Shoulder Arthroscopy
What is shoulder arthroscopy?
Shoulder arthroscopy is a minimally-invasive technique that allows access to and treatment of many injuries and diseases of the various structures that make up the shoulder joint. The joint is accessed through two or three small incisions of less than one centimetre.
Arthroscopy has become the technique of choice for shoulder pathologies, enabling the treatment of difficult-to-access structures of the shoulder by providing a complete view of the inside.
Why is it performed?
Shoulder arthroscopy is used to treat shoulder problems in people with shoulder pain or limited movement who have not improved with medical and physiotherapy treatment. In the past, shoulder injuries required more complex surgeries and recovery periods were longer.
Specifically, shoulder arthroscopy is used for:
• Rotator cuff tear
• Shoulder dislocation
• Traumatic injuries: glenoid fractures, acromioclavicular dislocation and soft tissue injuries.
What does it involve?
Shoulder arthroscopy is performed in the operating room, with the person in a semi-seated position or on their side, placing the arm to be operated on in a traction and positioning device. The specialist will create two holes and introduce the arthroscopy, in order to see the inside of the shoulder clearly. Once the surgery is complete, the specialist will seal up the holes and apply a compression bandage and a sling.
In addition to sedation, local anaesthetic will be applied to numb the nerves that go to the arm. This makes the postoperative period more comfortable and less painful compared to conventional shoulder surgery. The surgery itself takes between 30 and 90 minutes, depending on the condition being treated.
Normally, after the operation, you will spend one night in the hospital and be discharged the next day. You will also be given some instructions on how to take care of your shoulder to ensure a full recovery.
Preparing for Shoulder Arthroscopy
To prepare for the procedure:
• You must inform the specialist of any medication you are taking
• A preoperative study will be performed based on blood count, biochemistry, a chest X-ray and ECG
• You must not eat or drink in the eight hours before surgery
Post-operative care
You are likely to feel discomfort during the first few days after the operation, as well as swelling. However, this will soon subside with the help of medication recommended by the surgeon.
You must also wear a sling to immobilise and rest the operated arm for days to six weeks based on the surgical procedures. You should nonetheless carry out some small exercises such as elbow flexions and extensions, and move the fingers. Prof Imam or a member of the team will explain how to do this.
It is important to avoid the incisions getting wet until the stitches are removed, which will be 5-10 days after the operation. Once the stitches have been removed, rehabilitation will be necessary, and this can last up to eight weeks. As the rehabilitation progresses you will be able to do more activities, such as driving, and, after two to four months, more strenuous physical exercise.
Shoulder Tendonitis
What is shoulder Tendonitis?
Tendonitis means the inflammation of a tendon, in which micro-tears and areas of necrosis occur. Tendonitis in the shoulder can mainly affect the long portion of the brachial biceps and the muscles of the rotator cuff.
Prognosis
Physical therapy and exercise are usually effective to improve the symptoms and reduce shoulder pain. If these exercises do not work, surgery may be needed. Otherwise, the tendon may rupture completely.
Symptoms of Shoulder Tendonitis
The symptoms of shoulder tendonitis are:
• Inflammatory pain
• Pain from pressure on the tendon
• Lack of strength
• Difficulty to perform daily activities
• Pain when performing active shoulder movements and pain when stretching the muscle-tendon.
Medical tests for shoulder tendonitis
Tests to diagnose shoulder tendonitis are as follows:
• Ultrasound scan
• X-ray
• MRI scan
• Computed tomography scan (CT)
These tests and the detailed study of the patient’s medical history usually provide an accurate diagnosis.
What causes shoulder tendonitis?
The main causes of shoulder tendonitis include:
• Older age (wear and tear)
• Repetitive movement in certain work activities or sports.
• Poor blood supply to the tendons of the supraspinatus and infraspinatus muscles.
• Sudden movements.
• An imbalance of muscle groups closest to the humerus head.
Can shoulder tendonitis be prevented?
Shoulder tendinitis can be prevented by following basic exercise guidelines:
• Warming up the muscles before exercising
• Perform muscle-strengthening exercises
• Stretching after sports activities
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Treatments for Shoulder Tendonitis
Physical therapy is the appropriate treatment for tendonitis of the shoulder. The goal of this is to eliminate shoulder pain and improve joint stability and muscle strength. For this purpose, a series of exercises are performed that consist of mobilizing the joint to avoid the loss of movement, deep massage of the affected tendon and stretching. In addition, other techniques can be performed, such as:
• Steroid injections
• Shockwave therapy
• Painkillers
• Surgery