“There is nothing they can do for shoulders” Or is there?
M
any people suffer with shoulder pain. There is a belief that nothing can be done for this or that treatment has poor
results. Nothing could be further from the truth. This century has seen leaps of advances in the management of shoulder problems
Apart from joint replacements and the fi xation of broken bones, most treatments are now done by keyhole surgery (arthroscopy).
There are common complaints patients attend my practice with, which vary for different age groups. I would like to pick a few to demonstrate the treatments that are available:
Common shoulder problems of the young person
Younger patients often suffer from shoulder problems as the result of an injury. There are obvious fractures (broken bones) and dislocations of either the main shoulder joint or the ACJ (acromio-clavicular joint = the joint between the collar bone and the tip of the shoulder).
Dislocations of the main shoulder joint lead to damage of the cartilage rim of the cup part of the joint (labral tear) that can make the joint unstable.
The younger the patient is the greater is the risk of recurrent instability. If non-operative measures have failed, keyhole surgery often allows the reconstruction of normal anatomy and hence will give a stable joint. Just two small keyholes are required for the operation.
Common shoulder problems in the middle-aged
In this age group we often suffer from “impingement”. This means something catches in the shoulder which gives pain that is frequently referred down the side into the shoulder muscles.
There are a signifi cant number of causes for this. Some will improve with physiotherapy. But if after 2 months there has been no progress a review by a specialist is justifi ed. An X-ray will pick up obvious problems like
Another problem is the wear and tear of the rotator cuff.
keyhole operation, if it does not improve or when it is particularly painful.
Common shoulder problems with advanced age
The shoulder starts to wear with progressing age. This will affect all parts. As the rotator cuff degenerates (see above) tears become more frequent and the entire tendon may avulse of the shoulder. This can lead to loss of function and pain. Arthritis may result from this or be a primary problem. Both can be addressed with joint replacements.
Calcium in cuff tendon.
the build-up of calcium in the shoulder tendons (rotator cuff).
Initially this
is just an infl ammation; however it can progress to partial tears or lead to holes in the tendon Although symptoms can be suppressed by painkillers and injections, if not treated these tears can progress and over time the ability to lift the arm may be lost. For this reason and to exclude sinister problems, like bone tumours or metastasis of cancers, persistent
Although these have not been used for as long as hip or knee replacements, the treatment is just as successful for pain relief and improvement of function. Different replacements are done for different causes
When I started as an Orthopaedic Surgeon over 10 years ago I set out as a General Orthopaedic
Total shoulder replacement. Arthroscopic cuff repair. shoulder symptoms should be investigated.
Another very common problem is that of a “Frozen Shoulder”. This is not that easy to diagnose but can be successfully treated with a
Meet the Expert
Mr Hagen Jahnich FRCS (Tr & Orth) Consultant Orthopaedic Surgeon
26th February at 7pm Nuffi eld Health, Knightspark Leisure Park,
Arthroscopic stabilisation of a shoulder.
Surgeon with an interest in Upper Limb Surgery. Over the last few years my practice has become very much sub-specialised to Shoulder and Elbow Surgery. Shoulder and Elbow Replacements are now registered on the National Joint Register. I am the Regional Clinical Co-ordinator for the South East for the NJR. You can look up my level of activity and see this compared with other surgeons in the UK (http://www. njrsurgeonhospitalprofi
le.org.uk).
Although not everybody can be cured most patients with a shoulder problem can be helped successfully.
Knights Way, Tunbridge Wells, Kent TN2 3UW
For further information or to arrange an appointment please call 01892 552932 or email tun.enq@nuffi
eldhealth.com www. nuffi
eldhealth.com/tunbridgewellshospital
www.mrhjahnich.com
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