Shoulder Surgery
What is Shoulder Surgery?
Shoulder surgery treats injured shoulders by repairing the muscles, connective tissue, or damaged joints that occur from traumatic injury or from where the shoulder has been overused. The shoulder is the most flexible joint in the body, allowing the arm to be placed and rotated in many positions in front, above, to the side and behind the body. This degree of movement makes the shoulder susceptible to injury.
Shoulder injuries are common. In fact, approximately 14 million people were evaluated by physicians for shoulder problems in 2003, including 3.7 million visits for shoulder and upper arm sprains and strains. (Source: National Center for Health Statistics; Centers for Disease Control and Prevention 2003 National Ambulatory Medical Care Survey)
We expect a lot of our shoulders, but sometimes we ask too much of them. The shoulder is capable of the greatest range of motion of any joint; however, its flexibility makes it prone to both sudden injury and chronic wear and tear.
The proper function of the shoulder depends upon the interrelationship of many types of tissue: balanced muscle function, smooth joint cartilage, functional tendons, strong ligaments, and good motion. A physician must have the ability to recognise deficits, and the technical skill to work with each of these structures and an understanding of their interrelationships.
Shoulder problems that require surgery
Bursitis or tendinitis
The rotator cuff can cause pain in many different ways, which includes tendonitis, bursitis or mechanical impingement. These are due to repetitive activities such as swimming or weightlifting. The repetition causes rubbing or squeezing of the rotator cuff under the acromion and in the acromioclavicular joint.
Impingement
This occurs when the top of the shoulder blade puts pressure on the underlying soft tissues when lifting the arm away from the body. Symptoms of impingement include difficulty reaching up behind the back, pain when using the arm over the head and weakness in shoulder muscles.
Full-thickness rotator cuff tears
Full-thickness rotator cuff tears are often the result of shoulder impingement, partial-thickness rotator cuff tears or can occur from heavy lifting and falls. Rotator cuff tears may involve the entire thickness of the tendon, or they may be incomplete, which is known as partial thickness. Rotator cuff surgery and rehabilitation allows patients to regain the lost function in shoulders with cuff disease.
Instability
One of the shoulder joints is forced out of its normal position. This condition can result in a dislocated shoulder. Patients will experience pain when they raise an arm, and it may also feel like their shoulder is out of place.
Diagnosis of a shoulder injury
Prof Imam will discuss the medical history of the patient and then examine the shoulder. He will check to see whether it is tender in any area and whether there is a deformity. The strength of the arm will also be tested, and the arm will be moved in different directions. Other tests that help with diagnosis include imaging tests, X-rays and MRI scans.
Non-surgical treatment of shoulder injuries
Prof Imam will explain certain exercises that are aimed to strengthen the shoulder muscles, which will include wall push-ups and shoulder press-ups. They may also prescribe anti-inflammatory medication.
Surgical treatment for shoulder injuries
• All-arthroscopy repair – this allows the surgeon to insert a thin device with a small lens into tiny incisions to look inside the joint. The images are relayed onto a television screen, allowing the surgeon to be guided and make a diagnosis.
• Open repair – in some cases, open repair surgery is necessary. It is done through small incisions, which are only a few inches and are required if the tear is large. It is a good option if the tear is complex or if additional reconstruction, such as tendon transfer, is required.