Shoulder Problems

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The shoulder, also called the glenohumeral joint, is a ball and socket joint that has the ability to allow rotation of the arm through a wide range of motion, more than any other joint in the body. The rounded ball shaped humerus head fits in the cup shaped glenoid fossa of the scapula. The glenoid covers only a small portion of the humerus head and is deepened by the fibro-cartilaginous labrum to which the capsule and conjoint ligaments of the glenohumeral joint attach. These structures keep the humeral head in place on the socket.

The joint capsule that surrounds the joint is lined with synovial membrane. This synovial membrane secretes synovial fluid which lubricates the joint, absorbs shock and also feeds the cartilage.

Four rotator cuff muscles and their tendons, namely the supraspinatus, infraspinatus, subscapularus and teres major attaches the humerus to the scapula and stabilise the shoulder while it also allows the shoulder to rotate.

The scapula, of which the glenoid forms a part, is attached to the thorax wall with different groups of muscles. These muscles allow a wide range of motion of the scapula in relation to the thorax and also stabilises the scapula on the thorax. It also has a shock absorbing function and is responsible for positioning the glenoid in relation to the humerus during movements and changes of position of the arm. 

The acromioclavicular joint joins the scapula to the clavicle. It is a small, gliding type of joint that is fixed to the scapula by 2 groups of ligaments.

The clavicle is in turn attached to the sternum by the sterno clavicular joint and its stabilising ligaments. The clavicle is thereby the only bony attachment of the arm to the trunk.

Complications are not common but may occur. Please discuss any questions regarding anesthesia complications with the anesthetist who will see you before surgery. Please tell the anesthetist if you are allergic to any medication or if you are currently taking any medication.

Precautions taken to prevent infection include special skin preparation, sterile techniques and the use of antibiotics where appropriate. However, if infection does occur, it may mean further surgery or hospitalisation.

Swelling arises as a result of the fluid used during the arthroscopic procedure and it usually clears up within a few hours after the operation. Bleeding that may occur is usually in the form of spots on bandages. In some cases, excessive blood collection in the shoulder or elbow joint must be removed.

The joint capsule around the ligaments can respond to the operation and restrict the mobility of the shoulder for a period after such a procedure. This contracture can sometimes continue for 2 to 3 months after surgery. It usually clears up completely. An exercise program for such contractures is initiated from shortly after the procedure but the degree of such a contracture varies from person to person. Need for further surgery to clear such a contracture is rarely needed.

It is possible that a portion of a small surgical instrument may break down within the joint. This complication is rare and if it happens it can usually be removed with arthroscopic techniques. In some cases an incision may be needed to remove the part of a tool.

A few smaller nerves and some very important nerves cross the joint where the surgery is done and can be damaged by an surgical procedure. This complication is rare, but when it happens it can have serious consequences that may require additional surgery.

Small sensory nerves lie directly under the skin near the incision areas for arthroscopy. During the incision it is possible to damage these small nerves with the result of an area of sensory loss or a focused area of pain and skin sensitivity. These symptoms usually clear up over time.