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Until recently, stabilising repeated shoulder dislocations required complex "open" surgeries with extensive incisions. Recent years have seen a significant development of minimally invasive keyhole techniques (arthroscopy). The principle of the surgery is to shorten the loose joint capsule along with its ligaments, and to reattach the detached anulus fibrosus along with the joint capsule to the socket. In the course of this surgery, the labral capsular complex is attached to the bony margin of the shoulder socket using bone anchors. In most cases, our shoulder specialists, Dr. Lais, Dr. Mayer, and Dr. Schneider, are able to restore good shoulder stability using this technique. The pain after the surgery is minor. Another surgery is not required due to the use of self-dissolving material.
Open surgery may be required in exceptional cases (e.g. in case of damage to the margin of the shoulder socket). The damaged structures are visible through a skin incision on the front of the shoulder. The joint capsule is tightened along with the ligaments, shortened, and attached to the margin of the shoulder socket (so-called capsule shift). Areas of concomitant damage to the tendons (rotator cuff) are sutured.
The arm that was operated on is protected with a shoulder bandage for 3-4 weeks. However, physiotherapy begins early on. Only a good working relationship between the surgeon, the physiotherapist, and the patient can good surgical results. Overhead sports like tennis, badminton, volleyball etc. may only be practised again after approx. 6 months. The prognosis after surgical shoulder stabilization is very good.
The aim of the surgery is to reattach torn tendons to the humeral head to ensure normal load transmission. Inflammatory structures and painful, bony hooks must also be removed. In the case of small tears, this can be done using the minimally invasive keyhole technique (arthroscopy). Most often, however, an open surgery is required. Through a small skin incision on the front of the upper arm, our shoulder specialists Dr. Lais, Dr. Mayer, and Dr. Schneider examine the torn tendons and attach them to the humeral head using special bone anchors. Additionally, the sliding space of the tendon underneath the subacromial space is expanded (acromioplasty) so as not to jeopardize the tendon suture.
The long biceps tendon is jointly responsible for lifting the arm forwards. Due to its complex course, it often becomes inflamed or gets injured. We often find tendon tears at the upper margin of the joint socket (so-called SLAP lesions), which are caused by an accident. It is necessary to reattach them. In case of chronic tendinitis or partial tearing of the tendon, severing the tendon completely (biceps tenotomy) may be helpful.
Rehabilitation after rotator cuff surgery
Immobilization after the surgery is only necessary for a few days. The rehabilitation is lengthy (approx. 3-6 months), and must be carried out consistently. Early mobilization is essential to avoid adhesions. Overhead movements should be avoided for 6-8 weeks.
The minimally invasive keyhole technique (arthroscopy) allows for optimal assessment of the shoulder joint and the subacromial space. It also allows for treatment of the pathological finding at the same time. Our shoulder specialists, Dr. Lais, Dr. Mayer, and Dr. Schneider often find a chronically inflamed synovial bursa and tears in the tendons of the so-called rotator cuff. The bursa is removed and the cuff is smoothed. The lower margin of the subacromial space is filed down and smoothed in order to expand the sliding space for the tendons. Only a few small skin incisions are required. If there are additional symptoms and signs of wear (= osteoarthritis) on the acromioclavicular joint (connection between the clavicle and the shoulder), the protruding bone attachments can be polished. If there is advanced osteoarthritis of the AC joint, it is possible to remove parts of that joint. This will restore mobility as there can no longer be any friction pain.
The calcium deposit can usually be removed without any problems using minimally invasive keyhole technology (arthroscopy). The gliding space underneath the subacromial space is examined during the surgery. Sections of the inflamed synovial bursa are removed using mini cutters. Our shoulder specialists, Dr. Lais, Dr. Mayer, and Dr. Schneider investigate the tendons of the rotator cuff using a special small instrument. Once they have located the calcium deposit, they split the tendon and remove calcium. The intervention can be performed on an outpatient basis or during a short hospital stay.
The joint is gently widened using minimally invasive keyhole technology (arthroscopy). In particularly difficult cases, the capsule can be split and the inflamed synovium partially removed (= synovectomy).
Follow-up treatment; rehabilitation period:
Rehabilitation after a shoulder surgery takes 3 to 4 months. Functional follow-up treatment starts early on without the arm being immobilized for a long time. As early as on the day of the surgery, we start a gentle mobilization to stop adhesions from forming in the joint. The patient must be very disciplined in the course of his or her follow-up treatment in order to achieve optimal functional results and freedom from pain. In some cases, we also use a CPM splint for passive shoulder movement. It is often necessary to use anti-inflammatory medication. The results after shoulder surgeries are considered good.
Shoulder joint replacement is carried out under general anaesthesia. The joint is inserted at the front of the shoulder through a cut that is only 10 cm long. The surgery by the shoulder specialist Dr. Mayer or Dr. Schneider takes 90-120 minutes.
Physiotherapy starts already on the first day following the surgery. For the first 6 weeks, active internal rotation must be avoided, as well as outwards rotation beyond the neutral position. A tubular bandage is worn at night to immobilize the patient. A loose sling is sufficient during the day. The patient stays in the hospital for a short time. This may be followed by inpatient rehabilitation over a period of 3-4 weeks. The physiotherapeutic treatment is then carried out by selected therapists on an outpatient basis. The surgeon regularly monitors the rehabilitation. The close cooperation between the surgeon and the physiotherapist guarantees the maximum safety and improves the result of the surgery in terms of improved functions and freedom from pain.
If patients experience any problems after the surgery, we ask them to come back to our hospital. This will allow us to ensure optimal healing, and quickly address any complications.