SHOULDER SURGERY

Decompression

In case of impingement there is too little space for the rotator cuff to move freely and this rotator cuff is trapped(impingement) under the acromion. So, we need to create more space.

This procedure is done via an arthroscopic technic with 2 or 3 small stitching holes. So there is more space available for the rotator cuff and the bursitis (inflamed tissue) is removed.



After the procedure the patient must use a sling for two days. After that we allow progressive mobilisations (shoulder rehabilitation).

Rotator cuff repair


The rotator cuff is the muscle group responsible for the smooth movements in the shoulder. A tear is treated best quickly because of the danger of retracing or retracting of the two ends of a tendon. The longer the wait, the more difficult the surgery and the necessary rehabilitation to follow, will be.

The actual surgery is done via the day hospital or including just one night in hospital. It is a so-called keyhole surgery or arthroscopy of the shoulder.

The torn ends of the tendon are being repaired. Afterwards you need a sling to protect the connections of the tendon.

The total rehabilitation takes around 3 or 4 Months.

In case of chronic or long-lasting tears, it is often impossible to make the right connections. If you are in a lot of pain or you cannot move your shoulder enough, you need a prothesis.


Shoulder stabilisation


If conservative treatments, like kinesitherapy, fitness and so on do not help then the shoulder will be stabilised through surgery.

In case of a classic anterior shoulder stabilisation the anterior ‘labrum’ of the shoulder pocket (glenoid) is torn. The vice versa happens with an inferior shoulder disbalance. You can compare the structure of the labrum with the meniscus disc of a knee. It is situated around the ‘glenoid’ and stabilises the shoulder ball beautifully in the pocket.

A lesion of this kind is also called “Bankart” lesion (see the illustration above).

The total rehabilitation of this Bankart lesion takes around 3 or 4 Months.

The stabilisation technic usually used is keyhole surgery (arthroscopy) (see the schedule on the left). Repetitive cases or quite outspoken cases require an ‘open’ entrance with an incision on the front (anterior) of the shoulder.

After the procedure of shoulder stabilisation, the shoulder needs support with a special shoulder dressing.



During the first six weeks it is absolutely prohibited to bring the shoulder into ‘exoration’ and abduction movements (see the illustration on the right). These types of movements can cause another dislocation.

Intense contact sports can be practised after 3 Months of rehabilitation. Even better wait until 6 Months!

Biceps tendon

(intra-articular)

The biceps muscle has two heads, the short head and the long head, distinguished according to their origin at the coracoid process and supraglenoid tubercle of the scapula, respectively. From its origin on the glenoid, the long head remains tendinous as it passes through the shoulder joint and through the intertubercular groove of the humerus. When one suffers from biceps pain, it usually concerns the long head and tendon. Treatment of this lesion is mainly conservative, if possible. However, when the results are low and there is a tear, surgery is needed.

Dependent on the quality of the tendon, the procedure is either a tenotomy or a tenodesis.

A tenotomy is a surgical act which involves the division of a tendon. It and related procedures are also referred to as tendon release, tendon lengthening, and heel-cord release. The connection of the tendon is cut , and the tendon shoots away into the upper arm. Now the tension is gone, and the patient will be free of pain. A disadvantage is an esthetical change in the upper arm. Instead of the normal muscle belly one sees an aberrant muscle belly. But the strength of the muscle is sufficiently compensated by the remaining muscle belly.

During biceps tenodesis surgery, the normal attachment of the biceps tendon in the shoulder joint is detached (if not completely torn already), and the tendon is reinserted to the bone of the humerus (arm bone). When the biceps tendon has ruptured completely, it is obviously not necessary to detach the tendon from within the shoulder. This tenodesis surgery is more often performed with younger patients.

Complete shoulder replacement

There are three main reasons to place a shoulder prothesis:


1. Arthrosis (omartrosis)

Omartrosis: Chronic degenerative rheumatism (arthrosis) located in the scapulohumeral joint.

If all other (conservative) treatments fail, then shoulder replacement surgery is an option.

Shoulder replacement surgery is an option for treatment of severe arthritis of the shoulder joint. Arthritis is a condition that affects the cartilage of the joints. As the cartilage lining wears away, the protective lining between the bones is lost. When this happens, painful bone-on-bone arthritis develops. Severe shoulder arthritis is quite painful and can cause restriction of motion. While this may be tolerated with some medications and lifestyle adjustments, there may come a time when surgical treatment is necessary.

After surgery the patient will stay in the hospital for around three days. Meanwhile the first rehabilitation exercises are practised.

No special dressings for the shoulder are required. The idea is to return soon to the using of shoulder and arm.

2. Uncurable fracture

In case of an incurable fracture the shoulder joint is completely damaged. It is impossible to reconstruct a normal joint. And so, the patient needs replacement surgery.

Depending of the situation and condition of the muscles around, one chooses a classical shoulder replacement or a reversed prosthesis. This last option is the best when the rotator cuff is not good enough to assure enough mobility.

3. Rotator cuff insufficiency

The rotator cuff is the muscle group responsible for the smooth movements in the shoulder. Without it, the shoulder cannot function properly.

The development of safer, more effective techniques has led the to the increased use of reverse total shoulder arthroplasty. Reverse total shoulder arthroplasties are typically indicated when the rotator cuff muscles are severely damaged. There are a few major approaches for reverse total shoulder arthroplasties. The first is the deltopectoral approach. This approach saves the deltoid but requires the supraspinatus to be cut. The second is the trans deltoid approach, which provides a straight on approach at the glenoid. Both techniques are used.

After your surgery you can expect to be able to wash and get dressed by yourself again, comb your hair and so on. However, to perform intensive sports involving your shoulders ( like tennis) is less probable.