Treatment of the shoulder joint

The International Center for Orthopedics specializes in the treatment of the shoulder joint. Due to its anatomical structure, the shoulder is one of the most mobile joints in the human body.The large range of motion is possible because the shoulder joint does not have a solid skeleton, but is held together and stabilized by numerous muscles, tendons, ligaments and capsules.

Learn below how a shoulder injury or disease manifests itself. What symptoms should you look out for and when is the best time to see a specialist? You can also find out what treatment options are available today and what rehabilitation can look like afterwards.

Typical shoulder injuries and conditions include

What is shoulder tightness syndrome?

Shoulder tightness syndrome is an anatomical tightness under the acromion with frequent accompanying inflammation of a bursa (bursitis subacromialis). The space between the humeral head and the acromion is crossed by the tendons of the rotator cuff. The constriction causes mechanical friction and even bruising of the tendons, for example when lifting or rotating the arm. A spur-like protrusion at the lower anterior edge of the acromion/acromion is often responsible for this. The so-called impingement situation, which causes the resulting tightness, often leads to inflammation with night pain and, in the course of time, also to restricted movement. If the shoulder tightness syndrome persists for a long time, the rotator cuff tendons – especially the supraspinatus tendon – can be mechanically damaged and also tear.

How to diagnose shoulder impingement?

To diagnose imgingement of the shoulder, an ultrasound and / or magnetic resonance imaging is performed in addition to the medical history and a clinical examination. In the early stages of the disease, the degree of discomfort can be temporarily alleviated by injection treatment (by means of an injection) under the acromion.

What is the best way to treat shoulder impingement?

Therapeutically, arthroscopy / minimally invasive surgery is therefore recommended. In this procedure, the inflamed tissue (bursa) is removed, as well as the bony spur. The bony spur is removed by means of a bone cutter. If necessary, a tendon suture can also be performed if appropriate damage has already occurred.

What is AC joint arthrosis?

AC joint arthrosis is a painful swelling of the acromioclavicular joint. In the course of time, cartilage is reduced and thus – similar to the hip or knee joint – arthrosis occurs. The resulting friction between two unprotected bones leads to pain. In addition to joint swelling, osteoporosis is often accompanied by bone spurs, so-called osteopaths.Some of these can already be inspected, provided they grow upwards towards the skin mantle. Frequently, nose-like spur formations occur downwards towards the rotator cuff tendons, so that a bottleneck syndrome/impingement also develops here.

How can AC joint arthrosis be treated?

Therapeutically, the bony spurs can be removed by arthroscopy / minimally invasive surgery. In addition – depending on the severity of the arthrosis – an abrasion of the lateral joint forming part of the clavicle is carried out.

What is an acromioclavicular joint separation?
Acromioclavicular joint dislocation is a strain or sprain of the shoulder joint and ligaments in the shoulder girdle area.
It is also referred to as a shoulder joint dislocation, which is caused in particular by external factors (such as an accident, a fall and other external effects). In most cases, it is a sports injury. This results in varying degrees of damage to the capsule and ligamentous apparatus, which can be classified with the help of a medical diagnosis and treated accordingly.
What does the abbreviation AC stand for?
AC is the abbreviation for acrominoclavicular joint that holds the clavicle together with the acromion.
What are the typical symptoms?
These include acute pain, swelling, bruising and bulging at the affected site. Often, a protective posture is also adopted, as the shoulder can no longer be moved completely and cannot be further loaded. The so-called “piano key sign” is also typical: If the elevated collarbone is pressed down, it automatically springs back up again when released. In this way, acromioclavicular joint dislocation can often be detected with the naked eye. A medical diagnosis provides further information about the severity of the injury.
What is being diagnosed?
Whether it is a simple strain, a tear or, in the worst case, a complete detachment of the acromioclavicular ligaments, is determined by various medical examinations. In addition to physical examination (including testing for pressure pain, functional limitations, or malalignment), radiographs help to make a more accurate diagnosis.
What are the treatment options?
Depending on this, the therapy options (conservative/surgical) are aligned accordingly. A slight dislocation can already be remedied with immobilization of the shoulder. In addition, physiotherapy or cold therapy can support the healing process. However, if it is a serious ligament tear, surgery will be necessary for stabilization.

What is a rotator cuff?

Mehrere Muskeln und Sehnen bilden die Rotatorenmanschette, welche das komplette Schultergelenk stabilisieren und für entsprechende Beweglichkeit des Armes sorgen.

What is the best way to treat a tendon rupture?

If a tendon tear of the so-called rotator cuff occurs in the shoulder area, for example caused by an accident or also due to wear and tear, these can be refixed within the first three months as part of an arthroscopy and with the help of a special suture anchor system. Subsequently, immobilization in a shoulder abduction cushion is required. Furthermore, mobility is restored within the framework of physiotherapeutic exercise therapy.

What is special about the biceps (brachii) muscle?

The biceps is the two-headed muscle in the upper arm (also called the arm flexor) that is responsible for flexion of the forearm. Both tendons differ in length and originate at the elbow joint. If one of the tendons tears, it is called a biceps tendon tear or rupture.

What therapy is useful for a biceps rupture?

In the case of injuries to the biceps tendon, which is anchored in the shoulder joint at the so-called labrum, different therapies are possible depending on the type of injury. For younger patients who are active in sports overall, detachment from the biceps tendon anchor is recommended if a slap lesion is present accordingly. The detached biceps tendon is then refixed further out in the so-called sulcus bicipitalis and by means of a special anchor system, and in this way function is restored.

Due to the peculiarity that the biceps tendon muscle has two tendon attachments in the shoulder region, detachment of the long biceps tendon at the anchor without reattachment is recommended in older patients. The tendon then slips out of the joint and is no longer troublesome here or no longer causes discomfort due to instability. It then grows into the sulcus bicipitalis and the tensioning function is ensured by the short biceps tendon that is still present.

How to recognize instability of the shoulder?

Shoulder instability can be congenital (habitual) or caused by an accident with dislocation of the humeral head from the socket (traumatic). Injuries to the so-called labrum often occur.

What is important in the diagnosis?

In individual cases, the consequences of injuries must be objectified, for example by sonography (ultrasound) and magnetic resonance imaging.

Which therapeutic treatment approach is recommended?

In young athletically active patients, surgical stabilization is recommended if there is evidence of a labral injury or concomitant injuries to the rotator cuff. In older patients, initial traumatic dislocation can initially be treated conservatively without surgery. However, in the event of a recurrence of dislocation, surgical stabilization, performed arthroscopically, is also recommended in this case. In the case of habitual shoulder instability, appropriate therapy must be initiated on an individual basis depending on the severity of the findings.

What is a shoulder fracture?

The term fracture means a break in the bone. A distinction is made between different forms of fracture. The bone can be partially or completely broken. External influences are usually the cause, such as a fall or impact.

What are the conservative / surgical treatments?

In the case of fractures of the humeral head or clavicle, depending on the displacement of the bony parts, either a non-operative, i.e. conservative or operative therapy is initiated. For this purpose, in addition to the X-ray examination, a computed tomographic clarification of the situation is often necessary in order to offer the appropriate and individually tailored therapy to the patient.

What is a frozen shoulder?

Frozen shoulder is a disease that occurs in three stages: 1) First, inflammation occurs in the shoulder. 2) In the further course, the affected person notices an increasing restriction of movement (therefore also called “freezing”). 3) In the further course, appropriate therapy can help to reduce the inflammation and improve mobility (“onset of freezing”).

What are the symptoms of those affected?

Those affected often suffer from permanent pain, which also occurs at night and disturbs sleep. Accordingly, sufferers position themselves on one side, which places additional stress on the shoulder. Imaging procedures such as sonography (ultrasound), X-rays and magnetic resonance imaging are therefore necessary for clarification.

In addition, the patients hardly move the arm due to the severe pain, so that there is an increasing shrinkage of the capsule and a frozen shoulder sets in.

What are the treatment options?

Initial treatment with inflammation-reducing medication and often also with cortisone (in the form of an injection or medication) is necessary at an early stage. Only when the acute pain symptoms have subsided is physiotherapeutic exercise treatment advisable.

If necessary, surgery can also help with frozen shoulder. This involves arthroscopy to remove inflamed tissue and also to loosen adhesions. Each anesthesia is followed by anesthesia mobilization, which may be followed by intensive physiotherapy.

What does therapy depend on?

Um den Schweregrad der Schulterverletzung richtig zu bestimmen, wird eine Klassifikation (nach Tossy/ Rockwood) vorgenommen. Die Zuteilung bestimmt dann die entsprechend passende Therapie, die bei der Verletzung notwendig ist. Man unterscheidet in folgende drei Typen:

Tossy/ Rockwood I – The AC joint is compressed, the capsule overstretched. The bones and especially the clavicle do not shift under load. Conservative therapy is used in this case.

Tossy/ Rockwood II – Es handelt sich um eine Teilruptur der Gelenkkapsel und der akromioklavikularen Bänder. Auch in diesem Stadium kann konservativ behandelt werden.

Tossy/ Rockwood III – Complete rupture of capsule and ligaments with horizontal and vertical instability. Since the so-called coracoclavicular ligaments are completely torn, the clavicle is significantly higher compared to the acromion (shoulder roof). Successful treatment can only be achieved surgically.

What is a calcific tendinitis?

Calcific tendinitis (tendinitis calcarea) occurs when a calcium deposit builds up in the tendon (attachment to the rotator cuff) of the upper arm. It is often a gradual process that can be divided into several phases:

  • Cell transformation – during this process the tendon tissue transforms into so-called fibrocartilage, which, however, still causes my pain
  • Calcification – as the cartilage partially dies, calcium forms. This can already be detected by imaging. This leads to constriction in the acromion (shoulder roof), so that the tendon becomes increasingly irritated
  • Resorption – an inflammatory reaction of the tendons and bursa (bursitis) follows due to resorption, which is now reponsible for severe pain in the upper arm

What is the cause of tendinitis?

The cause of tendinitis is not known. Middle-aged women in particular are affected, and calcific tendinitis manifests itself as a stabbing pain that worsens when the patient is lying down. Lifting the arm also becomes increasingly problematic to no longer possible and in some cases a thickening of the tendon is noticeable.

Using imaging techniques, calcified shoulder can be diagnosed and differentiated from other possible conditions such as osteoarthritis or tendon rupture. A calcified shoulder can be treated both conservatively and surgically. Conservative treatment methods include local injections and physiotherapeutic exercises.

How to treat calcified shoulder surgically?

If there is no improvement after prolonged use, arthroscopy (joint endoscopy) is recommended. With the help of minimally invasive surgery, calcium deposits can be removed extensively, without damaging the joints or the tissue. This therapy allows a return to the usual active daily life in only a few weeks. Immobilization of the arm is not necessary; on the contrary, physiotherapy leads to a faster recovery.