Heavy demands, such as continuous work with hands held over the head or sports like tennis, badminton, and intensive weightlifting, also lead to irritation and inflammation of the mucous membrane under the shoulder roof. The result is an impingement syndrome under the bony shoulder roof. Calcification areas in the tendon, tears in the tendon, bony protuberances under the shoulder roof, or arthroses in the shoulder joint can also be the cause of these pains. Pains occur principally in lifting things high to the side or in the over the head position. Work over the head is painful or sometimes even impossible. In the initial phase, relief can be achieved with physical therapy, taking medications to reduce inflammation, injections under the shoulder roof, and the avoidance of over the head work. However, without treatment, the pains will get stronger, last longer, and occur even at night. It becomes barely possible to lie on the affected shoulder. Inflammation then occurs in the chronic stage, and overlaps onto the muscle cuff. The arm can then be lifted to the side only with great effort. Many patients report arm weakness. It is often in this phase that the first tears of the rotator cuff are determined. The shoulder becomes increasingly immobile and gradually become stiff. If the ailment is already in this stage, then conservative forms of treatment can help only in rare cases.
Technique of the operation
Endoscopy of the joint (arthroscopy) allows the best evaluation of the shoulder joint in the area under the shoulder roof; at the same time it permits a diagnosis of the ailment. Very frequently we find a chronically inflamed mucous membrane and tears in the rotator cuff. The mucous membrane is removed, and the muscle cuff is smoothed out. The lower edge of the shoulder roof is planed off and also smoothed in order to expand the sliding room for the tendons. Only very few incisions in the skin are necessary. If additional pains occur with symptoms of wear on the shoulder corner joint (arthrosis), then bony protuberances that may occur can be polished off. In advanced shoulder corner joint arthroses in this joint, in may be necessary to remove part of the shoulder corner joint in the operation.