Conservative treatment of shoulder pain.
There are some very basic procedures which are done out of theatre. These treatments are for example could be injections or medication.
Shoulder arthroscopy surgery.
At the Cape Shoulder Institute, a large proportion of surgical procedures are performed arthroscopically. The arthroscope is a lens, which is passed through a cannula (small metal tube), that is passed into the shoulder joint through a small incision in the skin.
The surgery entails three or four small incisions (each about 3mm), through which the arthroscope is passed and through the others, surgical instruments. Attached to this above-mentioned scope is a camera, which transmits the picture of the inside of the joint to a large TV monitor. This allows the surgeon to see the inside of the shoulder clearly through this small hole. The instruments are passed through other holes (referred to as “portals”), and the surgeon can watch these instruments while he performs repairs, removal of certain abnormal tissues etc.
With these specialised instruments even stitching type of repairs can be done to torn tendons and ligaments. The success rate of such minimally invasive procedures is very high, and is performed whenever technically feasible.
Open shoulder surgery.
Some operations can only be carried out through “open” incisions as it is not possible to perform them arthroscopically. Examples of such operations are a shoulder replacement or the Latarjet stabilization operation. Every effort is made to reduce the scarring. Achieving maximum function with minimal pain is the aim of surgery.
Dr Joe de Beer
Orthopaedic Shoulder Surgeon
Dr Joe de Beers’ practice is confined to the care of shoulder problems of all types, and he does both open and arthroscopic surgery. He is a keen shoulder arthroscopist, and has developed an expertise in ultrasound of the shoulder, both diagnostically and for intervention.
Joe de Beer specialises in the following shoulder surgery types.
Frozen Shoulder is a condition with no known cause in the majority of cases, with spontaneous onset. It is most common in females (40-50 years) but could affect males and other age groups.
A calcium deposit accumulates in one of the tendons of the shoulder. The cause is unknown and not related to injury, diet or osteoporosis. The patient most commonly affected is a female 40-50 years of age.
Pectoralis Major Tendon Rupture
The pectoralis major (large pectoral) is a large muscle on the front of the upper chest and arm. There are 2 “heads” – the clavicular and sterno-costal.
Proximal Humeral Fractures
Fractures of the proximal humerus (ball) account for 5-15 % of all fractures. Majority of these occur in elderly individuals with osteoporosis, and are a cause of major morbidity. In younger individuals, these fractures occur after high-velocity trauma.
S.L.A.P. is an acronym for Superior Labrum Anterior Posterior, which simply means that the attachment of the long tendon of the biceps is torn away from the upper end of the shoulder socket. (Superior Labrum = Biceps attachment, Anterior = front, Posterior = back).
Shoulder Instability & Dislocation
The shoulder consists of a ball (humeral head) and socket (glenoid). The ball is stabilized in the socket by a cartilage rim (“labrum”, which means “lip”) and the ligaments, which attach to the labrum.
Subscapularis Tendon Tears
The subscapularis is a most important muscle at the anterior (front) of the shoulder joint. It is often mentioned separately from the rest of the rotator cuff (supraspinatus, infraspinatus and teres minor) but is essentially part of this group of muscles.
Rotator Cuff Tears
Most tears are as a result of degeneration or “wear and tear”. The circulation to the tendon becomes impaired in older people and leads to degenerative tears.
Osteoarthritis of the Shoulder (Arthritis)
The shoulder joint (gleno-humeral joint) is one of the most mobile joints in the body. The gleno-humeral joint consists of a ball (humeral head) and socket (glenoid). As in any other joint, the bone surfaces are covered with a specialised cartilage layer.
A shoulder condition found mostly in people in the 40-60 year old age group.
The overlying acromion may squeeze or impinge upon the rotator cuff, causing inflammation and pain when elevating the arm.
Thoracic Outlet Syndrome
The thoracic outlet is the upper aperture of the chest, between the collar bone and the first rib.This narrow passageway is crowded with blood vessels that run out of the chest to the arm (subclavian vein and artery), as well as the nerves that exit the spine in the neck to supply the arm.
Suprascapular Nerve Entrapment
Suprascapular nerve injuries have become increasingly recognized as a cause of shoulder pain and dysfunction1. Recent advances in diagnostic and surgical techniques have simplified the management of injuries of this nerve.
The clavicle is prone to fracture because of its very superficial localisation. A fall onto the arm, a lateral blow or a direct impact over the clavicle can cause a fracture.
The Biceps Tendon
The Biceps is an upper arm muscle that acts across the shoulder and elbow joints. At the elbow, it helps to bend the joint. At the shoulder, its function is more complex and incompletely understood.
Acromio-Clavicular Joint (AC Joint) Degeneration
This is the small joint on the top of the shoulder. It connects the tip of the clavicle (collar bone) to the acromion (shoulder bone). It is held together by ligaments between the two bones as well as strong ligaments between the collar bone and the coracoid (a protrusion from the shoulder blade).
Acromio-clavicular (AC) Joint Dislocations
The acromio-clavicular joint is between the clavicle (collar bone) and the acromion (shoulder bone). This injury usually results from a fall onto the tip of the shoulder or on to the back of the shoulder.
Os-acromiale is a loose / mobile acromion of the shoulder which may or may not cause pain. In the most cases the loose acromion may go undetected as it does not lead to any painful symptoms.
Injections around the shoulder joint are necessary for diagnostic and therapeutic reasons in the course of evaluation of shoulder pain. The injection consists of local anaesthesia and cortisone, either separately or mixed together.