Shoulder Debridement

The Goal

Dr. Kevin Wall provides specialized, fellowship-trained surgical treatment for Shoulder Debridement to restore function and relieve pain for patients in Richmond, VA, and the surrounding Central Virginia communities. While simple debridement focuses on "cleaning up" mechanical irritants like frayed labrum or rotator cuff or inflammation, the CAM Procedure is a more extensive, specialized approach designed for younger, active patients with shoulder osteoarthritis who wish to delay or avoid a joint replacement. The goal of CAM is to mechanically "reset" the joint by addressing all the secondary pain generators that develop as a result of arthritis, thereby extending the life of the natural shoulder joint.

The Procedure

  • The Approach: Performed entirely arthroscopically (minimally invasive) using small "keyhole" incisions.

  • Tissue Smoothing & Clean-up:

    • Frayed Labrum & Cuff: Trimming loose edges of the labrum or rotator cuff to eliminate mechanical catching.

    • Synovectomy/Bursectomy: Removing the inflamed joint lining and bursa to reduce the "chemical" pain of arthritis.

  • The CAM Components:

    • Cartilage Debridement: Any injured cartilage on the glenoid or humeral side can be carefully cleaned up, although not replaced using this technique.

    • Osteophyte Resection: Using a surgical burr to remove large bone spurs (osteophytes) from the humerus and glenoid that physically block motion.

    • Subacromial Decompression: Creating more space for the tendons by removing bone spurs from the underside of the acromion.

    • Axillary Nerve Release: In cases of severe arthritis, the axillary nerve can become scarred to the bottom of the joint capsule. Dr. Wall precisely releases this nerve to alleviate "dull ache" pain.

    • Biceps Tenodesis: The long head of the biceps is often a primary source of pain in arthritic shoulders; relocating it out of the joint is a hallmark of the CAM protocol.

  • Infection Management: Debridement is also utilized as a critical irrigation and washout procedure for septic arthritis, ensuring the joint is cleared of harmful bacteria and inflammatory debris.

Post-Op Protocol

  • Immobilization: A sling is used for comfort only for the first 1–3 days. Because there usually are no structural repairs to protect, early motion is the priority. This changes if a biceps tenodesis is also performed.

  • Start Formal PT: Professional physical therapy begins within Week 1.

  • Phase 1 (0–4 weeks): Immediate progression through passive, active-assisted, and active range of motion (PROM/AAROM/AROM). For CAM patients, the focus is on maintaining the new range of motion achieved in the operating room.

  • Phase 2 (4–8 weeks): Strengthening of the rotator cuff and scapular stabilizers begins.

  • Phase 3 (8+ weeks): Gradual return to full activities, including weightlifting and sports, as tolerated.

When to Seek Care

You should schedule a consultation if:

  • You have been told you have shoulder arthritis but feel you are "too young" for a replacement.

  • You experience a painful "catching," "locking," or limited motion that interferes with exercise or work.

  • You have persistent bursitis or "aching" that has failed to improve with conservative management.

  • Urgent Care: Seek evaluation immediately if you have sudden shoulder pain accompanied by a fever, chills, or redness (signs of possible infection).