Our Patients

What is suprascapular nerve decompression?

Suprascapular nerve decompression is a minimally invasive surgery performed arthroscopically under regional anesthesia to release pressure on the suprascapular nerve. The suprascapular nerve runs through the scapula (shoulder blade) and sends motor and sensory to the rotator cuff muscles that for movement of the shoulder joint. Compression or pinching of the suprascapular nerve often leads to suprascapular neuropathy (nerve dysfunction). Suprascapular neuropathy present with posterior shoulder pain and weakness noted in the posterior shoulder muscles (infraspinatus and/or supraspinatus muscles).  Surgery to decompress a compressed suprascapular nerve can relieve pain and facilitate functional muscle recovery of the shoulder joint.  Dr. Riley J. Williams, orthopedic shoulder surgeon, serving Manhattan, Brooklyn, New York City, NY and surrounding areas, has extensive experience in performing suprascapular nerve decompression and other shoulder surgeries.

What is suprascapular neuropathy?

Suprascapular neuropathy (SSN) is also called suprascapular nerve entrapment. The suprascapular nerve originates in the back of the neck and runs through the shoulder blade. This nerve sends sensory and motor signals to the supraspinatus and infraspinatus muscles of the rotator cuff. These muscles move the shoulder joint and the arm. Suprascapular nerve compression is associated with sports that require repetitive overhead arm motion including swimming and volleyball. Direct trauma such as a fall on the shoulder can also cause SSN. Suprascapular neuropathy is a rare injury that occurs in approximately .04% of patients with shoulder pain. Undiagnosed SSN can be a cause of continued shoulder pain after shoulder procedure performed for other shoulder problems including rotator cuff tear, labrum tears and shoulder impingement.

How is suprascapular nerve decompression performed?

The surgery is performed with sedation and regional anesthesia. The procedure is done arthroscopically in an outpatient setting; most patients go home the same day as the surgery. Arthroscopic surgery requires very small incisions at the top and sides of the shoulder. Dr. Williams inserts an arthroscope, which is a fiberoptic viewing lens, and surgical tools in these incisions to complete the procedure. The arthroscope projects images of the shoulder and nerve onto a monitor. Nerve is decompressed is achieved by removing all compressing structures around the nerve (ligaments, cysts). Decompressing the nerve alleviate pains and weakness in the shoulder girdle.

How is suprascapular nerve decompression performed?

The surgery is performed with sedation and regional anesthesia. The procedure is done arthroscopically in an outpatient setting; most patients go home the same day as the surgery. Arthroscopic surgery requires very small incisions at the top and sides of the shoulder. Dr. Williams inserts an arthroscope, which is a fiberoptic viewing lens, and surgical tools in these incisions to complete the procedure. The arthroscope projects images of the shoulder and nerve onto a monitor. Nerve is decompressed is achieved by removing all compressing structures around the nerve (ligaments, cysts). Decompressing the nerve alleviate pains and weakness in the shoulder girdle.

How long does it take to recover?

The patient typically goes home within two hours of the procedure. The arm will be in a sling for approximately a week after the surgery. To rehabilitate the shoulder, physical therapy starts after the first week to help regain range of motion and strength. Most patients should plan to do PT twice a week for 8 weeks. Pain relief is noted soon after surgery; muscle strength recovery may take months to improve after suprascapular nerve decompression.

For additional resources on suprascapular nerve decompression or to have your shoulder pain evaluated, please contact the office of Dr. Riley J. Williams, orthopedic shoulder surgeon serving Manhattan, Brooklyn, New York City, NY and surrounding areas.

What is shoulder bursectomy?

Shoulder bursectomy is arthroscopic surgery that is performed to remove an inflamed bursa. The human body has over 150 bursae that rest between the bone and soft tissues found in many large joints, including the shoulder. There are five main bursae in the shoulder, and when any of these become irritated, it causes inflammation and a condition known as bursitis. The subacromial bursa sits between the top of the rotator cuff and the roof of the shoulder (acromion process). The subacromial bursa can become inflamed by overuse and repetitive overhead arm motion. A shoulder bursectomy is often performed when bursitis persists despite the application of nonoperative treatment modalities. Shoulder bursectomy physically removed the inflamed thickened bursa; this procedure provides patients with pain relief and better shoulder function. When a damaged bursa is removed, a healthy bursal layer grows in its place. Dr. Riley J. Williams, orthopedic shoulder surgeon, serving Manhattan, Brooklyn, New York City, NY and surrounding areas, has extensive experience in performing shoulder bursectomies and other shoulder treatments.

What is bursitis?

Shoulder bursitis or shoulder impingement syndrome occurs when there is an irritation that causes inflammation to the subacromial bursa. The role of bursae is to reduce friction and cushion joints. Increased friction or pathologic overuse can cause the bursa to become inflamed and painful. More severe cases of bursitis can be characterized by an overproduction of fluid and thickening of the bursal tissue. The extra production of fluid can enlarge the bursa; persistent fluid collection associated with bursitis can lead to a predilection toward infection (most commonly in the elbow). Bursitis may be seen in individuals who participate in activities that require repetitive overhead arm movements such as painting, building, swimming, and throwing.

How is a shoulder bursectomy performed?

The surgery is performed under sedation and regional anesthesia; patients typically go home shortly after the procedure on the same day. The procedure is done arthroscopically, which requires two to three small incisions made about the shoulder girdle. An arthroscope is a small camera that’s used to insert in the shoulder to display images of the injury onto a monitor. These images allow Dr. Williams to perform the bursectomy. The inflamed bursa is removed with a small vacuum shaver. If needed, Dr. Williams may remove a small amount of overhanging bone (spur) if he determines that this bony issue was part of what caused the bursitis condition.

What are the risks?

Surgery can come with risks such as blood vessel damage, nerve damage, infection or numbness at the incision sites. Because arthroscopic surgery only requires small incisions, these risks are rare. There is a chance with a bursectomy that an individual may experience pain and a feeling of rubbing or friction in the shoulder joint after surgery until the shoulder fully heals.

How long does it take to recover?

Dr. Williams recommends patients us a sling for 5-7 days following shoulder bursectomy. Physical therapy starts one week after the procedure. Normal activities can be resumed shortly after with pain tolerance as a guide. There are no restrictions or limitations after a bursectomy. A full recovery is anticipated between 2-3 months.

For additional resources on a shoulder bursectomy or to have your shoulder pain evaluated, please contact the office of Dr. Riley J. Williams, orthopedic shoulder surgeon serving Manhattan, New York and the surrounding New York boroughs.

What is total shoulder replacement (Arthroplasty)?

Total shoulder replacement (TSR) is also known as total shoulder arthroplasty. TSR involves replacing the arthritic and damaged surfaces of the shoulder joint using prosthetic implants. The shoulder is a ball and socket joint and is comprised of three bones: the humerus, scapula and clavicle. The humerus is the upper arm bone, and the scapula is the shoulder blade. The superior portion of the humerus (humeral head) along with the glenoid socket of the scapula make up the glenohumeral joint.  Total shoulder

replacement is performed on the primary shoulder joint or glenohumeral joint. Articular cartilage lines the end of all long bones and provides the cushion within the shoulder joint, thus allowing the shoulder to move easily and comfortably. Cartilage loss or erosion can occur in association with wear and tear or trauma. Cartilage loss leads to symptomatic arthritis.  Cartilage loss results in bone-on-bone contact within the joint, and can cause significant pain and dysfunction. Resurfacing of the humeral head and glenoid socket using the appropriate prostheses as part of the TSR procedure can provide affected patient with durable pain relief and increased function. Doctor Riley J. Williams, Orthopedic Shoulder Surgeon in Manhattan and the New York area, is an expert in performing total shoulder replacement and total shoulder arthroplasty.

Why is total shoulder replacement/arthroplasty performed?

Total shoulder replacement is performed to provide patients with pain relief and increased function. Articular cartilage allows joint surfaces to move fluidly against one another; cartilage is a durable tissue that as a shock absorber. Articular cartilage damage progresses to cartilage loss and exposure of the underlying bone. Joints that are characterized by bone on bone contact are often painful and poorly functioning. Total shoulder replacement enables affected individuals to regain shoulder range of motion of the shoulder and perform normal activities and sports without pain. Degenerative conditions of the shoulder occur following trauma, a fracture, a torn rotator cuff, in association with rheumatoid arthritis (autoimmune) or in association with osteoarthritis (wear and tear). These conditions can lead to significant cartilage loss, joint pain, joint swelling, decreased range of motion and pain.

What is shoulder arthritis surgery?

When conservative treatment methods (rest, corticosteroid injection, physical therapy, NSAIDs, and activity modification) fail to alleviate pain in the arthritic shoulder, TSR may be recommended. There are a few different types of shoulder arthritis surgery that Dr. Williams may suggest depending on the type of injury and age of the patient. These may include:

• Shoulder debridement & synovectomy: Removal of loose bodies and inflamed tissue.
• Total shoulder replacement

Dr. Riley J. Williams, orthopedic shoulder surgeon, serving Manhattan, Brooklyn, New York City, NY and surrounding areas, has extensive experience performing total shoulder replacement and shoulder arthritis surgery.

How is total shoulder arthroplasty performed?

The goal of a total shoulder replacement is to replace the worn and damaged portions of the shoulder with a prosthesis, thus eliminating the pain of osteoarthritis. The humeral head or ball of the shoulder is replaced with a thin metal cover, which is attached to a small stem. This stem is inserted in the proximal humerus bone as a press fit. A high-density plastic prosthesis is used to resurface the socket. Total shoulder replacement is done as an outpatient, and patients can expect to go home the same day. Some patient may wish to stay overnight one night after TSR; Dr. Williams will advise you as to which pathway is best for you based on your medical condition. The surgery is performed with a combination of general and regional anesthesia.  Regional anesthesia or nerve blocks help patients with postoperative pain relief. Most patients will not experience pain for several hours after the surgery. Total shoulder replacement surgery takes approximately one hour.  Intravenous antibiotics are used before the operation to help limit the chances of infection. Following surgery, patients are advised to use a sling for two weeks.

What are the risks of total shoulder replacement?

Individuals in the New York area who have had total shoulder arthroplasty typically have a very successful outcome. Complication are very rare. TSR surgery has certain risks that may include:

• Infection, although uncommon due to intravenous antibiotics, is possible
• Nerve damage
• Shoulder stiffness

How long is the recovery after a total shoulder replacement?

Once the patient leaves the hospital, his or her arm will be in a sling for two weeks. Absorbable sutures are used, thus removal is not necessary. Dr. Williams will evaluate you two weeks after surgery, subsequent to which, physical therapy will commence. Physical therapy will continue for 2-3 months, twice week. There are daily home exercises that are prescribed to ensure a good outcome.  An individual will need to avoid driving for approximately two weeks. A return to normal activities of daily living should be expected by six weeks. Full unfettered recovery takes 4-6 months depending on how quickly the patient is able to restore normal shoulder girdle strength.

For additional resources on total shoulder replacement, shoulder arthritis surgery or to have your shoulder pain evaluated, please contact the office of Dr. Riley J. Williams, MD, orthopedic shoulder surgeon serving Manhattan, Brooklyn, New York City, NY and surrounding areas.

What is shoulder arthritis?

The glenohumeral joint of the shoulder is where the head of the humerus (upper arm bone) and the glenoid socket of the scapula (shoulder blade) come together. Articular cartilage lines the ends of these bones within the shoulder joint.  Cartilage is a slippery white connective tissue that surrounds the ends of bones and facilitates painlessly bone on bone motion within joint movement. Shoulder arthritis is characterized by cartilage loss or damage; loss of the articular cartilage leads to painful bone-on-bone joint movement. There are many types of arthritis; each type of arthritic condition has a unique cause. Osteoarthritis is also known as wear and tear arthritis. Osteoarthritis typically occurs because of repetitive loads across a joint surface. Osteoarthritis can occur as part of the aging process, usually affects individuals over the age of 50. Autoimmune conditions (rheumatoid arthritis, psoriatic arthritis) can also result in shoulder arthritis. In these conditions, the body’s own immune system attacks and destroys the joint cartilage; the shoulder joint can be affected by rheumatoid and psoriatic arthritis. Post-traumatic arthritis occurs following a traumatic injury such as a fracture or dislocation. Shoulder arthritis, when left untreated, can cause chronic shoulder pain, joint damage, and, in some cases, loss of movement.

What is the treatment for shoulder arthritis?

Individuals with mild to moderate shoulder dysfunction associated with degenerative joint disease may benefit from conservative therapy alone. Rest, activity modification, the application of ice and heat, and non-steroidal anti-inflammatory medications (NSAIDs) can be used to control pain and decrease inflammation. Corticosteroid injections can be administered if the pain and inflammation are not relieved with oral medications. A physical rehabilitation program may also be helpful to affected patients by improving shoulder girdle strength and range of motion.

Individuals with severe shoulder pain and dysfunction associated with degenerative joint disease, and those patients who fail conservative measures, are best treated with reconstructive shoulder surgery. The goal of shoulder arthritis surgery is to resurface the bone of the glenohumeral or shoulder joint. Shoulder resurfacing or replacement surgery decreases pain, and restores function, strength, and range of motion. Total shoulder replacement has been the “gold standard” for the treatment of shoulder arthritis for many decades. Less intrusive methods of treating shoulder arthritis have been developed over the past several years, and include shoulder resurfacing. The shoulder resurfacing technique involves removing only the diseased portion of the shoulder joint and is less invasive than total shoulder replacement.

What is shoulder joint resurfacing?

Shoulder joint resurfacing is effective for the treatment of osteoarthritis or rheumatoid arthritis; this surgical procedure is also indicated for other shoulder conditions such as rotator cuff arthropathy, post-traumatic arthritis, and avascular necrosis. Shoulder resurfacing replaces the damaged surfaces of the shoulder with prosthetics designed to restore the natural curvature and glide of the joint. Doctor Riley J. Williams, orthopedic shoulder surgeon, treats patients in Manhattan, Brooklyn, New York City, NY and surrounding areas, who have experienced shoulder arthritis and need surgical treatment.

How is shoulder joint resurfacing performed?

Dr. Williams evaluates several key factors, such as the patient’s age, medical history, and desired outcome, to determine if the patient is a good candidate for shoulder joint resurfacing. This procedure is typically done on an outpatient basis using a combination of sedation, and regional anesthesia. Once positioned, a traditional anterior incision (delto-pectoral) and approach is used to access the joint and perform the surgery.

Shoulder joint resurfacing is performed on the humeral head and the glenoid socket of the scapula. The humeral head is resurfaced using specialized surgical instruments that remove and cover the damaged area. The humeral head is prepared to receive the hemispheric, metallic implant; most the proximal humeral humerus is left intact. For the glenoid, a high molecular weight dense plastic prosthesis is used to reconstruct the shoulder socket.

What are the advantages of shoulder joint resurfacing?

Dr. Williams is a proponent of shoulder joint resurfacing in the appropriate circumstances.  Shoulder joint resurfacing is less disruptive to the local shoulder anatomy and requires minimal bony resection. Shoulder joint resurfacing patients should expect clinical outcomes that are equal to more traditional total shoulder replacement techniques.

What is the recovery period like after shoulder joint resurfacing?

Most patients can expect a return to normal daily activities approximately 3-4 weeks after shoulder joint resurfacing. In general, patients in New York can typically anticipate:

• Same day discharge home after the procedure or an overnight hospital stay.
• Joint immobilization using a sling for 2 weeks. Shoulder movement exercises are encouraged immediately after surgery. The sling is used to allow muscle-tendon healing following the resurfacing procedure. Heavy lifting is discouraged during the early stages of recovery.
• Post-surgical pain and inflammation are controlled with a combination of rest, ice, and non-steroidal anti-inflammatory medications (NSAIDs). Dr. Williams may prescribe stronger pain medication to be taken as directed.
• The key to a successful recovery following shoulder joint resurfacing is adhering to and completing the physical rehabilitation program designed by Dr. Williams. The physical therapy program will be aimed at improving the mobility and strength of the shoulder muscles. Physical therapy typically lasts 2-3 months following the shoulder resurfacing procedure.

For more information on shoulder joint resurfacing, or to discuss your shoulder osteoarthritis treatment options, please contact the office of Riley J. Williams, MD, orthopedic shoulder doctor at the Hospital for Special Surgery (HSS), serving Manhattan, Brooklyn, New York City, NY and surrounding areas.