Shoulder surgery

What does shoulder surgery do?

Shoulder surgery is a medical discipline concerned with the diagnosis, treatment and rehabilitation of pathological conditions of the shoulder joint and surrounding tissues.
It treats problems resulting from various injuries, joint wear, instability and fractures. In more severe cases, surgical solutions are used.

An integral part of shoulder surgery is joint reconstruction surgery, such as shoulder replacement. It is particularly common in older patients, where wear and tear of the shoulder joint causes pain and limited mobility.
Apart from prosthesis implantation, most operations are performed by the shoulder surgeon using an endoscopic, or minimally invasive, procedure. The advantage of shoulder arthroscopy is that it reduces the amount of surgical trauma and allows for a faster recovery.

How is the shoulder joint built?

The shoulder is the most mobile and complex joint in the human body and is subjected to heavy loads during everyday life. Due to its complexity and high stress levels, it is extremely fragile and, not surprisingly, one of the most stressed joints in the human body.
For proper functioning, the bones, joints, muscles and ligaments need to work together in harmony.

Main anatomical components and their functions:

1. Bones:

• Keystone: Join the sternum to the shoulder blade.
• Lapocka: It is located in the back region and surrounds the shoulder from the back. The two main parts are the scapula and the acromion.
• Humerus: The main bone of the arm, located between the shoulder joint and the elbow.

2. Joints and ligaments:

• Glenohumeral joint: Main joint where the head of the humerus meets the glenoid fossa of the scapula. This is a so-called ball and socket joint, which allows a wide range of motion of the arm.
• Acromioclavicular joint (AC joint): The area between the tip of the shoulder blade and the clavicle.
• Tapes: The stability of the shoulder joint is provided by the glenohumeral ligaments, the coracoid ligament and the acromioclavicular ligament, among others.

3. Muscle groups and tendons:

• Rotator cloak: It consists of four muscles - supraspinatus, infraspinatus, teres minor and subscapularis. These muscles and tendons help to stabilise the shoulder and move the humerus in different directions.
• Deltoid muscle: It is located on the outer surface of the shoulder and is involved in lifting the arm.
• Biceps muscle: It is located at the front of the upper arm.

For what complaints should you consult a specialist shoulder surgeon?

• Durable shoulder pain - For long-standing pain that interferes with sleep and quality of life.
• Limited range of movement - Difficulty lifting, rotating the arm or performing other movements.
• Clacking of bones - If the shoulder joint makes clicking, jogging or other abnormal sounds.
• Pain after injury - If the shoulder has been injured (e.g. during sports or in an accident) and the pain does not subside or becomes unstable.
• Persistent pain radiating to the arm or hand - Shoulder problems sometimes take the form of pain in the arm or hand.
• Long-standing weakness or numbness - A feeling of weakness or numbness in the shoulder, arm or hand may indicate a problem with the shoulder joint, the surrounding nerves.

Some shoulder problems can be improved with conservative treatment such as physiotherapy, physical therapy or medication, while others may require shoulder surgery.
The symptoms listed are the leading indicators of shoulder problems. However, there may be other underlying medical conditions, so it is always worth consulting a doctor to determine the exact diagnosis and treatment.

What are the most common diseases of the shoulder?

Rotator cuff syndrome

This includes damage, rupture or calcification of the rotor sheath. Damage to the rotor shell can restrict arm movement and cause pain, which can significantly affect everyday activities and quality of life.

Arthritis of the shoulder joint

An inflammatory joint problem, often caused by an autoimmune disease. Severe condition warrants a shoulder surgery and prosthesis.

Arthritis of the shoulder joint

Abrasive joint disease most often occurs with age. Its advanced stage requires prosthesis.

Shoulder dislocation

A shoulder dislocation involves the humerus moving out of the socket. There are two main types of dislocation: traumatic and dislocation due to connective tissue laxity. Labral injuries can also be associated with shoulder dislocations.

Bursitis

A small fluid-filled sac called the sphincter in the shoulder becomes inflamed. The main cause is repetitive movements or some kind of trauma. The most common symptom is pain with overhead movements.

Impingement syndrome

Impact syndrome, which involves a collision of the rotator cuff tendons. The narrow structure of the shoulder joint causes the shoulder components to collide and become damaged and inflamed.

Tendinitis

Calcific tendinitis. Tendinitis is inflammation of the ligaments or tendons that connect muscles to bones. This inflammatory condition often develops as a result of repetitive movements, overuse or trauma. The disease is generally well managed with conservative therapy. In severe cases, when the tendons rupture or tear, surgical intervention may be necessary.

Frozen shoulder syndrome

The main symptom is severe shoulder pain and reduced mobility. The lesion is associated with thickening and stiffness of the connective tissues around the shoulder.

Overview of medical history

Identification of previous musculoskeletal complaints and diseases.

Ultrasound examination

The functional examination is complemented by the doctor's own UH examination, which is part of the basic orthopaedic examination.

Making a diagnosis

As mentioned above, it is carried out during the first test or during the control.

Publication of an outpatient magazine

In all cases, the medical examination is concluded by the writing of an outpatient form.

Ultrasound examination performed by a doctor

An accurate diagnosis is essential to choose the right treatment. Therefore Dr. Bálint Major a shoulder specialist in the shoulder surgery clinic, in addition to the physical orthopaedic examination, will also examine the patient's shoulder joint using ultrasound.

The UH scans allow the doctor to determine the cause of the complaint that is causing the shoulder joint pain. He or she will then recommend a treatment.
In the case of cartilage replacement by injection, the procedure is ultrasound-guided. In this way, the substance to be injected can be injected most precisely into the problem area.
(The UH examination is part of the orthopaedic consultation and is not charged separately.)

What types of shoulder surgery do we perform in the shoulder surgery department?

• Rotator cuff tear (tendon suture): Most often it affects the muscle called the supraspinatus of the sheath. The surgery involves arthroscopic reattachment of the torn tendon. The recovery period after the operation is 4-6 months, after which the patient can return to his or her old life.
• Rotator cuff calcification: Arthroscopic surgery is used to remove the calcific deposit. The operation is performed for acute, prolonged complaints.
• Shoulder instability surgery: Surgical intervention is most often required after traumatic dislocations. The aim is to eliminate the chance of recurrent shoulder dislocations and to reconstruct any damaged ligaments and tendons.
• Frozen shoulder surgery:The aim of shoulder surgery is to release the bound, accumulated connective tissue around the shoulder joint. The aim is to reduce pain and increase the range of motion of the joint.
• Shoulder prosthesis implantation: Recommended for advanced shoulder joint wear and inflammation, the main cause of which is joint disease or wear and tear. The aim is to reduce the limitation of movement and pain. Prosthesis helps to regain the arm's range of motion so that the patient can live a full life again. The procedure is performed by open exploration.

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