- Traumatic shoulder instability after traumatic recurrent dislocations
- Non-traumatic (congenital) shoulder instability with laxity of the joint capsule and decreasing passive mobility
Depending on the type of dislocation and other factors, various procedures are implemented:
- Arthroscopic stabilization for traumatic (sub-) luxations, infrequently recurring dislocations (absence of glenoidal defects and younger patients)
- Open stabilization (procedure according to Bankart) for traumatic dislocations, frequently recurring dislocations and a variety of capsular shift procedures
- Open stabilization using the J-span technique (iliac crest bone graft) for instabilities with glenoidal defects and for revision surgeries
Shoulder pain - Impingement Syndrome ("Tight fit" syndrome)
The most frequent reason for shoulder pain. Defined as a mechanical and/or inflammatory irritation of the rotator cuff, most importantly the supraspinatus tendon. A long-standing mechanical irritation can lead to a wear and finally tearing of the rotator cuff.
- Infiltration, electrotherapy, mobility and coordinational exercises for 3 months
- Arthroscopic subacromial decompression (ASD): intraarticular soft tissue and the area between tendons and the shoulder roof can be examined using an arthroscope, inflammated bursal and scar tissue adhesions are resected and the shoulder roof is freed off any constricting osteophytes (bone spurs) and smoothened. The joint space below the shoulder roof is extended, tendons can heal, thus breaking the inflammatory process.
Rotator Cuff Tears
The rotator cuff consists of four muscles that originate on the shoulder blade and form a common tendon cap, attaching the humeral head. It is the "engine" of the shoulder and it is responsible for the powerful and high range of motion of the shoulder joint.
- 3 months (see impingement syndrome above)
- Reduction of the torn tendon back to the humeral head in order to restore function and strength of the shoulder. Small to medium tears can be reconstructed using arthroscopic techniques (arthroscopic anchor systems). If this is not possible, an open surgical technique is required (involving transosseous tendon suturing, or tendinoplasties for large tears).
- Tendon transfer surgeries: Latissimus dorsi-transfer, Pectoralis-transfer.
- In cases resistant to conservative therapy, large tears may be debrided in old patients with low shoulder specific demands (removal of painful tendon pieces and stumps; arthroscopic / open). In younger and more active patients with a high demand on the shoulder, implantation of a special shoulder prosthesis (inverse prosthesis) may help to alleviate pain. It should, however, be noted that shoulder function can only partially be restored using these methods.
Proximal humerus fractures
For proximal humerus fractures, non- and minimally displaced fractures have to be separated from displaced fractures. The first group can widely be treated conservatively (immobilization for 2 - 4 weeks). Displaced or unstable fractures are considered for surgical management.
- Closed reduction and percutaneous pin fixation - ("Humerus block") - and screw fixation
- Open reduction and plate fixation in subcapital comminuted fractures or fracture-dislocations of the shoulder (in young patients)
- Fracture prosthesis, in that do not qualify for closed or open reduction (humeral head not recuctable or reconstructable).
Acute and chronic acromioclavicular joint dislocations, simple fractures of the lateral clavicle
Acromioclavicular joint - Arthritis
- Infiltration, ultrasonography, physiotherapy
- Arthroscopic / open resection of the lateral extension of the clavicle
Endoprosthesis (joint replacement) of the shoulder joint
In cases of particularly painful damage to the shoulder joint caused by wear and cuff tears, inflammatory diseases, or osteonecrosis of the humeral head, joint replacement surgery is indicated. The objective of this therapy is pain alleviation and restoration of shoulder function. The extent to which the joint is replaced depends on the duration of disease or injury, as well as the state of the surrounding soft tissue.
- Fracture endoprosthesis for non-reductable or non-reconstructable humerus fractures
- Hemi- or total prosthesis for humeral head arthritis or necrosis
- Revision endoprosthesis following problematic conservative or operative therapy of a humeral head fracture
- Prosthesis exchange / revision following failed implantation or loosening of a shoulder prosthesis
- Special prosthesis (inverse prosthesis) in the casees of missing rotator cuffs