Dr Tan Chyn Hong, an orthopaedic surgeon practising at Mount Elizabeth Novena Hospital, explains how many shoulder problems can be effectively treated with minimally invasive surgery.
In general, younger patients tend to have sports injuries which result in repeated dislocations, while older patients tend to suffer from frozen shoulder or tendon tears.
With minimally invasive keyhole techniques, patients experience less pain and faster recovery, and have small surgical scars that are cosmetically pleasing.
Frozen shoulder
Frozen shoulder is a condition where the connective tissues around the shoulder joint contract. The shoulder then stiffens up, resulting in difficulty and pain during movement. Patients can feel very helpless with this condition.
If you have a painful or stiff shoulder, you will find it difficult to partake in sports like swimming or tennis which requires good range of motion in your shoulder. Some may even have difficulty with simple tasks like sleeping, dressing and combing their hair.
Mrs X is a 50-year-old who came to me complaining of right shoulder pain and stiffness for the past 3 months.
She tried to live with the pain and stiffness but the final straw came when she couldn't put on her bra. She couldn't reach the clips at the back and had to ask her maid to help dress her.
Symptoms of frozen shoulder
Frozen shoulder normally develops slowly, going through three stages. Each of these stages can last for months, and some people may find the pain gets worse at night.
Freezing stage
In this first stage, any movement causes pain and your shoulder's range of movement is affected.
Frozen stage
In this phase, you may feel less pain. However, the stiffness in your shoulder will worsen, making movement more difficult.
Thawing stage
This final stage is when your range of motion begins to improve.
Treatment for frozen shoulder
On its own, frozen shoulder can take about 2 years to get better.
With minimally invasive keyhole surgery, patients experience less pain and faster recovery, with cosmetically pleasing surgical scars. The surgery involves putting a small camera into the shoulder and releasing all the tight connective tissues responsible for the stiffness.
Rotator cuff tear
The rotator cuff is a group of muscles and tendons that surround the shoulder joint. They can become damaged through injury or overuse. While it becomes more likely as you get older, younger people are also not spared especially if their work requires frequent lifting of their arms above their head, such as painting.
Symptoms of rotator cuff tear
Common symptoms include a dull ache deep in the shoulder that makes it difficult to reach behind your back or raise your arm to comb your hair. It may also be accompanied by a feeling of weakness in the arm.
Some people find that the pain interferes with their sleep, as one of my patients experienced.
"Doctor, I can't sleep. I keep waking up with this terrible pain in my left shoulder."
Mr Y is a 60-year-old who had a torn tendon in his left shoulder. He was visibly distressed by the constant pain at night. He would wake up from the sharp pain when he turned to sleep on his left side.
Mr Y was very puzzled when the ultrasound scan showed a torn tendon as he couldn't remember sustaining any injury to his shoulder.
I explained that there was a bone spur in his shoulder and it would cut into the tendon whenever he raised his arm. The constant attrition eventually caused the whole tendon to tear through.
Unfortunately, a torn tendon doesn't heal by itself. I performed keyhole surgery on him, removing the bone spur and repairing the torn tendon.
Treatment for rotator cuff tear
Keyhole surgery to repair rotator cuff tears, also known as arthroscopy, is a procedure that requires a small cut to allow your doctor access to the affected area. Using small tools, he or she can then reattach the torn tendons to the bone.
In some cases, conventional open tendon surgery may be more suitable, or your doctor may recommend a tendon transfer instead if the torn tendon is too damaged to be reattached. For severe injuries, some patients may require shoulder replacement surgery instead, in which an artificial joint will be implanted.
Physiotherapy can help to strengthen the other muscles surrounding the shoulder and may help to decrease the pain and improve the strength.
Shoulder dislocation
A dislocated shoulder means that the upper end of your arm has popped out of its socket in your shoulder blade.
Symptoms of shoulder dislocation
A dislocated shoulder is usually clearly visible. It may look like the shoulder joint is deformed or not in its usual position. Usually, it is the result of a strong force or impact, and a person with a dislocated shoulder is likely to feel intense pain and be unable to move their shoulder. It is normally accompanied by swelling and bruising.
Student Z, 17, plays rugby for his school. His right shoulder was dislocated during a rugby tackle. The blow caused the top of his arm bone to pop out of the shoulder socket.
His coach pushed it back into the shoulder socket and Z managed to finish the game.
However, his shoulder started feeling 'loose' and it dislocated again when he was doing pull-ups.
An MRI scan showed that there was a tear in his shoulder labrum, which is the stabilising structure in the shoulder joint. The chance of Z having recurrent episodes of dislocation was as high as 90%.
Having the torn labrum repaired via keyhole surgery could reduce the dislocation risk to less than 10%, and patients may be able to return to their former level of activity in a few months.
Treatment for shoulder dislocation
Positioning the arm bone back into its socket without surgery is a procedure known as reduction. However, there is a high risk the dislocation may occur again, as Z experienced.
Through keyhole surgery, which requires only a small incision, damaged ligaments or tendons caused by shoulder dislocation can be repaired. This can help reduce the risk of the injury recurring.
Once you recover from surgery, with the advice of your doctor or physiotherapist, you can slowly begin to exercise the arm and shoulder to relieve pain and build strength.
