Written by Nikolaos Piskopakis, MD, PhD Orthopaedic, ex President of Hellenic Arthroscopic Society, Director of Sports Medicine Department, Athens Medical Center, Athens Medical Group
Shoulder arthroscopy may be used to treat the following:
Subacromial impingement syndrome - (Acromioplasty)
It is a pathology of the rotators’ tendon, and mainly the supraspinatus, which may involve both young athletes and older people. The tendon of the rotors protects the head of humerus and it is located just below the acromion, creating the subacromial space, which is protected by a popliteal bursa.
When lifting the hand upwards the subacromial space is reduced and consequently the rotors’ tendon is injured. This may get worst as time goes by, creating a painful inflammation, which may even lead to rotors’ rupture. The causes that may lead to this is the form of the acromion, mainly its front surface, the presence of osteophytes, and any muscular atrophy that may occur after injury, leading to continuous impingement of the tendon to the subacromial space. Subacromial impingement syndrome treatment may be conservative and, if the symptoms persist, surgical - arthroscopic.
Acromioclavicular joint arthritis (Shoulder Arthritis)
Shoulder arthritis causes intense pain and shoulder motion weakness, and it should be managed.
The acromioclavicular joint is the contact point between the clavicle and the front inner part of the acromion. This area is normally characterised by a small space, which allows the clavicle’s micromotion and contributes to the composite motion of the shoulder.
As time goes by, in young athletes, but especially at more advanced ages, acromioclavicular degeneration - arthritis with presence of osteophytes may occur due to the repeated impingement of the area. This arthritis causes intense pain and shoulder motion weakness, and it should be managed. Shoulder arthritis surgical treatment comes after conservative treatment failure, and the arthroscopic technique can give excellent results.
Shoulder instability repair (Bankart lesion) - Shoulder Dislocation
Glenohumental joint is an unstable in nature joint. Both dynamic and static factors contribute to the stability and great range of motion that characterise it. These are the shoulder girdle muscles and the ligaments of the shoulder region. During possible injuries with the hand usually in abduction and external rotation, a displacement of the humeral head and its sliding out of the glenoid is usually caused. More often, this may occur in a forward direction (anterior dislocation), and less frequently in backward direction. In some young people it may contribute to more frequent presence of dislocations, an idiopathic relaxation of the shoulder’s joint. Shoulder instability is a pathology which definitely requires surgical treatment in young people. Today, it has been demonstrated that results are better when shoulder instability is treated in a timely manner, and arthroscopic treatment comes first. In some special cases open surgical repair is also indicated.
Long head of biceps repair (slap lesion)
The long head of the biceps tendon is a very strong tendon and is one of the two brachial biceps muscle’s tendons. The long head of the biceps tendon contributes to the humeral head stability relative to the glenoid. The long head of the biceps tendon is in contact with the rotors’ tendon, and anatomically it is attached to the humerus on the groove of the biceps. It adheres to the glenoid, at its top part, and it is in direct contact with the labrum. After long-term use and repeated micro-injuries inflammation may occur, with intense symptoms of pain both during movement and at rest. At more advanced ages in particular, degeneration of the tendon fibers is also present, which can be easily and with very good results managed arthroscopically through the biceps tenotomy method. In cases of damage coexisting in the rotors’ cuff, it is possible to perform, always arthroscopically, tenodesis of the long head of the biceps and repair together with the rotors’ damage. In young athletes of throwing sports mainly, a pathology of long head of the biceps tendon detachment from the glenoid may occur (SLAP LESION), which is only arthroscopically treated with good results and athletes’ rehabilitation.
The deposition of calcium salts - calcific (shoulder tendinitis) is a very painful shoulder pathology. Shoulder tendinitis mimics the symptoms of subacromial impingement, with severe pain that does not resolve easily with conservative treatment. The symptoms of shoulder tendinitis may last from 1 week to over a month. Calcium salts deposition in the mass of the rotors’ cuff and concomitant bursitis of the subacromial bursa cause the above symptoms.
After conservative treatment (anti-inflammatory – physiotherapy – local cortisone injection) symptoms resolve, without requiring radiological disappearance of calcification. In persistent cases that do not respond to conservative treatment arthroscopic treatment of the syndrome has excellent results in shoulder tendinitis.