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.
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.
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.
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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