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SHOULDER SURGERY

Problems with shoulder joint, such as instability, rotator cuff tear, or degenerative disease are my main area of interest. Below you will find some information regarding most common pathologies, and their visual presentation.

To find out what kind of rehabilitation protocols should follow each of the below surgical procedures, please go to rehabilitation.

Shoulder joint instability

Post traumatic instability is a condition occurring most often in young, physically active patients. It is usually anterior dislocation, and in surgical treatment labrum of the shoulder and labrum ligaments are reconstructed, using  Bankart or BLS techniques.

Patients, whose shoulders get dislocated with no particular reason or trauma history, will find more information in rehabilitation.

For patients suffering from recurrent instability with posterolateral humeral head fracture (Hill-Sachs lesion), additional stabilization which alters kinematics of the shoulder (glonohumeral) joint  is recommended -remplissage.

In more complex cases when together with instability a larger bone loss is observed (>20%), I use Latarjet technique or bone block to recreate normal translation in the glenohumeral joint - Latarjet or bone block technique.

Shoulder impingement syndrome

Narrowing of sub-acromial space causes pain, restricted abduction, and may lead to rotator cuff tear. For shoulder impingement syndrome recommended treatment is acromioplasty.

Rotator cuff tear

Rotator cuff is a group of 4 muscles that cover humeral head and allow movements of the shoulder.

Rotator cuff tears usually occur in patients over the age of 40. It causes pain, also nocturnal pain, weakness, and restricted range of motions of the upper limb. For rotator cuff tear recommended treatment is arthroscopic reconstruction of injured muscles.

In the most commonly occurring injuries to the supraspinatus muscle tendon (SST), patients will notice restrictions in upper limb abduction – activities such as combing or performing manual tasks above head will cause problems.

When the subscapularis muscle tendon (SSC) is injured, restriction in upper limb internal rotation is observed, which means problems with reaching to the back pocket, or clasping the bra.

Irreparable rotator cuff tears

Extensive and old muscle damage with substantial retraction and steatosis (fatty deposits replacing muscle fibers in a muscle), make it impossible for the surgeon to recreate them anatomically.

In such cases I use different techniques to restore the movement:

- arthroscopic reconstruction of the superior capsule (SCR)

- implants in the subacromial space – balloons

- reversed alloplasty

Long head biceps patologies

While in majority of shoulders with rotator cuff tear a long head biceps (LHB) pathology can be found, it may also occur as an isolated problem.

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Injury to the insertion of LHB to the superior glenoid labrum of the shoulder is called SLAP lesion.

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Instability of the LHB tendon in the bicipital groove causes pain and a clunk when the arm is turned inward or outward.

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Different procedures can be employed in LHB treatment: reconstruction of the insertion, LHB tenodesis (fixing it to the humerus below the original insertion point), or tenotomy (cutting the tendon), which may result in an aesthetic complication – so called Popeye deformity.

Posttraumatic acromioclavicular joint instability / clavicle dislocation

Instability of acromioclavicular joint occurs mainly in physically active adults, often cyclists. Traumatic rupture of coracoacromial ligament may lead to the acromioclavicular joint sprain, and as a consequence the patient can feel the distal part of the clavicle spring when pushed, in a so called “piano key sign”. Such sprains are fixed in an arthroscopic surgery, where the torn ligament is reconstructed. In cases of old injuries – I use patients own ligaments harvested from other parts of the body to achieve extra stabilization.

Acromioclavicular joint degeneration

Pain localized in the area of the distal end of the collarbone may be related to degenerative changes in the AC joint. If non-surgical treatment is ineffective, the joint may be resected in an arthroscopic surgery.

Collarbone fractures

This type of injury is common among cyclists and skiers, and it heals well under conservative treatment. However, with substantial shortening and dislocation of the bone fragments, surgical treatment should be considered.

Shoulder joint degenerative disease

Degenerative changes in shoulder joint occur rarely, as the joint hangs freely. It may however be observed in older patients, or be secondary to previous significant joint trauma. Depending on condition of rotator cuff muscles and the character of the pathology I use different techniques of replacing damaged joint surfaces:

- hemiarthroplasty,

- total  shoulder arthroplasty (TSA)

- reverse shoulder arthroplasty (RSA)

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