Shoulder
Shoulder pain: causes, diagnostics and modern treatment methods
Shoulder pain is common and can have a variety of causes. A careful clinical examination, supplemented by appropriate radiological imaging techniques (X-rays, MRI, CT scans), is the basis for a correct diagnosis. Only then can a decision be made as to whether further conservative or surgical treatment is necessary. Depending on the type of injury or damage, state-of-the-art minimally invasive, arthroscopic, or open surgical procedures are available if surgery is necessary. The most common pathologies and their treatment are briefly explained below.
Rotator cuff: function, injuries and treatment
The rotator cuff of the shoulder is formed by four tendons and allows the transfer of force from the shoulder blade to the humeral head. This allows the arm to be raised sideways, forwards, and backwards, as well as rotated internally and externally. An accident and/or wear and tear can cause one or more of these tendons to tear. This can lead to limited mobility, loss of strength, and pain.
diagnosis
In addition to clinical examination, ultrasound and magnetic resonance imaging (MRI) are used as diagnostic tools. For specific treatment, it is important to assess the exact cause, extent, and quality of the rotator cuff muscle-tendon unit.
Treatment
Minimally invasive and arthroscopic procedures are now available for rotator cuff reconstruction. The torn tendons are reattached to the humerus using small suture anchors.
Aftercare
Following surgery, the shoulder is placed in a shoulder abduction cushion to prevent tension on the freshly sutured tendon and allow it to heal in a relaxed state. Physical therapy for the shoulder begins immediately the day after surgery. Discharge can be followed by outpatient or inpatient rehabilitation for further physical therapy. The postoperative treatment plan typically includes the shoulder abduction cushion for 6 weeks. After this period, active mobility is gradually increased. Depending on the diagnosis and the nature of the surgery, sports that place strain on the shoulder can be resumed between 3 and 6 months after surgery.
Impingement syndrome: Shoulder impingement syndrome
Rotator cuff injuries can be associated with a condition called impingement syndrome. This condition occurs when rotator cuff tendons become trapped between the humeral head and parts of the shoulder blade, which can lead to pain and tears in the rotator cuff.
Treatment
If conservative treatment for partial tears of the rotator cuff is unsuccessful, the constrictions caused by bone or soft tissue can be removed with a precision milling cutter in an arthroscopic procedure.
rehabilitation
The rehabilitation period after such procedures is short, and patients are usually largely free of symptoms and able to return to work after 3–6 weeks.
Tendinosis calcarea (calcified shoulder):
Cause and therapy
Calcific tendonitis is a condition characterized by calcium deposits in the tendons of the rotator cuff. The causes are not fully understood, but the condition progresses through phases of varying pain intensity. While some sufferers experience little discomfort, others may experience severe pain. The condition is usually self-limiting but can persist for years.
Treatment
Initially, conservative therapy is recommended, which includes anti-inflammatory medications, physiotherapy and shock wave therapy.
Surgical therapies
If conservative treatment is not successful, arthroscopic removal of the calcium deposit can be performed.
Aftercare
Symptoms usually improve quickly after the procedure. Depending on the severity of the condition, rehabilitation lasts three to six weeks and requires intensive physiotherapy afterward.
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Shoulder instability: causes and treatment
When it comes to shoulder instability, a distinction is made between congenital (habitual) and accident-related (traumatic) instability.
Habitual instability
This form is congenital and characterized by hypermobile joints and very lax ligaments. In some cases, the shoulder can even be dislocated intentionally. In these cases, intensive physical therapy to strengthen the muscles and improve proprioception (self-awareness of joint position) is usually the treatment of choice.
Traumatic instability
After an accidental dislocation, injuries to the joint lip (labrum) or an impression on the humeral head (Hill-Sachs lesion) often occur.
therapy
Young patients are at higher risk for recurrent dislocations, which is why early surgical treatment is recommended. Repeated dislocations can lead to cartilage damage and premature osteoarthritis.
Surgical treatment
Arthroscopic stabilization is achieved by refixing the labrum with small suture anchors. In cases of bony injuries to the socket, open procedures with bone grafting may be necessary.
Aftercare
- Certain movements are not allowed for 6 weeks.
- The arm is initially carried in a sling to protect it.
- Full load capacity for overhead and contact sports is only achieved after approximately 5–6 months.
Acromioclavicular joint dislocation (ACG dislocation): injury to the acromioclavicular joint
Calcific tendonitis is a condition characterized by calcium deposits in the tendons of the rotator cuff. The causes are not fully understood, but the condition progresses through phases of varying pain intensity. While some sufferers experience little discomfort, others may experience severe pain. The condition is usually self-limiting but can persist for years.
Treatment
- Conservative: Minor instabilities can be treated without surgery.
- Surgical: Severe instabilities are treated arthroscopically to restore the anatomical joint position.
Chronic injuries
If the injury has been present for a long time, a tendon from the body can be used for reconstruction to ensure long-term stability.
Aftercare
- Movements beyond the horizontal are not permitted for 6 weeks.
- Lifting heavy loads is also not permitted during this time.
- Full load capacity for overhead and contact sports is achieved after approximately 5–6 months.
Pathologies of the long biceps tendon (LBS): pain and injuries
The long biceps tendon (LBS) runs through the shoulder joint and can cause discomfort in various locations. These include:
- Tears at the origin of the tendon in the joint (SLAP lesions)
- Changes in the course and exit point of the tendon from the joint
- Damage to the guide loop (pulley lesions)
therapy
Conservative treatment usually does not lead to the desired success.
Surgical treatment
Depending on the type of injury, either a suture is placed at the tendon origin or the tendon is removed with or without refixation to the humerus.
Osteoarthritis of the shoulder joint: joint wear and treatment options
Shoulder joint arthrosis leads to pain during movement, pain at rest and increasing restriction of movement.
Conservative treatment
This can only control the symptoms to a limited extent and includes anti-inflammatory medication, physiotherapy and infiltration therapies.
Surgical therapy
If conservative measures are insufficient, an endoprosthesis (artificial joint) can be used. There are two main types:
Anatomical shoulder prosthesis:
This design preserves the natural joint structure and is used in patients with an intact rotator cuff. A partial or total prosthesis can be implanted as needed.
Inverse shoulder prosthesis:
In cases of irreparable rotator cuff tears, this prosthesis allows continued pain-free movement by reversing the joint mechanics.
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Whether it's an acute injury, chronic pain, or limited mobility – our specialized team at Sports Orthopedics Munich offers you the best possible diagnostics and therapy.
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