Shoulder Joint Surgery

Reference Corner [PDF]
 Frozen Shoulder
Ligament Tear And Repair
Shoulder Pain

The shoulder is a very mobile joint. Shoulder injury is common and it can be in the form of fracture, dislocation and tendon rupture. Rotator cuff syndrome and frozen shoulder are common and affect many people. These diseases are easily treatable.

Shoulder Dislocation
The head of the arm bone (humerus) fits in to the shoulder blade socket (glenoid). We call this the shoulder joint (gleno-humeral joint). There is a firm tissue rim (labrum) around the shoulder blade socket so that the socket is deepened and the head of arm bone can therefore fit better into the socket. When the head of the arm bone comes out of the socket, we call this a shoulder dislocation. When the firm tissue rim (labrum) is torn from the socket (glenoid), we call it a glenoid-labrum tear.

What should I do when my shoulder dislocates?
You should seek medical help and have the shoulder put back (reduced) in to place as soon as possible. X-ray is often needed to confirm reduction of the dislocation. If the shoulder dislocates frequently, we call it recurrent shoulder dislocation. If it becomes so frequent that it interferes with activities, surgery is recommended.

What is recurrent shoulder dislocation?
Recurrent shoulder dislocation means the shoulder becomes easily and frequently dislocated. The younger you are at the time of the first dislocation episode, the higher risk you have of recurrent episodes. Often the glenoid labrum is torn and sometimes the bone in the glenoid is damaged, these can contribute to the subsequent episodes of dislocation.

What are the causes of shoulder pain after dislocation?
There are many causes. It may be that there is not enough rehabilitation. In the younger patients, a glenoid labrum tear is often the cause. Sometimes a biceps tendon tear is the cause. In the older age group, rotator cuff tear is the most common cause.

How can they be diagnosed?
Shoulder injuries are diagnosed clinically and confirmed by imaging studies. Your doctor will talk to you to obtain a history of the injury and your symptoms and perform a physical examination. Imaging investigations are often needed. MRI scan can be very useful. A special test (arthrogram) is sometimes needed. It is a test which requires a contrast medium injected into the shoulder joint so that these tears can be easily seen. This is often done at the same time with the MRI scan.

How can they be treated?
Non-operative treatment includes:
• Medication
• Local injection

Operative treatment
• If the symptoms are not relieved by non-operative measures, surgery should be considered.

• Can be tried to relieve the symptoms

Most of the time, the torn glenoid labrum can be repaired by key hole surgery (arthroscopically). Your doctor will make a few holes about the shoulder and insert instruments into the shoulder. The torn glenoid labrum is sutured back with the use of suture anchors. After the operation, the shoulder is sometimes immobilized with shoulder immobilizer and physiotherapy is often needed.

Rotator Cuff Tendonitis
The rotator cuff is comprised of 4 muscles and tendons (supraspinatus, subscapularis, infraspinatus and teres minor) which wrap around the upper arm at the shoulder joint. It holds the head of the humerus or the arm bone in the shoulder joint and provides stability to the shoulder joint and power to the arm in rotation.

What cause the tear?
It is often a wear and tear process. It may be associated with overuse of the muscles and tendons. People undertaking repetitive overhead activities such as tennis and weight lifting are particularly at risk. However, a single injury can cause the tear, e.g. from a major fall. It can also be associated with fracture or dislocation of the shoulder. Most patients have recurrent episodes of shoulder pain for months. People over 40 years old are more commonly affected.

What happens when it is torn?
When it is torn, it can often cause pain and disability. Most tears are in the supraspinatus tendon although other parts of the rotator cuff can be affected. The pain may be aggravated when lifting the arm or lowering the arm from a raised position. There may be a crackling sensation in the shoulder joint when the arm is moved. Some may feel weakness when moving the arm. When it is severe, there may be pain at night or when lying on the affected shoulder.

How is it diagnosed?
Rotator cuff tear is diagnosed clinically. Investigation such as X-rays, MRI and ultrasound can be helpful.

Your doctor will take history and do a physical examination to examine on your shoulder, neck and abdomen to confirm the diagnosis and to exclude other causes. X-rays sometimes show bone spur. MRIs are best to look at the soft tissue and the extent of the rotator cuff tear.

How is it treated?
Non-operative treatment
Non-operative treatment can relieve pain and improve the function of the shoulder and may include:
• Medication to relieve pain and inflammation
• Rest
• Physiotherapy
• Local steroid injection

Operative treatment
Operative treatment is recommended if:
• The symptoms are not relieved by non-operative treatments
• The rotator cuff tear is acute and caused by a recent trauma
  and results in significant symptoms
• High demand of shoulder function is needed

The types of operative treatment can be
• Remove the bone spur so that the underlying cuff tendon will not rub against it
• The torn tendon can be repaired

These procedures can usually be performed arthroscopically, however in some cases the surgeons may recommend a mini open or an open technique to achieve the most optimal outcome.

Rehabilitation after surgery
After the tendon is repaired, the shoulder is immobilized with a shoulder immobilizer until the tear is healed. The length of immobilization depends on the size and extent of the tear. Motion is allowed and exercise is encouraged subsequently to regain function. Recovery may take several months.