Arthroscopy – Diagnosis and treatment of the shoulder pathology

The shoulder is a very complex joint. It is the joint with the greatest mobility in the human body. All hand movements which are essential for any activity of our daily lives, are controlled by the shoulder.

Any pathology that affects this complex shoulder joint becomes highly uncomfortable when accomplishing simple day-to-day tasks, mainly due to associated pain, but often also incapacitating from a functional point of view; for example, dressing/undressing and personal hygiene.

In order to have a healthy shoulder the integrity and correct functioning of all the anatomical structures involved is indispensable.

Pain is the main complaint related to the shoulder, and it is also the main reason for the patient to seek medical help. Shoulder pain can be attributed to any of the anatomical structures of the shoulder.

Depending on age, and whether the pain is associated with trauma, several pathologies should be considered.

The most frequent pathologies are: tendon injuries (inflammation, calcification or rupture) of the rotator cuff (supraspinatus, infraspinatus, subscapularis), inflammation of the subacromial bursa with eventual mechanical conflict (subacromial impingement syndrome), joint cartilage lesions involving the humeral head and the glenoid cavity on the shoulder blade (arthrosis), capsule lesions and ligaments that stabilise the shoulder (dislocation).

Other problems such as adhesive capsulitis (or frozen shoulder), lesions of the long head of the biceps, minor instability, acromioclavicular joint pathologies, among others, are less frequent and more difficult to diagnose, with complementary diagnosis often giving us little information. In these cases a physical medical examination is fundamental for diagnosis and treatment.

Arthroscopy of the shoulder, which first began in the 20th century, has greatly improved the ability to diagnose and treat problems of the shoulder joint, leading to a very significant improvement in the results obtained.

Arthroscopy is a mini-invasive technique where, through small incisions (approximately 0.5 cm), a camera and instruments are introduced. This allows direct visual access of all shoulder joint structures and simultaneous treatment of the lesion. The advantages are less tissue destruction to reach the affected joint and consequently less postoperative pain and greater speed in the rehabilitation process when compared to conventional open surgery.

From an aesthetic point of view the small incisions usually become imperceptible at the end of a few months, avoiding large scars. Using this arthroscopic technique helps to significantly increase diagnostic accuracy and treat pathologies/diseases. This is due to the direct visualisation of the shoulder joint.

Patients who were condemned to live their lives with the diagnosis of “tendinitis” began to see their lesions diagnosed and treated.

There are lesions however that continue to require classic open surgery, due to the inherent pathology and necessary technique (fixation of fractures or arthroplasty, for example).

Following the highly diverse areas of Orthopaedics in recent years, the Hospital Particular do Algarve has an Orthopaedic Consultation since 2014 specifically dedicated to shoulder and elbow pathology.

This consultation is dedicated to the diagnosis and treatment of all injuries involving the complex shoulder joint, namely in the treatment of fractures, sports injuries, arthrosis or ligament and tendon injuries.

The unit is equipped to perform treatment of shoulder pathologies, both non-surgical and surgical (open or arthroscopic), always using the latest techniques and technology available.

By Dr Diogo Silva Gomes
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Dr Diogo Silva Gomes is an Orthopaedic Surgeon specialising in shoulder pathology, working at Hospital Particular do Algarve