This is a technique which involves key hole surgery to correct certain pathologic conditions in the shoulder.
These conditions are
like bankart repair, latarjet procedure and remplissage techniques are used for correction of dislocation of shoulder which occurs in mostly in atheletes but also in the non athletic population .
Rotator cuff is a tendinous cuff of tissue which helps lifting and rotating the arm. These can we ruptured as part of degeneration or due to a fall. Cuff repair surgery is done arthroscopically , through portals or key holes around the shoulder joint. Patient requires rehab of atleast 3 months and usually returns to full active movements of the shoulder.
Pathologies in the joint could be dislocations and painful arthritis.
1. AC joint Dislocations can be corrected by keyhole surgery used to reconstruct the coracoclavicular ligament.
2. Ac joint arthritis- is treated with injection into the joint .Painful arthritis which doesn’t respond to injections might require bone resection (mumford procedure).
Is a self limiting condition charecterised pain and restricted motion of the shoulder joint. It is initially managed conservatively, but in resistant cases may require release of the contracted capsule. Patients recover after rehab for a month after surgery.
Ac joint is a small joint formed by collar bone and the scapula(shoulder blade). It is very important for stabilising the shoulder . the stability comes from the ligaments and the capsule around the joint.
This is a condition where the biceps tendon is injured at its attachment. Usually occurs due to overhead activities or throwing. Initial treatment can be with anti-inflammatory medication , if no response and when the slap lesion doesn’t heal it may require shoulder arthroscopic surgery.
Can be a major cause of pain in the shoulder . impingement is caused by friction bet ween 2 moving structures in the joint.
Is of 2 types
I. External – caused by friction in the sub acromial space usually between the bone and the rotator cuff or the bony projections in the CA ligament and the rotator cuff. Patient presents with pain in the shoulder while abducting in a painful arc.
II. Internal- is caused by friction between the labrum and the cuff, Usually in throwers.
Treatment is to reduce the inflammation, strengthening and surgical sub acromial decompression.
Inflamed biceps tendon can result in pain in the front of the shoulder. May also result in biceps rupture. Inflammation subsides with anti inflammatory medication or steroid injections into the tendon sheath.
Usually happens near the shoulder joint. Patients present with a “popeye” sign( swelling in arm).treatment would be tenodesis – meaning fixation of tendon surgically some times to new position.
This rare compared to the knee joint . in the early stages the causative factors can be removed arthroscopic debridement with Visco supplementation can be helpful. The later stages may require shoulder resurfacing surgery or total shoulder replacement.
SHOULDER REPLACEMENT OR ARTHROPLASTY
Replacement involves replacing the smooth articulating surface of the joint. Usually done when this smooth surface is eroded off.
Hemiarthroplasty- is a procedure where one part of the joint is replaced. Usually for fractures which cannot be reconstructed.
Total shoulder arthroplasty- here the entire articulating surface is replaced by prosthetic components. Done for arthritis of the shoulder – like osteoarthritis, rheumatoid arthritis, posttraumatic arthritis or avascular necrosis of shoulder.
Reverse shoulder arthroplasty
This is a technique done when rotator cuff is insufficient and cannot be reconstructed/ repaired.
Here the joint position of the ball and socket is reversed with prosthetic components .
Injections in and around the shoulder joint are used for diagnosis ( to find out the pathology) or for therapeutic for the treatment . it is usually the second line of management for treating various pathologies like , sub acromial bursitis, biceps tendinitis, impingement and frozen shoulder.
Most commonly given therapeutic injection are PRP or steroid injections.