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.
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).
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.
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.
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.
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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Consultant Orthopaedic & Sports Surgeon