Shoulder Arthroscopy

Rotator cuff tear

Tendons are cord-like bands that connect the muscle to the bone. Rotator cuff is a group of 4 muscles and tendons that surround the shoulder joint and keep the head of the humerus (upper arm bone) in the shoulder socket.

Rotator cuff tear refers to the partial or complete rupture in one or many of the rotator cuff muscle group (Supraspinatus, Infraspinatus, Subscapularis, Teres Minor) The tear can occur suddenly (acute tear) or can develop over a long period of time (chronic tear). Acute tears may be caused by:

• A fall, especially on an outstretched arm.
• Lifting very heavy objects with a jerking motion.

Chronic tears may be caused by overuse of the muscles. This may happen in sports, physical work, or activities in which your arm repeatedly moves over your head. Symptoms of this condition depend on the type and severity of the injury:

• An acute tear may include a sudden tearing feeling, followed by severe pain that goes from your upper shoulder, down your arm, and toward your elbow.
• A chronic tear includes a gradual weakness and decreased shoulder motion as the pain gets worse. The pain is usually worse at night.
• This condition is diagnosed with your medical history and physical examination. Imaging tests may also be done, including: X-rays and MRI.

Treatment for this condition depends on the type and severity of the condition. In less severe cases, treatment may include:

• Rest with a sling immobilisation, Activity restriction, Icing the shoulder, Anti-inflammatory medicines.
• In more severe cases and if the pain does not improve with non-surgical methods, surgery is required.

Shoulder instability

Shoulder dislocation occurs when the head of the upper arm bone is forced out of the shoulder socket. This typically happens as a result of a sudden injury, such as a fall or accident. Once a shoulder has dislocated, it is vulnerable to repeat episodes. When the shoulder is loose and slips out of place repeatedly, it is called as Recurrent shoulder dislocation or instability.

Instability results from the tear in the rim of cartilage (labrum) around the edge of the shoulder socket (glenoid). In some cases, bone loss happens at the ball (humeral head) and/or the socket (glenoid)

Common symptoms are:

• Repeated instances of the shoulder giving out, A persistent sensation of the shoulder feeling loose, slipping in and out of the joint, Pain in the shoulder. Diagnosis is arrived by physical examination. X ray, MRI with or without CT scan is used to assess the tear in the labrum and bony defects resulting from repeated episodes of dislocation.
• First time shoulder dislocation is often first treated with nonsurgical options.
• Recurrent shoulder instability always need surgical treatment.

Frozen shoulder

Frozen shoulder, also called adhesive capsulitis, causes pain and stiffness in the shoulder. Over time, the shoulder becomes very hard to move.

Frozen shoulder most commonly affects people between the ages of 40 and 60, and occurs in women more often than men. In addition, people with diabetes are at an increased risk for developing frozen shoulder. Normal shoulder joint is capable of moving in all directions. Adhesive capsulitis is when you lose the ability to move your shoulder around in all directions. The shoulder capsule thickens and becomes stiff and tight.

Frozen shoulder generally gets better over time, although it may take few months. The focus of treatment is to control pain and restore motion and strength through physical therapy. Pain medications helps to reduce the pain and relax the muscles. Using a heating pad or ice pack may help to reduce the pain.

Surgical Treatment

If your symptoms are not relieved by therapy and other conservative methods, surgical treatment might be recommended.

Shoulder Impingement

Shoulder joint pain commonly results from the following:

• Tendinitis: The rotator cuff tendons can be irritated or damaged.
• Bursitis: The bursa can become inflamed and swell with more fluid causing pain.
• Impingement: When you raise your arm above the shoulder level, the space between the acromion and rotator cuff narrows. The acromion can rub against (or impinge on) the tendon and the bursa, causing irritation and pain.

Those who do repetitive lifting or overhead activities using the arm are prone to develop this condition.

The symptoms include:

• Pain at night
• Loss of strength and motion
• Difficulty doing activities that place the arm behind the back, such as buttoning or zipping clothing.

The diagnosis is arrived through physical examination, x rays and MRI. In most cases, initial treatment is nonsurgical. Many patients experience a gradual improvement and return to function. When nonsurgical treatment does not relieve pain, surgery is recommended.

AC Joint disruption

• The AC joint is where the collarbone (clavicle) meets the highest point of the shoulder blade (acromion). When this joint gets disrupted, collar bone separates from the shoulder blade, creating a bump on the top the shoulder.
• The most common cause for a separation of the AC joint is from a fall directly onto the shoulder. The injury is easy to identify when it causes deformity.
• When there is less deformity, the location of pain and X-rays help to make the diagnosis.
• Nonsurgical treatments, such as a sling and medications can effectively help manage the pain in almost all patients. Most people with this injury return to normal function with nonsurgical treatments.
• Surgery can be considered if pain persists or the deformity is severe.

Biceps tendonitis

Biceps tendonitis is the inflammation in the tendon that attaches the top of the biceps muscle to the shoulder. The most common cause is overuse from certain types of work or sports activities. It can also happen suddenly from a direct injury.

Patients generally report the feeling of a deep ache directly in the front and top of the shoulder. The ache may spread down into the main part of the biceps muscle. Pain is usually made worse with overhead activities.

Treatment typically involves a period of rest and avoidance of activities that aggravate the pain. Most patients recover with medicines and physiotherapy. Some injuries require surgery for treatment.

SLAP tears

A SLAP lesion (superior labrum, anterior [front] to posterior [back]) is a tear of the labrum (a rim of cartilage) that occurs on the upper part of the shoulder joint socket (glenoid) It may also involve the origin, or starting point, of the long head of the biceps tendon. Injuries to the tissue rim surrounding the shoulder socket can occur from acute injury like fall or repetitive shoulder overuse.

Symptoms of this condition include: Pain, usually with overhead activities. Occasional night pains, Locking or popping sensation, Decreased range of motion, Loss of strength MRI scan of the shoulder is required to diagnose this condition. In many cases, nonsurgical methods are effective in relieving symptoms and healing the injured structures. If these nonsurgical measures are insufficient, or if the symptoms return, Surgery is recommended.

Arthroscopic Rotator Cuff Repair

The rotator cuff is a large tendon comprised of four muscles which combine to form a "cuff" over the upper end of the arm, the head of the humerus. The rotator cuff helps to lift and rotate the arm and to stabilize the ball of the shoulder within the joint.

A rotator cuff tear may result from an acute injury such as a fall or may be caused by chronic wear and tear with degeneration of the tendon.

Surgery is recommended if you have persistent pain or weakness in your shoulder that does not improve with nonsurgical treatment.

Surgery to repair a torn rotator cuff involves re-attaching the tendon to the head of humerus (upper arm bone) using specialized suture anchors. Advances in surgical techniques for rotator cuff repair include less invasive procedures. Surgery is done through small incisions and using Arthroscope and small specialized instruments.

Arthroscopic rotator cuff repair causes minimal trauma to the tissues that surround the shoulder and the rotator cuff. Because of this, patients have smaller scars and less damage to nearby structures than open surgery.

Arthroscopic Shoulder Stabilization

Shoulder Instability results from the tear in the rim of cartilage (labrum) around the edge of the shoulder socket (glenoid). In some cases, bone loss happens at the ball (humeral head) and/or the socket (glenoid)

Recurrent shoulder dislocation almost always needs to be treated with surgery.

Types of surgery for shoulder Instability:

• Arthroscopic Bankart repair – This refers to stitching of the torn labrum tissues back to the glenoid socket via key hole procedure. This is recommended in the cases with minimal or no bone loss.
• Remplissage procedure – This refers to the filling of the bone defect in the ball (humeral head)
• Latarjet procedure – This is recommended for the recurrent shoulder instability with significant bone loss. The procedure involves transferring a small piece of bone called the coracoid process along with its muscle attachments to the socket of the shoulder joint. This compensates for the bone loss and also provide a soft tissue support.

Arthroscopic Shoulder decompression

Arthroscopic decompression is a procedure used to treat shoulder pain due to shoulder impingement syndrome, when this condition has not been relieved with medicines and physiotherapy. In this procedure, the inflamed bursa or bone spur in the shoulder is removed, or shaved away through key-hole incisions using specialized instruments.

This creates more space for the rotator cuff tendons and allows smooth gliding of the rotator cuff under the acromion bone, and enables pain free overhead movements of the shoulder.

AC Joint Reconstruction

Surgery is recommended when the AC joint disruption results in persisting pain or severe deformity.

In this procedure, the AC joint is “reduced” into its normal anatomic position. This can be held with a variety of methods, some requiring metal implants and others require special suture tapes with buttons. The ligaments connecting the collar bone (clavicle) and the shoulder blade (acromion) are reconstructed using the tendon graft harvested from elsewhere in the body.

Biceps Tenodesis

Biceps tenodesis treats biceps tendon tears caused by injury or overuse. The procedure also treats SLAP tears (superior labrum tears of the socket) extending into the biceps tendon.

Biceps tendon is located at the top of the biceps muscle. It’s connected to the upper portion of the labrum (rim of cartilage that lines the shoulder socket)

In the biceps tenodesis procedure, the torn biceps tendon is released from your labrum and it is relocated to your upper arm bone (humerus) using a special tenodesis anchoring devices through mini-open technique and Arthroscopy.

Frozen shoulder surgery

Frozen shoulder, also called adhesive capsulitis, causes pain and stiffness in the shoulder. Over time, the shoulder becomes very hard to move.

If your symptoms are not relieved by therapy and other conservative methods, surgical treatment might be recommended.

Manipulation under anaesthesia - During this procedure, your shoulder is made to move after putting you to sleep. This causes the capsule and scar tissue to stretch or tear. This releases the tightening and increases range of motion.

Shoulder arthroscopy. In this procedure, tight portions of the joint capsule are released through arthroscopy. This is done using pencil-sized instruments inserted through small incisions around your shoulder. Tight capsular tissues are released using special radio-frequency probe.