Shoulder joint. Damage and treatment

Ask a question to the doctor

Make an appointment

Doctor's recommendations

Traumatologist-orthopedist > Treatment > Treatment of the shoulder joint

Rotator cuff injuries Habitual shoulder dislocation Latarge surgery SLAP injury Pathology of the long head of the biceps tendon Problems of recovery after shoulder dislocations

The shoulder is a complex joint made up of four anatomical structures, the movements of which together provide its extensive mobility. During development, stability was sacrificed in favor of mobility.

There are three possible directions of movement in the shoulder joint: flexion and extension in the sagittal plane, abduction and adduction in the frontal plane, as well as external and internal rotation.

The clavicle, scapula, and humerus provide the bony base of the shoulder joint. They are involved in the formation of three double joints: the sternoclavicular joint, the acromioclavicular joint, and the glenohumeral joint. The scapulothoracic joint is the fourth anatomical formation of the shoulder; it is formed by a scapula sliding on a layer of muscle and bursa along the posterior surface of the upper chest. These three bones are fixed to the axial skeleton and controlled by 19 muscles. The muscles are divided into an internal group, which moves the humerus relative to the scapula, and an external group, which moves the shoulder girdle and humerus relative to the axial skeleton.

Rotator cuff injuries

Rotator cuff tendon damage can occur for several reasons:

degenerative changes;
narrowing of the space between the acromion and the head of the humerus;
injury;
chronic traumatization.

Degenerative changes are associated with poor circulation of the rotator cuff tendons, the aging process and tissue wear, as well as qualitative changes in the collagen fibers in the tendons.

Narrowing of the space between the acromion and the head of the humerus (impingement syndrome) occurs due to the special structure of the acromion process or after injury. The tendon of the supraspinatus muscle, passing through this space, falls into a vice, as it were, and is gradually compressed.

Typical injuries are a fall on the shoulder joint or on an outstretched arm, a sudden lifting of a heavy object, or a sudden movement of the arm to the side.

Frequent microtraumas of the shoulder joint area occur in people with heavy physical labor and throwing athletes. Typical professions include those whose work involves prolonged hand position at level 900 and above. These are, for example, hairdressers, dentists, electricians, carpenters, painters.

Symptoms of a rotator cuff tear.

Small tears or partial damage may be asymptomatic. But most often the leading symptom is pain. When an injury occurs, pain occurs sharply, and with repeated stress it intensifies gradually and increases over time. The greatest intensity of pain is determined when the arm is abducted in an arc from 600 to 1200. Periodically, the pain intensifies at night and leads to sleep disturbance.

During the examination, a decrease in muscle strength of the injured limb can be detected. Painful sensations limit the range of motion in the shoulder joint and lead to the development of contracture (stiffness).

Conservative treatment

Partial injuries to the rotator cuff tendons can occur on the articular surface, on the acromion side, or within the tendon. It is advisable to start treatment with conservative methods. The main task is to eliminate the cause of the pathological process and stop inflammation. The patient needs to reduce his physical activity. The doctor prescribes anti-inflammatory drugs, physiotherapy, and exercise therapy. In the absence of confirmation of a full-thickness tear, it is possible to administer subacromial corticosteroid drugs to relieve pain and reduce inflammation.

Recently, much attention has been paid to the possibility of tissue regeneration. As a modern alternative method of non-surgical strengthening of the soft tissue structures of the shoulder, intra-articular injection of platelet-rich plasma (PRP) in combination with shock wave therapy (SWT) is used. Conservative treatment is also considered as a preparatory stage before surgery.

Operation

A full-thickness tear can affect one tendon or several. Massive injuries of the rotator cuff in some cases are characterized as irreparable and require open surgery to plastically replace tendon defects or move other muscles to the rupture zone.

Bioabsorbable implants Titanium implants

For the majority of ruptures, modern arthroscopic suture technologies are used. Arthroscopy is performed under endotracheal anesthesia, which can be combined with conduction anesthesia of the brachial plexus nerves. On the operating table, already under anesthesia, the patient is placed in the “beach chair” position. Arthroscopic intervention involves making 4-5 5mm punctures around the perimeter of the shoulder joint, into which a camera and microsurgical instruments are inserted. With their help, the tendon is decompressed, the subaromial space is cleaned and expanded. The tendon suture is performed after installing special screws (anchors) with non-absorbable threads attached to them into the head of the humerus. Using threads, the tendons are stitched and fixed in the head of the humerus.

The best results of surgical treatment of a rotator cuff tear are observed within up to 3 months from the moment of injury.

Symptoms of arthrosis of the shoulder joint

Changes in cartilage and bone tissue begin long before the first signs of arthrosis appear. Joint structures have a great potential for self-healing, so pathologies are rarely diagnosed at a young age, when all metabolic processes are quite active. As the body ages, recovery processes give way to degeneration. The first signs of destruction may appear after 40-50 years, and with the deforming type of the disease, patients notice changes as early as 16-18 years.

Symptoms of arthrosis of the shoulder joint:

Crunching of the joint during movement.
Pain, especially severe after physical activity.
Stiffness of movement, expressed after sleep or long rest.
Increased pain during weather changes.

Habitual shoulder dislocation

One of the erroneous statements is that a dislocation is better than a fracture. The consequences of a primary dislocation can be quite serious and lead to recurrence of the injury.

Habitual dislocation is a pathological condition in which the head of the humerus is displaced relative to the glenoid cavity of the scapula (instability of the shoulder joint). The cause of dislocation in 90% of cases is trauma, for example: a fall on an outstretched arm, a blow to the shoulder joint, lifting a heavy object, too much swinging of the arms, muscle spasm due to epilepsy.

A predisposition to dislocation is dysplasia - a congenital disorder of the development of connective tissue, in which the joints have increased mobility (hypermobility).

During a dislocation, there is a sudden movement of the head of the humerus, as if it is coming out of the joint. As a result, the supporting elements are damaged: the fibrous lip and ligaments. As the number of dislocations increases, displacement occurs with less resistance. The soft tissue structures do not provide adequate support to the joint and the contacting bones gradually begin to be damaged, which are then erased. Instability of the shoulder joint progresses over time and dislocations can occur even during sleep.

Treatment

The main method of restoring the stability of the shoulder joint is surgical treatment. The most gentle technique is arthroscopy (Bankart operation). If the bone tissue is intact and a good quality fibrous lip is present, refixation of the fibrous lip is performed using special anchored absorbable implants. The entire operation is performed through 3-4 skin punctures of 5-6 mm. Through the first puncture, a camera is inserted into the joint cavity and the image is transmitted to the monitor. The joint is examined from the inside; a tear in the fibrous lip is found. Through other punctures, it is mobilized with special mini-instruments, and the surface of the scapula is cleared of scars. Channels are drilled into the scapula and anchors are inserted into them and secured into the bone. Using threads from these implants, the fibrous lip is stitched and pulled to the cleaned surface of the scapula. Stabilization of soft tissue structures thus restores the anatomy lost during dislocation. It takes time for the fibrous lip to heal, so after the operation the arm is placed in a soft support bandage for a period of 4 weeks.

Advantages of treatment in Israel

International level of specialist training.
Modern material and technical base of clinics
Performing surgical interventions using progressive methods.
Comfortable conditions for treatment.
Loyal prices.

Carrying out therapy at the initial stages of the disease allows most patients to forget about the disease and quickly restore lost functions. Do not hesitate, contact an Israeli clinic and undergo a full course of treatment and rehabilitation.

(0 votes, average: 5 out of 5)

Operation Latarget

If the shoulder joint is unstable due to a deficiency of scapular bone tissue, transposition of the coracoid process of the scapula is recommended - the Latarget operation.

The operation is also used in cases of poor condition of the ligamentous apparatus of the shoulder joint, recurrence of dislocation after the Bankart operation, and the absence of a fibrous lip. During the operation, a fragment of the coracoid process (2x1 cm) is cut off. With the muscles attached to it, it is carried through the subscapularis muscle to the anterior surface of the glenoid cavity of the scapula (glenoid). After preparation and correct positioning, it is fixed with 2 screws.

The operation provides restoration of the bone defect of the glenoid due to the transfer of the coracoid process and a supporting effect due to the relocated muscles closer to the head of the humerus.

Recovery and return to previous loads is possible within 3 months after surgery.

Causes of arthrosis of the shoulder joint

The disease is polyetiological. The development of deforming arthrosis of the shoulder joint can be associated with various factors:

Professional sports or intense training.
Endocrine diseases.
Hormonal imbalances.
Congenital pathologies of the development of the musculoskeletal system.
Hereditary predisposition, etc.

In most cases, secondary arthrosis is diagnosed: pathology occurs after exposure to a particular factor on the joint. Less commonly, the primary or idiopathic form of the disease is recorded. It is impossible to determine the exact cause of tissue degeneration in this case.

SLAP damage

Until recently, establishing a diagnosis of SLAP injury was very difficult. With the development of MRI diagnostics and improvement of arthroscopic technologies, this pathology has become mandatory in the practice of shoulder surgery.

SLAP (superior labrum anterior posterior) is characterized by separation of the fibrous lip from the glenoid in its upper segment with anterior and posterior distribution. In this localization, the tendon of the long head of the biceps begins from the fibrous lip, which is the main vector of traction during injury.

The cause of damage is most often trauma: a fall with support on the abducted arm, a blow to the shoulder area, often found in “throwing” athletes (handball, baseball, water polo), boxers.

Conservative treatment rarely leads to full recovery, because a return to specific loads provokes a recurrence of pain and progression of the rupture.

However, in patients without heavy physical and sports activities, complex therapy provides long-term relief from pain. First of all, rest is ensured for the shoulder joint by fixing the arm on a support bandage. Anti-inflammatory non-steroidal drugs are prescribed. To reduce the inflammatory reaction and reduce pain, physiotherapeutic procedures are necessarily used, such as phonophoresis with drugs, high-intensity laser (HILT), shock wave therapy (SWT), massage, and taping. Stimulation of regeneration is achieved by taking chondroprotectors and intra-articular administration of platelet-rich plasma (PRP). After inflammation has been relieved and the resting stage has been completed, proper rehabilitation under the supervision of a physical therapist will be an important factor in restoring function.

Arthroscopic fixation of the fibrous labrum, by analogy with the usual dislocation of the shoulder, is the most rational method of treatment, because ensures precise restoration of anatomical structures. Low-traumatic surgery reduces rehabilitation time. Under camera control, anchors are installed into the glenoid cavity of the scapula and the fibrous lip is returned to its place using non-absorbable sutures.

Pathology of the tendon of the long head of the biceps

Pathology of the long head of the biceps tendon often accompanies other conditions, such as: SLAP injury, impingement syndrome, ruptures of the supraspinatus and subscapularis tendons. However, even an isolated violation of the integrity of the biceps tendon can lead to dysfunction of the upper limb and requires surgical treatment.

The human biceps muscle consists of a long head, which is attached to the upper segment of the articular surface of the scapula, and a short head, which is attached to the coracoid process of the scapula. The short head bears the main load, while the long head gives the characteristic contour to the arm. When the tendon of the long head of the biceps is completely ruptured, a characteristic clinical picture occurs. The long head falls down, as a result the contour of the shoulder is deformed. This symptom is named after the famous cartoon character Popeye due to its resemblance to the hands of a sailor.

Persistent pain syndrome is supported by partial damage to the integrity of the tendon, the development of chronic tendonitis, and tendon instability in the intertubercular groove. It is difficult for the patient to perform rotational movements in the shoulder joint, push-ups and pull-ups. Pain localized in the anterior part of the joint is often accompanied by clicking sounds.

Treatment begins with conservative methods similar to SLAP injuries. To quickly relieve inflammation, a therapeutic blockade is often used. To the tendon area

An anesthetic solution with Diprospan is injected under ultrasound control. The effect is achieved quite quickly, however, in order to prevent relapse, compliance with the treatment regimen and physiotherapeutic treatment is necessary.

If conservative treatment is ineffective, the question of surgical intervention is raised. The development of technology has left no room for open surgery in this matter - all manipulations are performed under the control of an arthroscope through punctures.

The techniques used are varied and combined during the operation: debridement of the tendon (i.e., grinding of it and surrounding tissues), correction of concomitant pathology, subacromial decompression. Tenodesis of the long head of the biceps tendon is recommended for young active patients and athletes. This manipulation is performed at different levels of the intertubercular groove using arthroscopic implants. After fixation to the head of the humerus, the intra-articular part of the tendon is excised. For elderly patients, the method of choice is tenotomy - cutting off the tendon from its attachment to the scapula. This is a simpler method, but no less effective. However, in the postoperative period, Popeye's symptom may develop, about which the patient must be warned in advance.

If there is a complete rupture in a young patient, the first thing to think about is surgical treatment. The essence of the operation is to isolate the torn tendon and fix it to the anterior surface of the head of the humerus (tenodesis) in the intertubercular groove. The operation can be performed either arthroscopically or through an incision.

Diagnosis of arthrosis of the shoulder joint

The doctor must not only make a correct diagnosis, but also determine the cause of the pathology. Treatment of the underlying disease significantly improves the patient's well-being and slows down cartilage degeneration.

Manual examination

The first stage of diagnosis is a consultation with an orthopedic traumatologist. The doctor examines the diseased joint for swelling and severe deformation. As arthrosis develops, the muscles may partially atrophy - this is visible to the naked eye.

During a manual examination, the doctor evaluates the function of the joint according to several criteria:

Ability to make voluntary hand movements.
Thickening of the edges of the articular surfaces (large osteophytes can be detected by palpation).
The presence of a crunching, “clicking” sound that can be heard or felt by the hand during shoulder movement.
Joint jamming in the presence of free chondromic bodies.
Pathological movements in the shoulder.

Radiography

To detect signs of arthrosis of the shoulder joint, radiography is performed in two projections, which allows you to assess the degree of narrowing of the joint space, the condition of the bone surfaces, the size and number of osteophytes, the presence of fluid, and inflammation of surrounding tissues.

Ultrasound examination (ultrasound)

A non-invasive method that allows you to examine joints in pregnant women and young children. Using a sonogram, the doctor determines the thickness of the cartilage and the condition of the synovial membrane. The method well visualizes osteophytes and enlarged lymph nodes in the periarticular space.

Magnetic resonance imaging (MRI)

The MRI machine takes images in successive slices. The images clearly show not only the joint, but also the adjacent tissues. Today, magnetic resonance imaging is one of the most informative methods in the diagnosis of arthrosis.

Lab tests

As part of a comprehensive examination, the following is prescribed:

General blood analysis. Based on the results, the doctor can judge the presence and severity of the inflammatory process. The test also helps assess your overall health.
Analysis of urine. Kidney pathologies often cause secondary arthrosis deformans. Analysis is necessary for accurate diagnosis.
Blood chemistry. The data helps determine the cause of inflammation. Biochemical tests are also performed to monitor complications and side effects during therapy.