The actual shoulder joint is dependant on its environment. It is surrounded by four neighbours:
– the layer of muscle between thorax and shoulder-blade (scapula), which allows smooth movements ,
– the area below the acromion of the shoulder-blade (scapula) and the outer collar-bone (clavicle), known as the subacromial space ,
– both joints of the clavicle – the acromioclavicular joint,between the part of the scapula that forms the highest point of the shoulder and the distal end of the clavicle,and the sternoclavicular joint, which links the clavicle with the sternum.
Each of these neighbours can cause difficulties and impair the functionality of the shoulder.
A clinical examination, especially magnetic resonance imaging (MRI), gives a clear indication of the source of malfunction. Lighter disorders can be treated using targeted injections, heat treatment, electrotherapy and manual physical therapy. If conservative treatment fails to bring relief, operative therapy may be required.
Most shoulder operations make use of arthroscopy these days. This involves filling the joint with saline solution, in order to allow a clear view of all parts of the joint on a monitor by inserting a small camera. The damage can then be repaired by further holes.
In cases of capsulitis (capsule inflammation), for example, the inflamed synovial membrane is removed with a rotating shaver. Should the labrum acetabulare (fibrocartilaginous rim attached to the margin of the acetabulum) be torn due to injury, it can be reattached using bioabsorbable anchors.
The subacromial space [fig. 3] also often causes specific problems such as impingement as a result of anatomic variation. Incorrect or excessive stressing can lead to bursitis (inflammation of the bursa) and mechanical stress of the rotator cuff (which is generally not well supplied with oxygen).
This space can be enlarged arthroscopically to remove the impingement, creating space by means of decompression or removing bone formations of the clavicle [fig. 4]. Small tears in the rotator cuff can be corrected arthroscopically and areas of calcification can be removed.
In larger rotator cuff tears, access is gained through an upper cut and partition of the delta muscle. Tendon endings are mobilized and the degenerative area is removed.
The tendon is then reattached to the tuberculum majus on the exterior surface of the humerus head.
Lymphatic drainage and manual physical therapy play an important post-operative role. I have created individualized programs for each type of shoulder disorders.