Shoulder Open & Arthroscopic Shoulder Surgery
At the Cape Shoulder Institute, arthroscopic surgery, being a minimally invasive diagnostic and treatment procedure utilising a small, lighted, optic tube, is performed regularly. Many procedures can be carried out utilising this technique, some...
Open 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.
The osteo-arthritic symptoms: Shoulder joint becomes painful with limited range of motion and night pain can be an important feature. A “grating” feeling may be experienced in the joint and this may even be audible. A feeling of catching or slipping may also be felt due to the rough surfaces moving over each other.
Frozen shoulder symptoms are severe pain and restriction of movement. Night pain can be especially troublesome and with sudden movements intense pain may follow, e.g. reaching out to grab something. Reaching the hand up behind the back is usually a problem due to the restriction. To reach overhead the shoulder blade has to be lifted (see picture below)
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Pain on top of the shoulder: May be caused by acromio-clavicular (AC joint) problems, namely:
AC Joint Degeneration and AC Joint Dislocation. -
Pain in the shoulder and outside of the upper arm: Rotator cuff problems may have this pattern,
see Rotator Cuff Tears -
Pain at the back of the shoulder: Consider Arthritis of the Shoulder.
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Pain in the neck and upper part of the shoulder: May be caused by referred problem from the neck.
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Pain in the neck, shoulder and radiating down the arm into the hand: Consider neurological problems like disc problems in the neck or Thoracic Outlet Syndrome.
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Night pain: Pain at night occurs with most shoulder problems. Usually shoulder instability does not affect sleep but most other conditions do when a person lies down at night. The reason is that any inflammation is worse when the position of the structure is lower due to the pressure effect of gravity – in the upright position the shoulder is elevated.
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Constant or intermittent pain: Most mechanical reasons for pain e.g. Rotator Cuff Tears, mostly cause pain with certain movements like lifting the arm. On the other hand certain conditions cause constant pain unrelated to movement – these would be pain from nerve conditions like referred from the neck or Thoracic Outlet Syndrome.
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Severity of the pain:
Acute “blinding” pain usually occurs with calcific tendonitis when the calcium is being absorbed. Other conditions may cause intermittent pain depending on position of the arm and the activity. If the pain is constant and running from the neck down to the shoulder and hand it is most likely from a nerve problem in the neck or thoracic outlet. If the pain is more mechanical (occurring with movements only) it would suggest a damaged structure in the shoulder.
This condition usually causes pain on top of the shoulder. There is often some swelling in this area and tenderness with pressure. The pain can refer medially to the trapezius and collar bone area. Sleeping on it usually causes pain and certain arm movements such as moving the arm across the body, behind the back and also high up overhead, elicit the pain: Exercises in the gym like bench press, push ups and overhead lifting motions can make the pain worse.
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