Shoulder Pain & Role of Arthroscopy

The shoulder is a very flexible Ball a Socket joint that is made up of several tendons, ligaments, and muscles that all work together for the normal functioning of a joint. Shoulder pain can result from injuries, general wear and tear, and a number of inflammatory conditions. Several factors and conditions can contribute to shoulder pain. The most prevalent cause is Rotator Cuff Tendinitis. This is a condition characterized by swollen tendons around the shoulder joint.

Another important cause of shoulder pain is Frozen Shoulder (Adhesive Capsulitis). It is the result of inflammation, scarring, thickening, and shrinkage of the capsule that surrounds the normal shoulder joint. It occurs more frequently in patients with risk factors of diabetes and chronic inflammatory arthritis of the shoulder joint.

Signs and Symptoms of a Frozen Shoulder:

• It includes shoulder pain, stiffness, and loss of range of shoulder motion. These symptoms can make sleep very uncomfortable.

Treatment for a Frozen Shoulder:

• Most people with frozen shoulder improve with relatively simple treatments to control pain and restore motion.
• Non-steroidal anti-inflammatory medicines like Aspirin and Ibuprofen reduces pain and swelling.
• Steroid injections (Cortisone is a powerful anti-inflammatory medicine that is injected directly into your shoulder joint).
• Physical therapy – Specific exercises will help restore the shoulder motion.

Is it possible to prevent a Frozen Shoulder?

• Prevention of a frozen shoulder involves avoiding injury or re-injury to the shoulder.

Sometimes shoulder pain can be the result of an injury to other locations in your body, usually the neck or biceps tendon. This is known as referred pain. Referred pain generally doesn’t get worse when you move your shoulder.

Other causes of Shoulder Pain include:

• Arthritis — Age related or Traumatic
• Torn cartilage
• Torn rotator cuff
• Swollen bursa sacs or tendons
• Bone spurs (bony projections that develop along the edges of bones)
• Pinched nerve in the neck or shoulder
• Bicep tendinopathy
• Impingement syndrome (tendons get caught between the acromion and humeral head)
• Dislocated shoulder
• Injury due to overuse or repetitive use

Diagnosis of Shoulder Problems:

Mechanical problems of the shoulder are common. Such problems are often revealed by the answers to some simple questions:

• Is the shoulder stiff: can the arm be put in all normal positions?
• Is the shoulder unstable: does it feel like: going to pop out or slide out of the socket?
• Is the shoulder weak: does it have the strength to carry out desired activities?
• Is the shoulder rough: does it catch and grind with use?

Treatment:

Primary care is usually conservative: Reduce or avoid overhead activities; attention to any contributing factors; medication for pain relief, including corticosteroid injection. If symptoms don’t settle quickly or are severe initially, physiotherapy focused on the specific cause is indicated. Gently stretching and exercising the shoulder can also help people get back to their everyday activities as quickly as possible following an injury.

Arthroscopy:

Arthroscopy is a keyhole surgery that allows treating a broader variety of shoulder diseases. It uses a tiny camera called an Arthroscope to examine or repair the tissues inside or around your shoulder joint. The Arthroscope is inserted through a small cut (incision) in your skin.

When is Shoulder Arthroscopy Recommended?

We recommend shoulder arthroscopy if you have a painful condition that does not respond to nonsurgical. Treatment. Shoulder arthroscopy may relieve painful symptoms of many problems that damage the rotator cuff tendons, labrum, articular cartilage, and other soft tissues surrounding the joint.

How long a Shoulder Arthroscopy Surgery will take?

Most arthroscopic procedures take less than an hour; however, the length of this surgery will depend on what we surgeons find and what repairs are required.

Role of Arthroscopy in Frozen Shoulder:

Sometimes a frozen shoulder is resistant to conservative treatment. Patients with resistant frozen shoulders can be considered for shoulder arthroscopy. It involves the release of the scar tissue of the joint capsule. This is done using pencil-sized instruments inserted through small incisions around your shoulder.

Common Arthroscopic Procedures in Shoulder:

• Rotator cuff repair
• Bankart Repair
• Biceps tendon pathology
• Repair of labral tears
• Acromioplasty and distal clavicle resection
• Adhesive capsulitis (Frozen Shoulder) release
• Release of the suprascapular nerve

Rehabilitation:

An exercise program will help you regain shoulder strength and motion. We surgeons develop a rehabilitation plan based on the surgical procedures we performed.

Complications:

Most patients do not experience complications from shoulder arthroscopy. As with any surgery, however, there are some risks. These are usually minor and treatable. Potential problems with arthroscopy may include infection, excessive bleeding, blood clots, and damage to blood vessels or nerves.

Dr Romit A. Agrawal, Consultant Arthroscopy, Joint Replacement & Shoulder Surgeon at Shalby Hospitals, Indore.