Shoulder Joint
For
the treatment of the shoulder joint immense progress has been
achieved over the last years. This is mainly due to the introduction
of minimal invasive surgery. The development of precise instruments,
new resorbable suture material and fixation systems were essential.
Through tiny little skin incisions the shoulder joint can be operated
on by avoiding major surgical trauma similar to the knee or elbow
joint. By the help of a thin lens, which is connected to a chip
camera and a monitor, the inner space of the joint can be completely
inspected. Painful shoulders, limited range of movement, shoulder
instabilities, calcification or small tears of the rotator cuff
can be treated very effectively with these techniques. Postoperative
pain is low and functional treatment can be started at the very
first day. Scars are barely visible. Most interventions can be
made on an outpatient basis or as daycases. Endoscopic minimal
invasive surgery is very demanding and needs a lot of skill and
experience of the surgeon. A modern sophisticated instrumentation
is very important.
The free range of motion of the whole arm is mainly related
to the great mobility of the shoulder joint with its large
humeral head and the relatively small glenoid. The shoulder
joint has the greatest range of movement of all joints of
the human body. Since the congruence between humeral head
and the cavity of the glenoid is minimal, a complicated
system of ligaments and tendons, labrum and joint capsule
is necessary for the stabilization of the joint. The dislocation
of the humeral head, which is a very common injury, is always
associated with injuries to these structures and may lead
to chronic instability and recurrent dislocation of the
shoulder joint.
A group of muscles, the so-called
rotator cuff, is separating the shoulder joint from a gliding
area (subacromial space) below the “roof” of the
shoulder, the acromion. The rotator cuff is very important
for the centering of the humeral head and for elevation
and rotation of the arm. There is a bursa between the acromion
and the rotator cuff which facilitates the gliding of the
cuff. Tears of the rotator cuff, degeneration of their tendons,
bony appositions at the acromion, osteoarthritis of the
articular connection between clavicula and acromion (acromio-clavicular
joint) or calcified deposits in the rotator cuff often are
causing a painful inflammation of the subacromial bursa.
The patients history, a thorough clinical examination and
x-rays as well as ultrasound and/or MRI will lead to a precise
diagnosis.
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