23920 Disarticulation of shoulder

Name of the Procedure:

Disarticulation of shoulder
(Shoulder Disarticulation Amputation)

Summary

Disarticulation of the shoulder is a surgical procedure in which the entire arm is removed at the shoulder joint. This involves separating the arm from the shoulder girdle.

Purpose

Disarticulation of the shoulder is often performed to treat severe trauma, advanced infections, or malignant tumors that affect the arm and shoulder. The primary goal of the procedure is to completely remove the diseased or damaged tissue to prevent further spread and improve patient survival or quality of life.

Indications

• Severe trauma with irreparable damage to the arm.
• Advanced infections (e.g., septic arthritis).
• Malignant tumors (e.g., sarcomas) affecting the upper limb.
• Non-functional limb causing severe pain or disability.
• Life-threatening conditions where other treatments have failed.

Preparation

• Fasting for 8-12 hours prior to surgery.
• Discussions about current medications, with specific instructions on which to continue or stop.
• Pre-operative imaging and assessments (X-ray, MRI, CT scans).
• Blood tests and other diagnostics to ensure fitness for surgery.

Procedure Description

1. The patient is positioned and general anesthesia is administered.
2. An incision is made around the shoulder to access the joint.
3. Major blood vessels and nerves are carefully isolated, tied off, and transected.
4. Muscles attaching the arm to the shoulder are detached.
5. The joint capsule is opened, and the arm is removed.
6. The wound is closed using sutures or staples, and a drain may be placed to prevent fluid buildup.

Duration

The procedure typically takes 2-4 hours, depending on the complexity and underlying condition.

Setting

Disarticulation of the shoulder is performed in a hospital operating room.

Personnel

• Orthopedic or general surgeon
• Surgical nurses
• Anesthesiologist
• Surgical technologist

Risks and Complications

• Infection
• Bleeding and hematoma formation
• Phantom limb pain
• Nerve injury
• Blood clot formation (deep vein thrombosis)
• Poor wound healing or dehiscence

Benefits

• Removal of diseased tissue, preventing the spread of infection or cancer.
• Relief from intractable pain.
• Improved quality of life and functionality with prosthetics.
• Improved survival rates in life-threatening conditions.

Recovery

• Post-operative monitoring in the hospital for several days.
• Pain management with medications.
• Physical therapy to aid recovery and adaptation.
• Wound care instructions, including how to care for the site and signs of infection.
• Regular follow-up appointments for wound assessment and prosthetic fitting.
• Full recovery can take several weeks to months.

Alternatives

• Limb-sparing surgery, if feasible.
• Radiation therapy or chemotherapy for tumors.
• Antibiotic therapy for infections.
• Each alternative has its pros and cons, and the choice depends on the specific medical condition and patient health.

Patient Experience

During the procedure, the patient will be under general anesthesia and will not feel pain. Post-surgery, there may be significant pain and discomfort, which will be managed with medications. Patients might experience phantom limb sensations or pain. Emotional support and counseling may be required to adapt to limb loss and the rehabilitation process.