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-Knee -Ankle -Shoulder -Elbow -Hip -Wrist Anterior Cruciate Ligament Reconstruction Posterior Cruciate Ligament Reconstruction Arthroscopic Stabilisation Of The Unstable Shoulder Acromio-Clavicular Joint Arthritis Arthroscopic Rotator Cuff Repair |
Managing
Shoulder Golfing Injuries with Keyhole Surgery. Dr THO Kam San Consultant Sports Surgeon ISLAND
Orthopaedic Consultants
Mount Alvernia Medical Centre, Singapore
The
shoulder joint is designed to give a large amount of movement to enable us to
swing and throw with relative ease and with great force. It is often described
as a golf ball on a tee peg and is a ball and socket joint, with the ball much
larger than the socket. This results in greater mobility but the price to pay
for greater flexibility is reduced stability. Therefore support from the
ligaments and muscles is essential. Connecting the shoulder girdle to the trunk
is the acromioclavicular joint, which is a relatively rigid joint. Around the
shoulder joint lies a group of muscles known as the rotator cuff which moves the
shoulder up against gravity.
2.
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Rotator-cuff tear
Arthroscopic
Shoulder Surgery
Arthroscopy has revolutionized the treatment of these
shoulder problems. Most primary procedures are suitable for keyhole surgery and
the shoulder joint is one of the commonest joints where arthroscopic procedures
are performed. Advantages of the arthroscopic method include less tissue damage,
less blood loss, less post-surgery pain, being done as day case surgery with
shorter period of time off work, better cosmesis and less stiffness.
Acromioclavicular
Joint Arthritis and Arthroscopic Decompression of AC Joint The
acromioclavicular joint or ACJ is situated at the outer end of the collarbone.
As the ACJ is relatively stiff, it is subjected to high forces. This result in
overuse injury and may progress to ACJ arthritis. A typical presentation is a
sharp pain over the bump of the golfer’s left shoulder at the top of his back
swing, with almost immediate relief upon lowering the arm. Treatment includes
anti-inflammatory medication, physiotherapy and steroid injection into the
joint. Swing modifications include shorter backswing and recruiting the
pectoralis and latissimus dorsi in the downswing. In
advanced arthritis, surgical decompression of the joint will bring relief to the
golfer. The surgery done through keyholes, involves shaving 1 to 1.5 centimeters
of the outer end of the collarbone. Subacromial
Impingement and Arthroscopic Subacromial Decompression The subacromial area lies between the top of the humerus and acromion. A muscle and bursa lies between the humerus and the acromion. With certain positions these structures can become pinched and inflamed. The pain that you have been experiencing is caused by this pinching and is typically felt on movements such as reaching and putting your arm into a jacket sleeve. The golfer experiences pain when the trailing shoulder is at the end of the backswing. A shorter and flatter swing can help moderate the pain. If medication and physiotherapy fail to eliminate the pain, surgical decompression is necessary. The operation is done by ‘key hole surgery’; usually through two 5mm puncture wounds. It involves shaving away part of the acromion bone. This increases the size of the subacromial area and reduces the pressure on the muscle and bursa allowing them to heal.
Shoulder Instability and Arthroscopic Stabilisation Of The Unstable
Shoulder
Torn shoulder ligament Repaired ligament Rotator Cuff Tear and Arthroscopic Rotator Cuff Repair The rotator cuff consists of four muscles and their tendons. These surround the ball of the shoulder joint. The muscles fine tune the movements of the shoulder joint and assist other large muscles in moving the arm. The tendons run under the acromion (part of the shoulder blade) where they are very vulnerable to being damaged. This can lead to a tear resulting in a painful, weak shoulder. Not all rotator cuff tears can be treated arthroscopically. Large tears, which cannot be mobilized sufficiently to its insertion, should be treated with open technique. Smaller tears of less than 1.5 cm retraction are the ideal candidates for arthroscopic repair. The technique and equipments used is similar to that for arthroscopic shoulder stabilisation with the use of suture anchors. Conclusion With the development of better implants and techniques, arthroscopic surgery has revolutionized the management of shoulder injuries. Results of treatment are similar and in certain instances, superior to open procedures, enabling the patient to return to normal function early. Many professional sportsmen and women are able to resume training within one to two weeks of an arthroscopic procedure. Good post surgery physiotherapy is essential and gradual return to training is important to protect any reconstruction. |