Surgeries Of The Shoulder Joint
Common problems / surgeries of the shoulder joint ?
Considering the advances in orthopaedics, the shoulder joint has been ignored for a long time. Better understanding of shoulder problems has evolved over the last 10 years, with the advent of shoulder arthroscopy. Endoscopic technique provides a unique opportunity to look at the inside of the joint without having to cut it open. This has enabled accurate diagnosis and therefore precise treatment of a painful shoulder. The revolution in the understanding of the shoulder problems is best exemplified by a loosely termed condition, frozen shoulder. It is now established that majority of the painful / stiff shoulders are, in reality, not frozen shoulders ! A lot of these are in fact problems related to the Rotator cuff, an important group of muscles, essential for normal functioning of the shoulder joint.
Subacromial Impingement
Subacromial Impingement is one such common problem, where the rotator cuff muscle-tendon complex gets trapped or sandwiched within a tight, unforgiving, subacromial space, giving pain every time the arm is raised. When refractory to conservative treatment, this can be treated effectively by Arthroscopic Subacromial Decompression , thereby creating more room for this muscle complex to glide freely.
A rotator cuff tear
A rotator cuff tear may be the end result of either, long standing impingement or trivial trauma to an already degenerate muscle. A rotator cuff tear can be quiet disabling, as the patient is unable to lift the arm, which is essential for basic activities of daily living e.g. dressing-up, personal hygiene, etc. This torn muscle can be repaired by arthroscopic technique using special soft tissue anchors .
Shoulder Dislocation
Shoulder arthroscopy has revealed that unstable shoulder, is a group of conditions, usually affecting the younger population. Recurrent anterior dislocation is the most common variety of shoulder instability, seen particularly in those involved in throwing or overhead sports e.g. cricket, racket sports, javelin, shot put, basket ball, etc. Detachment of the inferior capsule-labrum complex i.e Bankart lesion is the most common cause of recurrence of shoulder dislocation. Arthroscopic reapir of the torn capsule-labrum (Bankart repair enables the patient to return to pre-injury level of activity / sports in a few months time.
Calcification
Within the rotator cuff tendon, usually seen after the age of 40 years, can be a very painful condition. Occasionally it may not respond to conventional treatment. Remarkable pain relief can be provided by arthroscopic removal of the calcific mass.
SLAP Lesions
SLAP lesions are tears of the superior labrum with or without instability of the long head of biceps origin. Interestingly these can be diagnosed exclusively by arthroscopy and are best reapired by arthroscopic techniques. “SLAP” tears are common in cricket injury and in throwing sports….
Acromioclavicular Joint
Acromioclavicular joint pain is common and often missed. Arthroscopic excision of the outer 5mm of clavicle (Mumford procedure) has given consistently satisfactory results. It can also be a cause of Rotator cuff impingement , in which case, Mumford procedure should be combined with Subacromial decompression.
“True” Frozen Shoulder
“True” Frozen Shoulder is an uncommon condition. Barely two out of ten painful/ stiff shoulders are True Frozen Shoulders! Though the exact etiology is not known, proliferation of firbroblast in the shoulder capsule is seen on histology. Majority respond well with infra articular injection followed by exercises. In those who do not respond to injection, arthroscopic release may be considered. Arthroscopic release is effective in relieving pain and leads to faster recovery of shoulder function.
Fracture around the Shoulder Joint
Proximal humerus fractures are common in my practice as a shoulder surgeon. Majority can be treated by conservative treatment, however some (particularly in young age) may need Internal fixation. Elderly patients with poor bone often need hemi-replacement and the very old (poor quality Rot.Cuff) may be better off with a Reverse shoulder replacement.
Shoulder Replacement
There are several varieties of shoulder replacement – Surface replacement, Stemless replacement, Anatomic Total Shoulder replacement and Reverse shoulder replacement. Selection is made on the basis of severity of the shoulder arthritis, Rotator Cuff quality and the age of the patient.
