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Focus On: Shoulder Injuries and Surgery


Most problems in the shoulder involve the muscles, ligaments, and tendons. Athletes are especially susceptible to shoulder problems. In athletes, shoulder problems can develop slowly through repetitive and intensive training routines.

Some people will have a tendency to ignore the pain and endure a shoulder injury, which only aggravates the condition and may possibly cause more problems. People also may underestimate the extent of their injury because steady pain, weakness in the arm, or limitation of joint motion will become almost second nature to them.

Orthopaedic surgeons group shoulder problems into the following 2 categories:

Instability
Sometimes, one of the shoulder joints moves or is forced out of its normal position. This condition is called instability, and can result in a dislocation of one of the joints in the shoulder. Individuals suffering from an instability problem will experience pain when raising their arm. They also may feel as if their shoulder is slipping out of place.

Impingement
Impingement is caused by excessive rubbing of the shoulder muscles against the top part of the shoulder blade, called the acromion.
Impingement problems can occur during activities that require excessive overhead arm motion. Medical care should be sought immediately for inflammation in the shoulder because it could eventually lead to a more serious injury.

 

Your shoulder is the most flexible joint in your body. It allows you to place and rotate your arm in many positions in front, above, to the side, and behind your body. This flexibility also makes your shoulder susceptible to instability and injury.

Depending on the nature of the problem, nonsurgical methods of treatment often are recommended before surgery. However, in some instances, delaying the surgical repair of a shoulder can increase the likelihood that the problem will be more difficult to treat later. Early, correct diagnosis and treatment of shoulder problems can make a significant difference in the long run.

Rotator Cuff Injuries

The rotator cuff is one of the most important components of the shoulder. It is comprised of a group of muscles and tendons that hold the bones of the shoulder joint together. The rotator cuff muscles provide individuals with the ability to lift their arm and reach overhead. When the rotator cuff is injured, people sometimes do not recover the full shoulder function needed to properly participate in an athletic activity.

Patients who may require surgery to repair a torn rotator cuff include:

  • Persons whose symptoms do not improve with appropriate physical therapy or rehabilitation
  • High-demand athletes after an acute injury
  • Overhead workers or labourers
  • Persons who have changes on X-ray or MRI that suggest that irrecoverable damage to the shoulder may occur if the shoulder mechanics are affected by the cuff tear.

Arthroscopic shoulder surgery, or shoulder arthroscopy, is a valuable tool to treat rotator cuff tears. Using the scope, an experienced surgeon can evaluate the entire shoulder joint and can usually fix the tear through very small incisions using specially-designed instruments and devices. The goals of repair are to restore normal and painless motion and full strength to the affected shoulder:

  • The rotator cuff tear is identified and loose, degenerated, and frayed tissue around the cuff edge must be removed back to healthy tissue. This process is called debridement.
  • The edge of the cuff tear must be brought back to its normal position without undue tension. This process is accomplished using techniques called mobilization.
  • The tear must be fixed into place using specially-designed suture anchors that allow the surgeon to approximate the cuff tear securely to the bone.
     

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