SHOULDERJOINT TREATMENT
ARTHROSCOPY REPAIR FOR RECURRENT DISLOCATION SHOULDER
The shoulder (a shallow ball and socket joint) can become unstable after major trauma such as during a fall or tackle where the structures that normally control its stability are torn. In more elderly patients recurrent instability is not usually a problem but in younger patients, particularly those engaged in contact and overhead sports (Rugby, Football, Tennis,) recurrent dislocations can occur and result in significant damage to the joint and its surrounding structures. Arthroscopic treatment have improved so much over the past decade that, provided there is no other injury present, the majority of traumatic dislocations can be treated with this technique. The arthroscopy is a small lens that can be placed into the shoulder thru very small incisions. This scope is connected to a camera and monitor so that the surgeon can see and operate with very minimally invasive incisions and technique. Patients undergoing arthroscopic surgery for shoulder instability usually do not stay overnight in the hospital. Local anesthesia and sedation is used during the procedure.
SLAP REPAIR
The labrum is a ring of cartilage that attaches to and extends the effective area of the glenoid (the socket of the shoulder). The labrum helps to stabilize the ball-and-socket joint (glenohumeral joint) and serves as an attachment site for ligaments around the shoulder as well as the biceps tendon.
Causes
The labrum can be injured either by overuse or through a single traumatic event. An injury to the superior labrum, where the biceps tendon attaches, is an example of an overuse injury whereas anterior labial lesions occur usually when the shoulder is traumatically dislocated.
Symptoms
→Clicking or popping →Sharp pain when torn labrum is pinched or displaced →Sense of instability or apprehension with activity
Treatment
Arthroscopic surgery is the mainstay for diagnosing as well treating SLAP tears. The type of surgery required depends upon the type of SLAP tear. The surgical options include: 1. Arthroscopic debridement of the SLAP lesion 2. Arthroscopic repair (fixing back the avulsed superior labrum and the biceps anchor back to the glenoid) 3. Biceps tenodesis (re-attaching the biceps tendon to the upper end of the humerus). This is reserved for patients with frayed or torn biceps tendon. This can be done arthroscopic or open.
ARTHROCOPIC/MINI OPEN ROTATOR CUFF REPAIR
Rotator cuff is the group of tendons in the shoulder joint providing support and enabling wider range of motion. Major injury to these tendons may result in tear of these tendons and the condition is called as rotator cuff tear. It is one of the most common causes of shoulder pain in middle aged adults and older individuals. It may occur with repeated use of arm for over head activities, while playing sports or during motor accidents. Rotator cuff tear causes severe pain, weakness of the arm, and crackling sensation on moving shoulder in certain positions. There may be stiffness, swelling, loss of movements, and tenderness in the front of the shoulder. Rotator cuff tear is best viewed on magnetic resonance imaging. Symptomatic relief may be obtained with conservative treatments - rest, shoulder sling, pain medications, steroidal injections and certain exercises. However surgery is required to fix the tendon back to the shoulder bone. Rotator cuff repair may be performed by open surgery or arthroscopic procedure. In arthroscopy procedure space for rotator cuff tendons will be increased and the cuff tear is repaired using suture anchors. These anchor sutures help in attaching the tendons to the shoulder bone. Following the surgery you may be advised to practice motion and strengthening exercises.
FROZEN SHOULDER
Frozen shoulder is the condition of painful shoulder limiting the movements because of pain and inflammation. It is also called as adhesive capsulitis and may progress to the state where an individual may feel very hard to move the shoulder. It is more common in older adults aged between 40 and 60 years and is more common in women than men.
Causes
Frozen shoulder is caused by inflammation of the ligaments holding the shoulder bones to each other. The shoulder capsule becomes thick, tight, and the stiff bands of tissue called adhesions may develop. Individuals with shoulder injury, shoulder surgeries, shoulder immobilized for longer period of time, other disease conditions such as diabetes, hypothyroidism, hyperthyroidism, Parkinson's disease and cardiac diseases are at risk of developing frozen shoulder.
Symptoms
Pain due to frozen shoulder is usually dull or aching. It can be worsened with attempted motion. The pain is usually located over the outer shoulder area and sometimes the upper arm. The hallmark of the disorder is restricted motion or stiffness in the shoulder. The affected individual cannot move the shoulder normally. Motion is also limited when someone else attempts to move the shoulder for the patient.
Treatment
Arthroscopic surgery: This involves doing a synovectomy (removal of inflamed inner lining of the shoulder) and capsular release using an arthroscopic shaver. Arthroscopic surgery has the advantage of being minimally invasive in nature, and is not associated with the risk of causing a fracture of the humerus or a rotator cuff tear. Additionally, it allows a complete visualization of the shoulder joint and subacromial space, and to deal with any other associated pathology like a rotator cuff tear.
ACROMIOPLASTY
Acromioplasty , also known as subacromial decompression, is an arthroscopic surgical procedure of the acromion, top of the shoulder blade or the part of the shoulder blade extending over the shoulder joint. This procedure is sometimes done to treat pinched tissues in the shoulder (called shoulder impingement). It is also used to treat tears in the rotator cuff. Acromioplasty can be done using anarthroscope. This slender instrument has a camera on the end that allows surgeons to work without making big incisions in the skin. Athroscopic acromioplasty is a less invasive procedure than open shoulder repairs, which require large incisions. The operation is performed through 2 small 1 cm incisions. Firstly an arthroscopy is inserted into the shoulder from the back and the joint is evaluated for any other problems which may be causing symptoms. The arthroscopy is then placed into the subacromial space above the supraspinatus tendon. The subacromial spur is identified and a second incision is made on the outside of the shoulder. A diathermy probe is used to remove soft tissue from spur which is then removed using a high speed burr. The incisions are then sutured and the arm placed in a sling. Gentle range of motion exercises are started the next day, and the sling is just for comfort and patients are advised to stop using it as soon as possible, sutures are removed at one week post surgery and the theraband strengthening is commenced. It takes at least 3 months for the shoulder to return to normal post surgery.