Shoulder pain

One-off dislocations can usually be treated conservatively. Surgical stabilisation can be discussed if there are frequent dislocations or if there are instabilities that cannot be brought under control with conservative measures. For this we essentially use two methods, depending on various factors: arthroscopic restoration of the normal anatomy by reconstruction of the injured joint lip (labrum) or minimally invasive stabilisation by means of a bone block transfer/offset on the edge of the joint socket (Latarjet procedure).

The rotator cuff consists of four tendons which are essential for centering the humerus head and movements in the shoulder. A distinction is made between wear-related (degenerative) damage and tendon injuries caused by an accident (traumatic). As a rule, degenerative damage can initially be treated conservatively. If conservative treatment does not lead to an improvement within a certain period of time, surgery may be considered. A recommendation for conservative treatment or surgery for injuries to the rotator cuff depends on various factors.

If an operation is necessary, we repair almost all tendon damage on the shoulder using arthroscopic technology.

Unfortunately, certain types of damage to the rotator cuff cannot be repaired. During treatment, other conservative and surgical procedures are used, all the way to artificial joint replacement (known as reverse prosthesis). 

As in other joints, wear and tear on the shoulder can lead to osteoarthritis (called omarthrosis when it occurs in the shoulder). Treatment is always initially conservative. If physical impairments persist that are annoying or even affect the quality of life, an artificial joint replacement (a shoulder prosthesis) can be discussed. Depending on the condition of the rotator cuff tendons, two different types of shoulder prosthesis are used (anatomical and reverse shoulder prosthesis). There have been major developments in surgical techniques and implant systems in recent years, so nowadays small, bone-saving implants can often be used. If the bone quality permits, we use shoulder prostheses without a long pin in the bone (known as stem-free prostheses). The results after shoulder prosthesis operations are very good. They often achieve freedom from pain and significantly improved shoulder joint mobility.

Due to its path and length, the biceps tendon is prone to injury and damage caused by wear and tear. These often occur on the deflection mechanism at the transition into the joint (known as a pulley lesion) or where the tendon attaches to the joint at the upper edge of the socket (an SLAP lesion). Chronic inflammation of the tendon can also be a cause of pain. Surgery may sometimes be necessary. In this, the tendon is transferred to the head of the humerus (biceps tenodesis or biceps tenotomy).

Mobility is painfully restricted in a frozen shoulder. This is caused by inflammation to the synovial membrane and the joint capsule. A frozen shoulder can be the result of an accident, immobilisation, or surgery. Most often, however, there is no trigger and it occurs out of the blue. The course of the condition can be very tedious and last for 2-3 years. Treatment of inflammation and pain are important therapeutic approaches. Surgery is very rarely necessary.

Calcareous shoulder is a calcium deposit in the tendons of the rotator cuff. Mere calcification is not necessarily painful and is also harmless. If inflammation occurs (often when the calcium breaks out of the tendon), it can lead to extremely severe pain and thus to restricted movement. Treating the pain and inflammation is paramount. (Arthroscopic) calcium deposit removal will only be necessary in about one in five cases.

The shoulder joint is formed by the outer end of the collarbone and the acromion. It is a very tight joint. The ligaments which stabilise the shoulder joint can sustain injury, especially as a result of a direct fall onto the shoulder. Depending on the extent of the instability, treatment is carried out with or without surgery.

The shoulder joint is often affected by osteoarthritis with increasing age. This osteoarthritis is often not painful and does not require treatment. As in other joints, there can be an acute, painful flare-up of inflammation. In this case, a one-off cortisone injection can relieve pain. Surgery is rarely necessary. If an operation is undertaken, the space within the shoulder joint is widened by removing bone matter.

Falling on the shoulder can lead to a break in the area of the collarbone (clavicle fracture) or the humerus head (humeral head fracture). Conservative or surgical treatment is recommended, depending on the extent to which the fragments have shifted in relation to one another and the quality of the bone.

If there are symptoms after an operation, the first thing to do is to find out the cause. Revision surgery may sometimes be necessary, depending on the reason.