Shoulder Surgery | Specialists and Information

The shoulder consists not only of a main joint but also of several secondary joints. These include the acromioclavicular joint and the subacromial space (the space between the acromion and the head of the humerus).

The shoulder joint consists of

• bones,
• muscles,
• tendons,
• ligaments,
• a joint capsule, as well as
• skin and subcutaneous tissue.

Since the shoulder is a ball-and-socket joint, it is naturally very mobile. Thanks to this joint, people can move their arm forward and backward or rotate it inward and outward. This makes the dynamic structures (tendons, muscles) of the shoulder particularly important, compared, for example, to the hip, where the static structures (bones) are under greater strain due to the high mechanical load when standing.

The head of the humerus is larger than the glenoid cavity. Thus, while this allows for great mobility, it comes at the expense of stability. Well-trained shoulder muscles are therefore essential for stabilizing the shoulder.  

Chronic shoulder pain is becoming increasingly common and has a severely limiting effect on those affected. The triggers for shoulder pain can be harmless in nature. However, they are often serious conditions or injuries that require treatment. We briefly outline the most common conditions below.  

Impingement Syndrome

Impingement syndrome occurs when, for various reasons, the shoulder no longer moves smoothly and the shoulder joint becomes “too tight.” Among other things, the head of the humerus can then strike the acromion. In addition, this can lead to bursitis, tendon irritation, inflammation, and damage to the rotator cuff. Pain and limited range of motion are the resulting symptoms. In the vast majority of cases, however, targeted muscle strengthening is sufficient to restore the smooth movement of the shoulder joint.

Bursitis in the Shoulder

Bursitis can also occur in the shoulder (subdeltoid bursitis). It is often a secondary symptom of another shoulder problem but can also be recognized as a warning sign rather than a standalone condition. Symptoms include pain—even at night—and limited range of motion. In most cases, the bursa above the acromion is affected, but bursitis can also occur in the area of the deltoid muscle.  

Rotator Cuff Tear

The most common cause of shoulder problems and shoulder surgeries is a rotator cuff tear. These tears can be degenerative—that is, caused by wear and tear—or result from accidents. Often, they are only partial tears rather than complete tears. Many tears can be successfully treated conservatively; however, if shoulder mechanics fail, surgery should be considered. There is a risk of rotator cuff insufficiency

Cartilage Damage in the Shoulder

Just as with the knee, injuries to the articular cartilage—the smooth layer between the humerus and the scapula—can also occur in the shoulder. Since the shoulder is not a weight-bearing joint, small defects are often well tolerated. However, larger cartilage defects can cause pain, limit mobility, and develop into full-blown shoulder osteoarthritis. In the past, these defects were often ignored or considered clinically irrelevant, but today there are minimally invasive and non-invasive treatment options.

Shoulder Osteoarthritis (Omarthrosis)

Omarthrosis is osteoarthritis of the shoulder caused by degenerative damage to the cartilage in the humeral head and/or the glenoid cavity. It is often seen in connection with accidents, systemic diseases such as rheumatism, or simply advancing age. Osteoarthritis causes pain and restricted movement, particularly in rotation (behind the back) and abduction (over the head). Since the shoulder is not a weight-bearing structure, the condition is often well tolerated for a long time.

A specific form of shoulder osteoarthritis is what is known as rotator cuff insufficiency—that is, the failure of the rotator cuff tendons—which leads to eccentric movement of the shoulder and, consequently, increased wear and tear on the joint.

Shoulder Dislocation

A shoulder dislocation occurs when the head of the humerus slips out of the glenoid cavity. Repositioning is often necessary. This can result in pain, accompanying injuries, and instability. In many cases, however, spontaneous reduction occurs, meaning the shoulder pops back into place on its own. It is not uncommon for patients to be surprised to learn that they had a shoulder dislocation.

For the shoulder to dislocate, stabilizing tissue must give way—that is, become injured. Depending on age, these are typically different structures, but what they all have in common is that, in the vast majority of cases, they can heal on their own. However, if healing is incomplete, the shoulder may remain unstable and cause further problems. The greatest risk here is shear stress on the joint surfaces, which can damage the cartilage. 

Shoulder Instability

Shoulder instability is a condition that must be considered somewhat separately from shoulder dislocation. It can be a consequence of a shoulder dislocation, but it can also occur without an injury. In the latter case, connective tissue weakness is often the cause, which can be either acquired or congenital. Congenital connective tissue weaknesses are often associated with other medical conditions. The symptoms of shoulder instability are often nonspecific, and in many cases, diagnosis is delayed. Nevertheless, once correctly diagnosed, the condition is highly treatable.

Calcific Tendinitis

Calcific tendinitis occurs when calcium deposits form in the area of the tendons, particularly the supraspinatus tendon. Poor blood flow to the rotator cuff is considered the cause. An active calcific shoulder is regarded as one of the most painful experiences in medicine, and patients often say that bone fractures or even labor pains would have been less severe than the calcium deposits in the shoulder.

Shoulder Fractures

Fractures around the shoulder are very common and occur in many different forms. Most people are familiar with clavicle fractures, either from personal experience or through others, and they occur in all age groups. If the spherical head of the humerus breaks, it is referred to as a humeral head fracture. This is primarily a problem among middle-aged and older adults, but it can also occur in young patients if the trauma is severe enough. Shoulder dislocations can also lead to fractures of the glenoid cavity. The scapula itself fractures relatively rarely. Not all fractures require surgical treatment. The shoulder has a remarkable ability to compensate!

Frozen Shoulder

Frozen shoulder is an inflammation that initially affects the synovial membrane and then leads to shrinkage of the joint capsule. This, in turn, can result in painful adhesions, such as those involving the bursa. There are a number of possible causes, but sometimes the problem occurs spontaneously. Frozen shoulder is self-limiting—meaning it goes away on its own—but the course of the condition is long, often lasting months, and is very uncomfortable.

Shoulder Problems in Children and Adolescents

Children and adolescents during growth have a number of specific risk factors and shoulder problems that are not seen in adults. Like all joints, the shoulder is naturally much more mobile during growth than in adulthood. However, this also puts children at risk of developing shoulder instability without a prior injury. As a compensatory mechanism in these cases, the rotator cuff becomes overloaded, leading to bursitis. These connections are often not recognized until later, but the rule of thumb is helpful: Bursitis or impingement in children and adolescents is almost always a sign of hidden instability.

Another particular vulnerability in children is the growth plates—the areas where bones grow in length. Intense sports activity can lead to separation of the growth plates, meaning the bone splits apart. This is commonly referred to as “little league shoulder.” It can also lead to a bony tear of the rotator cuff tendons.

Other shoulder problems:

• Subluxations
• Injuries to the acromioclavicular joint (Tossi I, II, III)

Shoulder surgery is a subspecialty of general surgery. In this field, it is particularly important for the surgeon to work with great precision in order to preserve the shoulder’s functionality. In this way, the shoulder surgeon can treat both degenerative conditions and injuries.

Shoulder joint arthroplasty is also one of the disciplines of shoulder surgery. The function of the shoulder is likewise maintained and restored through the implantation of an artificial joint.

This text was reviewed by PD Dr. med. univ. Patrick Vavken.