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SHOULDER

The shoulder is a very mobile joint that actually has the greatest range of motion of any joint in the body. However, this large range of motion can lead to joint problems and as it makes it particularly exposed to the risk of injury. In addition to the acute injury, problems can develop gradually, often due to activities that require repetitive joint movements.

The shoulder is made up of three bones: the scapula (shoulder blade), the humerus (upper arm bone), and the clavicle (collarbone). The roof of the shoulder, which is formed by a part of the scapula, it is called acromion. A part of the scapula, called the glenoid, forms the socket of the shoulder and the humeral head forms the spheroid portion of the joint. Both the glenoid and the humeral head are covered with articular cartilage, a tissue that covers the ends of the bones of any joint. The tendons and the muscles of the rotator cuff keep the joint stable. This group of muscles lies just outside the shoulder joint, help raise the arm from the side and rotate the shoulder in the many directions and they are involved in many daily activities.

Diagnostic examination and medical history

To diagnose your shoulder pathology, a thorough orthopedic evaluation would be performed, which may include medical history, physical examination and diagnostic tests. Data regarding the onset and duration of symptoms, any previous treatments and the presence of any disease family are helpful and along with a thorough physical examination of pain characteristics, limitation of movement and the possible lack of muscle strength, the cause of the shoulder problem could be determined.  Further test might be needed such as a radiographic control with X-rays that provides an overview of the bone and can show fractures, dislocations and arthritis, a bone scan or CT arthrography, which helps to identify the soft tissue lacerations, or an MRI (Magnetic Resonance Imaging) that clearly displays all the tissues.

Arthroscopy: look inside the joint

The use of arthroscopy has developed many different types of orthopedic surgery. During a shoulder arthroscopy, a small video camera is inserted into the joint to allow seeing and operate without making large incisions. It is also used as a diagnostic tool. The fact that the incisions are so small it makes the post-operative period less painful than open interventions. A fluid is injected into the joint to expand and ensure a clear field of view that is a space within which to work.

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Pathologies

Many shoulder pathologies have been identified and treated successfully either conservatively or with the use of arthroscope. The use of growth factor injections (platelet-rich plasma) has been proven capable in reducing symptoms and inflammation in many shoulder pathologies. A comprehensive rehabilitation program is essential both after conservative and surgical treatment of shoulder pathologies.

Subacromial Impingement Syndrome

Impingement syndrome occurs when the rotator cuff tendons rub against the roof of the shoulder (the acromion)and the Subacromial bursa or the tendon gets inflamed and swollen (bursitis or tendonitis) and create conflict with the acromion. Arthroscopic surgery helps to increase the space within the joint by removing the torn and degenerative tissue, any bone spurs that are rubbing on the tendons of the shoulder and smooth the under surface of the acromion.

Rotator Cuff tear

Subacromial Impingement causes gradual wear and tear of the tendons of the rotator cuff that can break due to a stress or repetitive movements. In this case, a persistent sharp pain appears and it becomes difficult or impossible to raise the arm above the head. Evaluation and treatment of the torn tendons using small screws or anchors can be performed arthroscopically with very good results. In severe chronic cases when the tendons are retracted, a repair is difficult to be achieved and a Subacromial decompression might provide symptom relief.

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Shoulder Instability – Labral tears

The labrum is a rim of soft tissue that increases the depth of the glenoid surface of the shoulder joint, which is normally shallow and flat. A shoulder dislocation or instability of the might cause tearing of the glenoid labrum. When the shoulder is forced beyond its natural limits movement of the humeral head comes out of the joint cavity. The labrum and the capsule tend to detach from the glenoid and thus cause instability. The head that crosses the rim causes pain and snap of the joint. MRI control confirms the pathology which can be treated arthroscopically by reinserting of the capsule on the glenoid and thus restoring shoulder’s stabilization.

Osteoarthritis

Several diseases, injuries or infections can cause arthritis or wear and deformity of the shoulder, due to the aging of the cartilage and release of osteocartilagineous fragments (loose bodies). The acromioclavicular joint in the shoulder is a common place for development of osteoarthritis in middle age. Arthroscopic debridement (“clean up”) of the joint might be helpful, when conservative treatment and growth factors injections do not provide symptom relief.

A comprehensive rehabilitation program is essential both after conservative and surgical treatment of shoulder pathologies.

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