Effective Treatments Towards Recovery
Dr Chua is an Orthopaedic Surgeon whose practice focuses on the surgical and non-surgical treatment of the shoulder, including corticosteroid injections, plating of clavicle, Arthroscopy for rotator cuff repair and more.
What you need to know:
Corticosteroid injections in the shoulder joint is a non-surgical treatment that can dramatically reduce inflammation and pain, however the effect is often temporary. This treatment is a choice if rest or activity modification, medication and physical therapy fail to alleviate symptoms and pain.
Candidates for Surgery
Both adults and children can have cortisone injections, yet doctors will discuss the use with patients when the need arises. Most pain that is caused by shoulder joint conditions such as arthritis, rotator cuff tears or tendinitis can be relieved by this injection. Local anaesthetic preparation may be required prior to injection.
The steroid injections work by releasing the medicine slowly into the joint to reduce any pain and swelling. The medicine will be injected into the bursa beneath the acromion to relieve pain due to shoulder impingement / rotator cuff tendinitis. For patients with arthritis, this treatment method is only used when just a few joints are affected. Some patients get increased pain and swelling where the injection was given initially, but the pain tends to go away after a few days, and the joint may feel better for several months – or even up to a year.
A cortisone injection is injected into the bursa and may relieve painful symptoms
In arthroscopy, thin surgical instruments are inserted into two or three small puncture wounds around the affected area. During arthroscopy surgery, a small fiberoptic scope camera (arthroscope) is inserted into the affected area via tiny incisions. This camera displays images onto a television screen in which the surgeon uses to guide other small surgical instruments to remove bones or soft tissues.
Candidates for Surgery
Patients who will be treated with arthroscopy include those who suffer from mild glenohumeral arthritis. During this procedure, the surgeon will clean out the inside of the joint. Although this provides pain relief, it will not eliminate arthritis from the joint, and further surgery may be needed in the future if the arthritic condition progresses.
Treating Shoulder Joint Tears
Shoulder joint tears can also be treated with arthroscopy. During arthroscopy surgery, the doctor will examine the rim and the biceps tendon to see if the injury is confined to the rim itself (without involving tendon, shoulder still stable) or the tear has extended into the biceps tendon.
If the injury is confined to the rim, the surgeon will remove the torn flap and correct any other associated problems. If the tear extends into the biceps tendon, or if the tendon is detached, the biceps tendon may be considered unstable, and thus will require repair or transfer to a safer location using absorbable tacks, screws or sutures. Tears below the middle of the socket will be treated by way of reattaching the ligament and tighten the shoulder socket by folding over or ‘pleating’ the tissues together.
This surgical method is most often used to treat clavicle fractures through open reduction and internal fixation. This is done to reposition the bone fragments into their normal alignment, and are then held in place with special metal hardware such as plates and screws, or pins.
Bones pieces are repositioned into their normal alignment, and then held in place with special screws and metal plates that are attached to the outer surface of the bone. The metal hardware requires routine removal after bone has healed, or when they are causing any discomfort, such as irritation in the collarbone area when using seat-belts or when carrying backpacks. After surgery, it is common to notice or feel a small patch of numb skin where the plate lies below the surface of the skin.
X-ray showing displaced clavicle fracture (left) which are then realigned and held in place with plates and screws (right)
Pins and screws can also be used to hold the fracture in good position after the bone ends have been put back in place.The incisions for pins or screws are usually smaller than those used for plates. These often irritate the skin where they have been inserted and are usually removed once the fracture has healed.
X-ray shows a single screw that is used to repair the clavicle fracture.
Subacromial decompression is usually performed to treat shoulder impingement / rotator cuff tendinitis when non-surgical treatments are not successful in relieving the pain. The goal of this surgery is to create more space for the rotator cuff. This surgery involves removing the inflamed portion of the bursa and also part of the acromion (anterior acromioplasty). It can be done arthroscopically or via open technique.
Preparing for Surgery
This surgery will be done under general anaesthetic, thus patients may be asked to follow fasting instructions for about six hours prior to surgery. Patients who are smokers will also be asked to stop smoking as it increases the risk of getting a chest or wound infection, which can complicate the surgery or slow down the recovery process. This procedure is usually a day case, which means patients are allowed home later the same day, yet he or she may need to arrange for someone to collect them from the hospital post surgery.
During most subacromial decompression, the front edge of the acromion is removed along with some of the bursal tissue. This is often done as an arthroscopic surgery. Other conditions that are present in the shoulder at the time of surgery may also be treated simultaneously, such as arthritis between collarbone and acromion, inflammation of the biceps tendon or partial rotator cuff tear, meaning that the surgeon may have to perform an open surgery and will make a larger cut in the shoulder
Bankart repair is an operation to treat the Bankart lesion, which is a tear of the tissue rim below the middle of the glenoid socket that also involves the inferior glenohumeral ligament. The goal is to restore the stability of the shoulder. This procedure can be performed arthroscopically or as open technique.
Components and Procedure
This surgery is performed under general anaesthetic, and is done using bone anchors such as biocomposite anchors that are drilled into the glenoid. These bone anchors have sutures attached that are then used to tie the labrum back to the anterior glenoid. They have a crystalline structure that is eventually replace by bone as it heals and grow.