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SHOULDER ARTHROSCOPY

Shoulder joint is the most mobile joint in the body it is potentially unstable. It is therefore the most common joint to dislocate in the body. In some patients only minor trauma can cause the shoulder to ‘pop out’ of joint. If it dislocate it needs to be ‘put back’ as soon as possible and you then require physiotherapy.

Over 70% of dislocations can recur, especially in young sports people. Repeated dislocations lead to more instability and stretching of the shoulder joint, leading to long periods off sports . therefore recommend early surgical fixation. Arthroscopic repair offers the advantages of less pain, less complications and an earlier return to sports.

The labrum is a cushion surrounding the socket of the shoulder joint (similar to the meniscus of the knee). Likewise, it can tear like the knee meniscus with injuries of the shoulder. Labral tears usually follow falls or direct blows to the shoulder, but may also occur with throwing or pulling injuries. They can be diagnosed with MR Arthrograms (MR scan with special dye injected into the shoulder joint), and confirmed at keyhole surgery (arthroscopy). Large tears are associated with shoulder dislocations and called Bankart Lesion.

ACJ joint is very important for overhead and throwing athletes. It is commonly sprained by repeated falls on the shoulder and tackling. It can also dislocate resulting in a more prominent painful lump on your shoulder. Sprained joints tend to cause more long-term pain than true dislocated joints. Injections and physiotherapy often improve the pain, but surgical removal of the joint is often required for persisting pain. This operation can be done by keyhole (arthroscopic) surgery, which has the advantages of less post-op pain and and early return to sport.
The rotator cuff is a group of tendons that provide movement and stability for your shoulder. Therefore when it is damaged pain and weakness can be significant. Tears caused by injury, benefit from early repair because the tears can get bigger and more difficult to repair later on. MRI Scan has the advantage of being able to pick up tears early on and treat them appropriately. Rotator cuff repair can be done by keyhole surgery.
Superior Labral Antero-Posterior (SLAP) tears of the shoulder are more common in overhead throwing, heavy lifting and tackling sports. The biceps anchor in the shoulder is forcibly peeled or pulled off its bone attachment by a large pulling or peeling force. This can occur during a heavy lift, hard throw, tackle or fall. The symptoms are pain deep inside the shoulder with lifting and sports. Some people complain of a clicking sensation and pain extending down the upper arm Arthroscopic surgery is the recommended treatment.

The weak points of the biceps muscle is where the tendon attaches to the bone at the elbow. The biceps usually ruptures at the elbow in athletes. You will usually feel a pop and notice a lump in the front of your arm. In athletes and manual workers prompt early repair is advisable, surgery is required the tendon is attached to the humerus ( tenodesis).

Subacromial Impingement (also known as Bursitis, Impingement Syndrome, Rotator Cuff Tendinitis, Supraspinatis tendonitis) occurs with repeated use of your arm overhead and in patients who develop small bony spurs which trap the rotator cuff tendons above the main shoulder joint. Treatment include Injections and physiotherapy often improve this condition, but repeated steroid injections should be avoided. Arthroscopic Surgery involves spring-cleaning of the subacromial bursa with removal of the bony spur. This is called Arthroscopic Sub-acromial Decompression.

True frozen shoulder (a very stiff painful shoulder with no obvious cause) is common in diabetic patients. However, a stiff painful shoulder following an injury is not rare. In these cases it is essential to treat the stiffness early and then also treat the underlying injury that caused the stiffness. The joint teamwork of an experienced physiotherapist and Arthroscopic shoulder surgery is very useful for an early recovery.

Calcific tendonitis refers to a build-up of calcium in the rotator cuff (calcific deposit). When calcium builds up in the tendon, it can cause a build up of pressure in the tendon, as well causing a chemical irritation. This leads to pain. The pain can be extremely intense. It is one of the worst pains in the shoulder requires conservative or surgical management.
Arthritis is when a joint wears with age or overuse. The lubricant is reduced and the joint becomes stiff and painful. Keeping the shoulder active and the muscles toned is of benefit, along with pain medicine . However, when the pain is severe enough to affect daily life and sleep a joint replacement is of benefit. Total shoulder replacement arthroplasty surgery for restoring comfort and function to the arthritic shoulder. In this procedure the arthritic ball is replaced by a smooth met- al ball fixed to the humerus by a stem that fits within it.

Rugby Shoulder
Dr. Konchwalla treat a large number of Professional Rugby players and have noticed specific patterns of injury as a result of the intense tackling associated with rugby these days.

Thrower’s Shoulder
With repetitive overhead throwing the front of the shoulder can stretch and the back get tighter. This can cause abnormal gliding of the shoulder joint and a ‘catching’ of the labrum and rotator cuff, leading to rotator cuff tears and abnormal wear of the labrum. It requires specific experise to diagnose and treat this condition.

Swimmers Shoulder
Swimming involves repetitivie overhead activity, with particular muscular imbalances occuring around the shoulder complex to accomodate this. Thus swimmers are prone to shoulder pain, with over two thirds of elite swimmers suffering this at some stage.

Management of Shoulder Fractures and Clavicle
Fractures around the shoulder have always been difficult to treat operatively, with new fixation devices and safer surgical techniques we are able to fix difficult fractures early and allow early return to sports better than in the past.

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By : Dr. Mohammad Ashfaq Konchwalla

Consultant Orthopaedic & Sports Surgeon

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