SHOULDER

The best expertise in Orthopaedic & Arthritis care

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MS (ORTHO), DNB (ORTHO), FRCS (GLAS), FRCS (TR & ORTH)
FELLOWSHIP IN SHOULDER AND UPPER LIMB SURGERY, UK
FELLOWSHIP IN TRAUMA AND JOINT RECONSTRUCTION, TORONTO, CANADA

Shoulder

Meet your shoulder specialist

Dr. Jayateerth Kulkarni

INTRODUCTION

The shoulder is an important joint in the body. It helps in positioning the upper limb for performing manual tasks. It is the most mobile joint of the body. The mechanical forces acting on the shoulder can be very high during heavy manual activities and during sports. These can result in various disorders.

Shoulder problems are quite common and cause a lot of disability. Unfortunately, in elderly patients, many conditions like frozen shoulder, rotator cuff degeneration, and arthritis are not treated properly due to lack of awareness and the tendency to attribute these to ‘ageing’. Young patients suffer from different conditions: instability (recurrent dislocation), rotator cuff tears and glenoid labral tears. Traumatic injuries occur at all ages and need specialised treatment. Shoulder surgery has now become established as a sub-speciality in orthopaedics.

SHOULDER INSTABILITY – RECURRENT DISLOCATION

Shoulder dislocation is a traumatic condition in which the head of the humerus (arm bone) comes out of its articulation with the socket (glenoid). This can occur as a result of sports injury, road traffic accident or violent muscle contraction (epileptic fit or electric shock). There is damage to the stabilising soft tissues – glenoid labrum, capsule and ligaments. Sometimes there is associated bony injury as well. First-time dislocation is treated by relocating the arm bone (closed reduction) and immobilising the shoulder for three weeks to allow the damaged tissues to heal. In a significant proportion of patients the damaged structures do not heal. This leads to repeated dislocations of the shoulder. This condition is called recurrent dislocation of shoulder or shoulder instability. It requires repair of the damaged structures by arthroscopic surgery. This is very successful in restoring stability to the joint and recovery of function at the shoulder.

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ROTATOR CUFF TEARS

The shoulder joint is controlled by two sets of muscles. Large extrinsic muscles arise from the shoulder girdle or the trunk. These provide strength to arm during various activities. Smaller muscles, called intrinsic muscles, span the articulation between the shoulder blade and the humerus. These are important in stabilising the humeral head against the glenoid; and enabling and fine-tuning the actions of the extrinsic muscles. The tendons of these muscles fuse to form a continuous layer called the rotator cuff that inserts around the humeral head.

The rotator cuff is subjected to high stresses during heavy activities. In addition it is liable to be pinched by the bony and ligamentous arch (formed by the collarbone and acromial process of the scapula) which overlies these muscles. This is called impingement. Due to these factors the tendons undergo degeneration and get torn. The tendons can also be damaged by injury.

Damage to the rotator cuff results in pain and loss of function. Pain is initially mild and felt during heavy activities or over-head actions. With progressive damage pain becomes severe, continuous and disabling. Some patients get severe pain at night. Functional disability can range from mild weakness to complete inability to lift the arm and do any work with the arm.

Partial tears with little pain and good function are treated by physiotherapy, exercises and painkillers. Persistent pain and moderate to severe weakness is treated by rotator cuff repair and decompression of the impingement. Severe degeneration and weakness of the cuff needs a reverse shoulder replacement. Surgical treatment is very successful in relieving pain and improving function of the shoulder.

ADHESIVE CAPSULITIS – FROZEN SHOULDER

This is a poorly-understood condition in which there is inflammation and shortening (contracture) of the capsule and ligaments of the shoulder. This causes pain, stiffness and disability. The condition can be mild with minimal pain and impairment; or severe with continuous pain, complete stiffness and extreme disability. Mild cases resolve on their own; or with physiotherapy and exercises (along with painkillers). However, some cases are so bad that nothing helps them. These patients need arthroscopic release of the capsule and ligaments. This gives very good relief of pain and restores function to the shoulder.

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ARTHRITIS OF THE SHOULDER

This refers to wearing away of the cartilage at the ball and socket joint of the shoulder. This can be caused by inflammatory process (like rheumatoid arthritis), age-related wear (osteoarthritis) or damage due to injury (post-traumatic arthritis). Severe degree of arthritis (end-stage disease) results in pain, stiffness and extreme disability. The treatment of end-stage arthritis is by shoulder joint replacement. Various types of replacement are being done. The choice will depend on the patient’s condition, the status of the rotator cuff and surgeon’s preference. Pain relief is excellent. Functional improvement is also very good following replacement surgery.

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