Shoulder

The shoulder joint is responsible for the greatest range of motion of all human joints. It is a spherical joint and therefore it is particularly vulnerable to injuries that arise during everyday activities, such as washing windows or working in the garden, or during physical activity (e.g., swimming, tennis, gym).

Shoulder pain is very common and can happen to anyone, regardless of age. They can be the result of overload, injuries, incorrect body posture, as well as degenerative changes, especially after the age of 60.

Shoulder pain can be acute or chronic. The former appears suddenly and is associated with the build-up of swelling after the injury. It can also be caused by rapid inflammation (e.g., in a gout attack). In this situation, urgent medical assistance and an appointment at the orthopedic emergency room are required.

Most often, however, shoulder pain is chronic and worsens periodically. At the same time, other ailments may appear, such as difficulty falling asleep on one side, a feeling of stiffness, tingling, as well as limited mobility of the entire joint, which prevents normal movement of the entire upper limb.

Shoulder diagnostics

The diagnosis of the shoulder joint begins with a medical examination. During the consultation, the orthopedist conducts an interview and palpation in a standing and sitting position. The orthopedist examines the range of motion and its final resistance, as well as stability. He also performs functional tests of the shoulder joint, which initially indicate the type of disease or injury. The most popular tests are the Jobe Test and the Neer Test.

The doctor may order imaging tests to confirm or detect other pathologies. In the case of the shoulder, it is usually an ultrasound. Thanks to ultrasound examinations, the doctor can see the image of the muscles, tendons of the rotator cuff, and the amount of synovial fluid. The orthopedic surgeon may order a shoulder X-ray or computed tomography to assess the condition of the bones. If all three of the above-mentioned tests do not answer the question about the cause of the symptoms reported by the patient, an MRI scan is performed. Thanks to them, the doctor can see both soft tissues and bones.

Shoulder Treatment Methods

The shoulder joint can be treated conservatively, by means of pharmacological treatment or appropriate rehabilitation methods. Sometimes regenerative medicine, is also helpful, helping to heal the damaged joint.

In most cases where there is more serious and more extensive shoulder injury, surgery may be the only option.

In the case of indications for surgical treatment, at the Carolina Medical Center, we use a wide range of arthroscopic procedures, allowing for a thorough assessment of damaged soft tissues, repair of damage or removal of damaged joint elements or degenerative changes. The undoubted advantage of shoulder arthroscopy is that it is a minimally invasive procedure, which means that only small scars remain afterwards. The recovery time is much shorter than in the case of classic, more invasive surgeries, which makes it easier to return to everyday life.

In the case of degenerative disease of the shoulder joint, we perform arthroplasty in patients for whom conservative treatment has not increased the range of shoulder mobility and has not reduced pain. It consists in replacing the “worn” parts of the joint with implants. This method allows you to return to normal life, and in most cases also to return to sports activities. At the Carolina Medical Center, we also use individual devices for the implantation of prostheses printed in 3D technology.

Shoulder rehabilitation

The basis of conservative treatment and a necessary supplement to surgical treatment is shoulder rehabilitation, which gives a chance for a quick recovery and return to activity. It improves the mobility and stabilization of the shoulder joint and has a positive effect on muscle strength. Each patient is examined by a physiotherapist in order to plan an individual treatment process adapted to the disease process and the patient’s expectations.

Treatment methods: Shoulder

1. Arthroscopy and bursoscopy of the shoulder joint
2. Shoulder arthroscopy – during this treatment, various procedures are performed, including:
   • long head tenodesis of the biceps,
   • stabilization of the shoulder-clavicular joint – old,
   • stabilization of the shoulder-clavicular joint – fresh,
   • fixation of the fracture of the acetabulum of the scapula and other parts of the scapula – open treatment,
   • subscapular muscle reconstruction – partial damage, biceps tenodesis, biceps tenotomy,
   • reconstruction of the rotator cuff,
   • suprascapular nerve release simultaneous stabilization of the joint and rotator cuff reconstruction.
3. Decompression of subacromial tightness
4. Shoulder dislocation repositioning – open treatment
5. Prosthetic arthroplasty (half, full)
6. Pectoralis major reinsertion – CITO or old
7. Open rotator cuff reconstruction or with tendon transfer
8. Shoulder stabilization – open or arthroscopically
9. Collarbone pseudarthrosis
10. Pseudarthrosis of the body of the humerus
11. Pseudarthrosis of the forearm bone
12. Excision of the shoulder end of the clavicle openly or arthroscopically
13. Fixing the fracture of the humeral head to the plate – simple or complex
14. Fixation of the fracture of the greater tubercle / epiphysiolysis of the humerus with screws – percutaneous or open
15. Fixation of the clavicle fracture with a plate / TEN intramedullary fixation
16. Fixation of the fracture of the acetabulum of the scapula and other parts of the scapula – open treatment
17. Fixation of the fracture of the humerus body to a plate or nail / TEN intramedullary

Injuries and ailments: SHOULDER

• Degenerative disease (osteoarthritis) of the shoulder joint
• Frozen shoulder
• Rotator cuff tear
• Shoulder Impingement Syndrome
• Calcific tendinitis of the rotator cuff
• Bicep injury
• Shoulder dislocation and instability
• Dislocation of the shoulder-clavicular joint
• Clavicle fracture
• Fracture of the humerus