Shoulder surgery

The shoulder is a complex construction, which is composed of the most diverse of components and which can be affected by a wide range of differing injuries and diseases. Often, shoulder pain is not caused by a disease of the shoulder joint itself. In most cases, areas which are close to or related to the joint such as ligaments, tendons, or the surrounding musculature are the triggers for pain experienced.

The most common shoulder discomfort and symptoms affect the rotary cuff, shoulder impingement, (shoulder adhesive capsulitis or shoulder compression syndrome), calcifying tendinitis, shoulder instability, shoulder luxation, frozen shoulder, acromioclavicular joint, (AC joint), shoulder arthrosis and shoulder prosthetic implants.

The rotary cuff is a group of four muscles and their accompanying tendons, which are positioned at the top of the humeral head, and which encircle the shoulder joint similar to a collar or cuff. Pain in the rotary cuff is caused by changes in the shoulder area, which are not located in the shoulder joint itself, but in the surrounding soft tissue. The diseases make themselves known by way of painful inflammation, infections and tears. They can affect the muscle sheath, the underlying bursa sac or the long biceps tendon.

Shoulder impingement, also known as shoulder adhesive capsulitis, describes limited space under the shoulder summit, allowing the humeral head and the tendons to rub against each other, unprotected. The resulting pain causes an extreme limitation of the arm’s mobility. Causes may either be changes to the osseous structures or damage to the surrounding soft tissue, which are rooted in degenerative changes or constant overburdening, for example through athletic activity.

Calcified shoulder is a painful deposit of calcium in the tendons of the rotary cuff, which is found under the shoulder summit. This space is characteristically narrow and limited. The calcium deposits irritate and thicken the tendons, causing the space under the shoulder summit to be even more limited. In particular, lying or resting on the affected shoulder and upward reaching movement result in pain, which can be felt in the upper arm and which often radiates down to the elbow. The causes for a calcified shoulder may be reduced blood circulation in the rotary cuff, overburdening, or degenerative processes.

A stiff shoulder, commonly known as a frozen shoulder, describes a pain-induced reduction of mobility in the shoulder joint, which can result in a complete loss of mobility in the shoulder joint. In such cases the differentiation must be made between two forms of frozen shoulder: the primary frozen shoulder and the secondary frozen shoulder. In cases of a primary frozen shoulder, the root causes are unknown. Usually, no correlation is found between the frozen shoulder and another disease. The secondary frozen shoulder is a result of another disease of the shoulder joint.

The term shoulder instability describes the loosening of the rotator cuff and tendons between the humeral head and the glenohumeral joint cavity or shoulder socket. There are two forms of shoulder instability: congenital instability and chronic traumatic instability. In cases of congenital instability, the body‘s supporting structural tissue is weak, making it possible for the humeral head to escape the joint without blunt traumatic force. In cases of chronic traumatic instability, the healthy and functioning connection between the humeral head and the shoulder socket is severed through external forces, for example through accident or sporting injury.

The acromioclavicular joint, also known as the AC joint, describes the connecting joint between the shoulder summit and the clavicle, or collarbone. The AC joint is surrounded by a robust articular capsule and is stabilized by tendons. When the shoulder joint experiences an injury or trauma, this results in a hyperextension or rupture of the stabilizing structures (AC joint rupture and AC joint instability). Injuries to the shoulder joint are caused for the most part by acute trauma, for example during athletic activity. Equally, overburdening, chronic inappropriate strain and degenerative processes can lead to diseases and dysfunctions of the acromioclavicular joint.

Shoulder arthrosis is a term used to describe a degenerative change of the shoulder joint. It is caused by erosion of the cartilage tissue on the glenohumeral joint cavity or shoulder socket and the humeral head, leading to friction between the bones and joints during movement, as these rub against each other, unprotected. After a longer period, musculature degenerates, leading to stiffness in the joint. Treatments for shoulder arthrosis range from conservative forms of therapy such as autohaemotherapy and stem cell therapy to the implantation of an artificial shoulder joint.

The implementation of an artificial shoulder joint is among the major advancements of modern medicine. This method is taken into consideration when conservative and joint-preserving measures, pain and anti-inflammatory medication, and substances designed to support cartilage show no effects. In this case, the main priority is to replace only worn or irreparably damaged portions of the joint and to preserve healthy body tissue as far as possible.