Breakthroughs in shoulder
surgery

Exploring the latest advancements, techniques and
innovative approaches in Shoulder Surgery

Dr. Chintan Desai - MS Ortho, Shoulder Surgeon (USA, Australia, Korea, Portugal)
www.desaishoulders.com
desaishoulders@gmail.com
Appointments - 70453 47654

Shoulder pain has often always been labelled as frozen shoulder. This incorrect diagnosis is the
reason why shoulder pain becomes long standing and the standard approach to it’s treatment
fails.

However, let’s try and understand here that not all shoulder pain is due to a frozen shoulder.

Let’s breakdown why your shoulder is painful

The following are some causes where the shoulder is painful but the problem is elsewhere

• A heart attach - Chest pain that radiates to the left shoulder
• Cervical spondylosis - Neck pain that radiates to the shoulder arm and the arm with associated
tingling numbness
• Gall bladder inflammation - Irritation of the diaphragm due to an inflamed gall bladder radiates
to the right shoulder

The following are causes of shoulder pain and restriction of shoulder movements where the
problem is in the shoulder itself. The shoulder joint is made up of the ball and socket joint, the
capsule and the rotator cuff muscles and tendons. Conditions affecting any of these structures
cause shoulder pain.

• Adhesive capsulitis or frozen shoulder
• Shoulder Dislocations
• Rotator cuff Tendonitis or tendon inflammation
• Rotator cuff tears
• Shoulder joint arthritis

The first step towards treatment is to understand the cause of pain

Clinical examination and investigations like X-rays and MRIs help us get the accurate diagnosis.

Frozen shoulder or adhesive capsulitis
This is common cause of pain the 40 - 60 year old age group. These patients also have
associated diabetes or hypothyroidism. The reason for stiffness is thickening of the capsule. The
muscles and labrum structure are normal in MRI. It is only then that a diagnosis of a frozen
shoulder is confirmed. Traditional treatment in the form of physiotherapy and medication is time
consuming and takes upto 2 years for the shoulder movements to return. The latest and the most
successful treatment is a key hole surgery. The thicken capsule is released. The advantage is that
the movements return in 1 week and strength in 1 month.

Shoulder Dislocation
In a patient with shoulder dislocation the ball slips out of the socket. This is an emergency
situation when in happens and requires immediate treatment to put the ball back into the socket.
However, this is not the final treatment. Once the shoulder dislocates it causes a tear in the
labrum (miniscus like tissue in the shoulder). Hence the shoulder always remains unstable and has
a 90 percent chance of a repeat dislocation.
This condition can be permanently solved today with surgery. There are several procedures
described in studies, however the latest treatment that gives the best results where the
dislocations stop and the movements return normally are the following. Most patients are return
back to sport after this treatment.

• Shoulder arthroscopy and Bankart repair
This is the latest keyhole surgery technique to repair the torn labrum after a dislocation. This is
most successful if done early after the first dislocation when the quality of the labrum is good.

• Latarjet
This is the most successful operation in patients with recurrent dislocations and high demand
athletes like wrestlers or kabaddi players. This involves transferring a small piece of bone to the
front of the socket.

Rotator cuff
The rotator cuff are 4 muscles and tendons in the shoulder

• Rotator cuff tendonitis/inflammation
This is the commonest cause of shoulder pain. The overhead movements are painful. The best
way to treat is with an Ultrasound guided injection to allow the medicine to be delivered exactly in
the inflamed tissues. Physiotherapy is recommended after the injection to improve strength.

• Rotator cuff tendon tears
Tendon tears cause significant shoulder dysfunction. They occur after an injury like lifting weight
or after falls. They may also be age related wear and tear. Complete tears and >50 % partial
thickness tears are best treated by a key hole surgery called arthroscopic rotator cuff repair. The
results are excellent if done early. If these tears are left alone, they worsen and the quality of the
tissue deteriorates with time. This is when shoulder joint wear and tear begins and this condition
is call rotator cuff tear arthritis. Once a patient reaches this stage of the disease, the only option is
shoulder replacement.

Shoulder arthritis
A patient who is over 60 years of age with a painful and stiff shoulder should be investigated for
shoulder joint arthritis.

Yes SHOULDERS can also be successfully REPLACED.

Shoulder replacements are the only way to permanently treat a worn out joint. Shoulder arthritis or
wear and tear is of 2 types

1. Arthritis with normal muscles and tendons
2. Arthritis with torn muscles and tendons

The material or implant required for a successful surgery is different for these 2 types of arthritis

Broadly

1. Anatomical shoulder replacements means the ball is replaced with a ball and the socket
with a socket, are used for patients with worn out joints but have normal muscles and
tendons. Stemless shoulder replacements are a type of anatomical shoulder replacements
with a smaller implant to preserve native bone.

2. Reverse shoulder replacements are the latest advance in shoulder replacement technology.
Reverse shoulder means a ball in implanted in the socket and a socket at the ball side of the
joint. This reverses the geometry of the shoulder joint. This is required to bring back function in
a patients joint which has arthritis and torn rotator cuff tendons.

These new techniques and advances are now studied for over 20 years of research and are
improving the patients outcomes and the overall quality of life.