When the shoulder goes out

 Many of these diagnoses are made with shoulder arthroscopy, a keyhole surgery that uses a tiny camera (called an arthroscopic device, ranging from 2-5 diameters in size) to look inside the shoulder joint. The equipment used for this procedure includes a camera and magnifying lens, which relays the image to the TV monitor. This enables the orthopaedic surgeon to clearly see the images from the monitor to guide him or her while performing the surgery.

Shoulder arthroscopy is also used to treat a range of conditions including inflamed or torn tendons and muscles, impingement syndrome, frozen shoulder, shoulder instability or recurrent dislocation and calcific tendinitis.

 

Inflammation and tear of rotator cuff tendinitis/tear

This is the inflammation of a group of tendons and muscles in the shoulder (rotator cuff) and results from overuse of the shoulder joint in sports such as tennis, swimming or badminton, which causes tendons to deteriorate. Another main cause of injury to the rotator cuff tendinitis is the narrowing passage under the acromion. Sometimes, the tendons may suddenly tear due to light accidents such as a shoulder twist or impact to the arm, which may result from falling and causes a humerus (upper arm bone) fracture. 

Signs and symptoms include weakness in the shoulder joint and difficulty in lifting the shoulders as well as pain in the shoulder joint area, especially while resting and during the night.

 

Shoulder impingement syndrome

Shoulder impingement syndrome affects the muscles and tendons during repetitive movement and can cause inflammation of the tendons, swelling of the muscles and difficulty in carrying weight. The tendons become enlarged and inflexible. In some cases, there is an increase in calcium deposits, reducing shoulder function. It also increases pain in the shoulder joint, and when the inflamed tendons heal, they do not return to normal. Some of the sports that cause shoulder impingement syndrome include swimming, tennis, badminton, baseball and other sports that involve a throwing or pitching motion.

The symptoms include weakness of shoulder muscles, difficulty in reaching up behind the back and pain with overhead use of the arm.

 

Frozen Shoulder

This is a condition where the shoulder becomes stiff or “frozen” due to scar-like tissue forming in the shoulder capsule. It begins with a chronic inflammation along with limitation in the movement of the shoulder. Scar tissue or adhesions develop around the shoulder joint, muscles become inflexible and contract, causing frozen shoulder.

Symptoms include pain in the shoulder and limitation in shoulder movement such as extending the arm and raising the arm above the head. Patients are unable to move their hands backwards, thereby affecting their daily routines and such activities as combing hair, fastening bra hooks or reaching for things that are placed high up on the shelves.

The main advantages of shoulder endoscopy are as follows:

1. Accuracy in diagnosis

2. Fewer complications such as infection, swelling, and blood clot in the joint (less than 1 per cent)

3. Duration of stay in the hospital is just 1-2 days and recovery period at home is short

4. Physical therapy can be started soon after surgery, resulting in quick recovery and a return to normal activities and routine much faster than with conventional surgery.

 

DR WICHIAN JIRABOONSRI is an Orthopaedic Surgeon attached|to the Sports and Orthopaedic Centre of Samitivej Sukhumvit Hospital. Call (02) 711 8494-6.