Shoulder joint-maintaining surgery - Medical specialists

So-called minimally invasive or arthroscopic surgical methods are used in shoulder joint-preserving surgery. These are surgical treatment options that are used to restore the original shoulder joint function. They have now replaced the majority of previously open procedures. Very few reconstructive procedures on the shoulder joint are still performed open today. However, there are still important open procedures that cannot yet be performed arthroscopically.

Here you will find further information as well as selected specialists and centers for shoulder joint preserving surgery.

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Article overview

Shoulder joint-maintaining surgery - Further information

The anatomy of the shoulder joint

The shoulder joint connects the upper arm to the shoulder blade. The junction of these two structures consists of the humeral head and the socket of the shoulder blade. The high mobility of the shoulder joint means that it is particularly well protected by

  • muscles,
  • ligaments and
  • tendons

necessary: These guarantee that the humeral head remains stable in the joint socket even with high deflections.

The protective and stabilizing structures of the shoulder joint are susceptible to wear and tear due to the high load. This leads to so-called joint wear and tear.

In addition, falls on the shoulder often lead to dislocations of the joint, despite the good protection provided by muscles and ligaments. The shoulder joint is particularly susceptible to dislocation. In contrast to the knee joint, stabilization is mainly provided by muscles and ligaments, but less by bony support.

Anatomie der Schulter
The ligaments and muscles around the shoulder joint © bilderzwerg | AdobeStock

When is minimally invasive shoulder surgery used?

Accidents or signs of wear and tear are the most common causes of problems in the shoulder area. A thorough clinical examination and appropriate imaging diagnostics can usually determine the cause of the symptoms.

Various procedures are used as part of image diagnostics. An X-ray series is mandatory. Depending on the changes, cross-sectional images such as magnetic resonance imaging and/or computer tomography(MRI or CT) can also provide important information.

The experience of the doctor in his field is also of great importance. This is the only way to make an optimal diagnosis.

As a rule, the first treatment option is conservative physiotherapy. If this is unsuccessful or cannot be used, a shoulderarthroscopy is often performed. This allows the doctor to confirm the diagnosis and treat the cause accordingly.

This usually requires a general anesthetic. The surgeon inserts a small camera and tiny instruments through small incisions in the shoulder area. He uses these to gain an overview of the condition of the joint and can carry out various procedures.

Classic indications for arthroscopic surgery on the shoulder joint are, for example

  • Instability of the shoulder joint due to sports injury or wear and tear of supporting structures such as the shoulder capsule, ligaments and muscles (for example: shoulder dislocation, dislocated shoulder joint, shoulder dislocation)
  • Tearing of important stabilizing and functional muscles of the shoulder joint (rotator cuff tear)
  • Calcification of the shoulder joint(calcified shoulder) and various painful conditions in the shoulder area:frozen shoulder, pinching of tendons and/or muscles in the shoulder joint (impingement syndrome), wear and tear of the acromioclavicular joint (AC joint arthrosis)
  • Necrosis of the humeral head, in which bone material decomposes due to the slowed conversion of cartilage into bone tissue. As a result, bone particles detach and change the structure of joint surfaces
  • Omarthrosis (shoulder osteoarthritis): Wear and tear disease of the shoulder joint
Schulterarthroskopie
Schematic representation of a minimally invasive shoulder arthroscopy © bilderzwerg | AdobeStock

    Minimally invasive shoulder surgery procedures

    If shoulder surgery is unavoidable, there are various options for surgical intervention:

    Especially after traumatic dislocations, surgery to repair the damaged, torn and displaced joint lip (labrum) and surgical tightening of the joint capsule (capsular shift) is often unavoidable.

    Tendon tears can be surgically repaired by suturing the tendon to the bone (tendon suture).

    If the tendon is calcified, the surgeon opens the calcified pocket and removes the calcified material. Adhesions of the joint capsule can also be treated in a similar way.

    During decompression, the surgeon creates a new joint by

    to relieve the tendons. In recent years, this procedure has been used too often without reflection for shoulder pain of any kind. It then fell into disrepute in the popular press due to poor application.

    A genuine tightness syndrome caused by bone changes (bony impingement) is the exception. In principle, it should initially be treated with conservative physiotherapy and manual therapy measures. These include

    • stretching the joint capsule and
    • strengthening and balancing the muscles of the rotator cuff, the shoulder blade stabilizers and the deltoid muscle.

    This means that subacromial decompression alone is a rare and exceptional indication today. It is usually used in combination with other procedures (e.g. rotator cuff suture).

    Cartilage smoothing (chondroplasty) is a procedure for treating cartilage damage that is performed during arthroscopy. Depending on the extent of the damage, either superficial cartilage tissue can be smoothed or a deeper procedure can be carried out. The bone tissue is stimulated to form new cartilage (microfracturing).

    Arthroscopic treatment of the early stages of shoulder joint arthrosis as part of a so-called Comprehensive Arthroscopic Management (CAM) procedure also includes

    • Removal of the inflammatory joint lining and the bursa,
    • the treatment of the long biceps tendon and
    • if necessary, resection (removal) of the acromioclavicular joint.

    In almost all cases of rotator cuff (RM) tendon tears, the long biceps tendon (LBS) causes considerable pain due to its destabilization. It is therefore almost always necessary to replace or remove the long biceps tendon.

    Specialists from the fields of

    decide on a case-by-case basis which surgical method makes the most sense.

    After the operation: possible complications and aftercare

    Minimally invasive shoulder surgery is not associated with any particular risks. It usually proceeds without complications. However, as with all surgical procedures, there is a small risk of

    • Bone or nerve injuries and
    • bleeding and bruising in the treated area.

    After the operation, swelling in the area of the incision is normal and will gradually subside. Pain and restricted movement are also possible consequences of shoulder surgery. Your doctor will therefore prescribe painkillers, which you should take as prescribed.

    Post-operative stiffening of the joint is a special case. Due to excessive inflammation and scarring, patients experience increased pain and long-lasting movement restrictions. This is well compensated for by taking cortisone therapy for 3-4 weeks.

    After surgery on the shoulder joint, it is usually necessary to immobilize the joint for three to six weeks. During this time, you should take it easy and not perform any movements that put strain on the joint. You should therefore avoid supporting yourself, lifting heavy objects and the like.

    Immediate rehabilitation, on the other hand, is advisable shortly after the operation and serves to relax the muscles. If healing is successful and as soon as you are physically able to do so, you can start a targeted rehabilitation program. It will be created for you according to physiotherapeutic criteria.

    Depending on the illness and surgical technique, the periods of immobilization will vary and mobilization will be adapted accordingly. You should always ask your surgeon for a detailed and individualized aftercare plan.

    Conclusion

    Timely diagnosis facilitates gentle, usually minimally invasive surgical treatment to restore the natural joint. Joint-preserving shoulder surgery is offered by specialized specialists who take the time to plan individual treatment and are available to answer any questions you may have on the subject.

    References

    • Deutsche Gesellschaft für Unfallchirurgie: Schultergelenk Erstluxation. https://www.awmf.org/uploads/tx_szleitlinien/012-012l_S1Schultergelenk-Erstluxation_2018-07.pdf
    • Deutsche Gesellschaft für Orthopädie und Orthopädische Chirurgie (DGOOC): S2e-Leitlinie „Rotatorenmanschette. https://www.awmf.org/uploads/tx_szleitlinien/033-041l_S2e_Rotatorenmanschette_2017-04_02.pdf
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