesis is performed, it is usually to maintain relatively normal appearance of the biceps muscle and to improve long-term function, strength, and endurance of the biceps muscle.  Alternatively, some patients choose to have a biceps tenotomy procedure, in which the tendon is simply clipped off of the labrum.  In many cases, the functional and cosmetic loss from a tenotomy are negligible – and the rehabilitation and healing process are much faster.

For more information about Biceps Tenodesis, please visit:

Biceps Tendinitis (AAOS Orthoinfo)

Injection of medication into the shoulder can provide rapid and significant relief of pain and stiffness.  Dr. Bushnell performs hundreds of shoulder injections a year.  These injections are performed during a regular office visit.

Sometimes, the rotator cuff tendons do not have enough room for moving underneath the shoulder blade, or the acromion.  This can lead to impingement, or rubbing of the tendon against the bone that causes the tendon to break down.  Sometimes this process can even lead to a full-thickness rotator cuff tear.  In a decompression procedure, the bone of the shoulder blade is thinned slightly using arthroscopic tools to create more room for the tendons.  Bone spurs are trimmed away.  The rough edges of the tendon are cleaned up or debrided.  This procedure eliminates the rubbing of the tendon against the bone and stops further damage from occurring.  Ideally, the procedure can be performed before the tendon impingement progresses to a full-thickness tear, since a decompression procedure has a much faster recovery than a rotator cuff repair.

For more information about Decompression surgery in the shoulder, please visit:

Shoulder Arthroscopy (AAOS Orthoinfo)

Repair of the rotator cuff is Dr. Bushnell’s #1 most frequently performed surgical procedure. While many tears may not require surgery, Dr. Bushnell uses advanced arthroscopic and minimally-invasive techniques when surgery is required. Arthroscopic repair of the rotator cuff involves placing several small “portal” incisions (usually about ¼ inch each) in the shoulder and using a small video camera to guide the surgery. With the use of special equipment, the rotator cuff is repaired with sutures and usually “suture anchors,” which are like small corkscrews that screw into the bone and provide a stable attachment for the stitches. Sometimes even more advanced techniques are needed, such as artificial patches and tendon slides.

For more information about rotator cuff tears, please visit these links:

Rotator Cuff Tears – Surgical Treatment Options
Rotator Cuff Repair – (National Library of Medicine)
Rotator Cuff Repair – (WebMD)
Arthroscopic Rotator Cuff Repair with video (AAOS Orthoinfo)
Regeneten Bioinductive Implant (Smith and Nephew)

Shoulder arthroscopy involves the placement of a small camera into the shoulder joint for diagnostic purposes or to guide an interventional procedure, such as a rotator cuff repair.  Using this video camera, the surgeon can “tour” the entire joint.  The camera can show the cartilage, labrum, rotator cuff tendons, shoulder ligaments, and other parts of the joint.

For more information about Shoulder Arthroscopy, please visit:

Shoulder Arthroscopy