Bois Bernard Private Hospital
Making appointments: 03 21 79 26 56
Secretariat: 03 21 79 26 36
Some treatments for the shoulder ...
The information in this section describes the principles of the different possible treatments, a few technical notions... The objective is to give you some general answers,
but this information can in no way replace the personalized information that your surgeon may give you during a consultation.
Different treatments are possible
The treatment that will be offered to you will take into account the severity of the lesions but also the use you make of your shoulder as in your professional, sports or leisure activities. To establish an effective diagnosis, your surgeon will need an X-ray as well as an ultrasound or an MRI to assess the condition of the tendons.
​
medical treatment
At first we can fight against pain and inflammation by prescribing analgesics and anti-inflammatories. Appropriate rehabilitation will also help restore shoulder flexibility and develop compensation for other unaffected muscles. These medical treatments can sometimes be enough to provide lasting relief from painful phenomena, however a ruptured tendon cannot heal naturally.
Surgical treatment of the shoulder
The first operative stage consists of freeing the subacromial space, the second stage of repairing the damaged tendons.
the rotator cuff repair is performed arthroscopically in surgery ambulatory .
When certain ruptures cannot be repaired either because they are too old, too wide or too retracted, the surgical intervention of arthroscopic decompression , relieves painful phenomena related to subacromial impingement.
In all cases, appropriate rehabilitation must be carried out with seriousness and motivation to obtain the best possible long-term result.
​
The treatment of unruptured tendinopathies is above all medical and re-education .
It is based initially on resting the shoulder, taking non-steroidal anti-inflammatory drugs, and corticosteroid injections in the most painful forms.
On a supple and painless shoulder, muscle rebalancing work for the benefit of shoulder depressors is secondarily implemented.
Calcifying tendinopathy of the shoulder is manifested by inflammatory pain, often insomnia and which can be exacerbated when the calcification appears or disappears.
Radiological diagnosis is essential to characterize the situation and the type of calcification. The repetition of radiological images is useful over time to judge the evolution of a calcification, or even its spontaneous disappearance.
It is a benign and very common condition, affecting especially women whose age is between 30 and 50 years old.
​
The first treatment to be offered is a drug treatment including analgesics and anti-inflammatories.
​
An infiltration is often proposed.
The treatment representing the best risk benefit is a washing puncture performed under local anesthesia, guided by ultrasound. The washing puncture eliminates the calcification. The painful symptom disappears in 3 to 4 weeks.
However, depending on the size of the calcification, arthroscopic surgery may be required to remove it. This intervention requires a very short hospital stay, on an outpatient basis.
The acromion is an arch-shaped bony rim that passes over the humeral head and the rotator cuff, it can be felt by passing the hand over the top of the shoulder. When osteophytes (bone spurs) develop there, the acromion can become aggressive for the tendons of the rotator cuff and cause painful inflammation: the subacromial impingement.
The intervention of subacromial decompression or acromioplasty under arthroscopy of the shoulder consists in making two small incisions which will allow the introduction of the optical fiber and the mini surgical instruments into the joint.
First of all, the surgeon will observe the state of the lesions of the tissues (muscles and tendons), of the cartilage and the formation of any osteophytes (bone beaks), in order to adapt his intervention very precisely to the lesions observed; we are talking about operative planning.
During the first operation, an instrument called a "shaver" is introduced, i.e. a kind of motorized cutter to perform the resection of the subacromial bursa, if the tendon of the long biceps is inflammatory or pathological (dislocated, ruptured) , a release of the tendon will be performed (tenotomy).
The second operation is that of bone resection, ie "flattening" of the acromion.
When the humeral head dislocates and comes out of the cavity of the glenoid, we say that the shoulder "dislocates". If the first shoulder dislocation generally occurs accidentally, the repetition of the phenomenon can lead to significant bone and muscle damage. ​
​
Treatment of instability first requires specific rehabilitation, emphasizing muscle strengthening (particularly of the medial rotator muscles) and proprioceptive work (proprioception work is based on rehabilitation of postural adjustment, balance and movement of the body in space. It improves the ability to anticipate muscle contraction).
In case of failure: recurrence of instability or persistence of pain, your surgeon may be required to offer you surgery.
​
Two techniques exist:
-
The coracoid stop , which consists of positioning the coracoid process (part of the scapula) on the anterior edge of the glenoid. It is the most reliable intervention, the risk of recurrence is less than 2%.
After the operation, the shoulder will be immobilized in a splint for 15 days. The postoperative rehabilitation protocol will begin after weaning from the splint.
-
Arthroscopic Bankart: procedure performed under arthroscopy of the shoulder which tightens the injured ligament plane.
When throwing, the shoulder acts like a catapult. Armed with the arm, the humerus constitutes an axis of rotation around which the soft parts are wound, particularly the ligaments and the muscles. This area is the center of the lower part of the glenoid.
The shoulders considered to be at risk are those which present a deficit of internal rotation and/or a malposition of the scapula (SICK scapula). What makes a shoulder pathology serious in a thrower is the appearance of glenohumeral intra-articular lesions.
This combination is particularly dangerous for the postero-superior bead, the inferior and posterior part of the supraspinatus and the antero-inferior capsular complex. The clinical examination must be complete, focusing on any pathologies of the kinetic chain concerned during the sporting gesture. An examination of the spine (lumbar) and lower extremities will look for asymmetry of mobility.
The arthro-scan or the arthro-MRI look for lesions of the glenoid bulge and the rotator cuff.
​
The vast majority of patients respond to rehabilitation treatment combining a postero-inferior capsular stretching program with specific scapula repositioning rehabilitation.
Here, it is essential to analyze the sporting gesture in an extremely precise way in order to look for a movement that is particularly damaging to the rotator cuff. The reprogramming of the throw is adapted in order to limit micro traumas and overuse lesions as much as possible.
Surgical treatment of the thrower's shoulder can only be done under arthroscopy. There is indeed no traditional surgical way to reach and repair the glenoid insertion of the biceps longus with implant-mounted wire suture.
.jpeg)
Medical treatments
At first we can fight against the pain and inflammation of the joint by prescribing analgesics and anti-inflammatories. Appropriate rehabilitation will also help to keep a flexible shoulder and fight painful phenomena.
An infiltration of anti-inflammatories or viscosupplementation may be suggested to you by your general practitioner or your rheumatologist.
These medical treatments aim to temporarily relieve you but do not prevent the progression of the disease.
​
The surgical intervention
It consists of replacing the damaged parts with prosthetic parts. There are two kinds of shoulder prostheses:
Allows you to replace only the humeral head (hemi-arthroplasty) or both surfaces of the humeral head and the glenoid (total shoulder prosthesis). It consists on the one hand of a metal humeral head fixed by a rod anchored inside the bone of the arm (humerus), and on the other hand of a polyethylene cup fixed by studs on the articular surface of the glenoid of the scapula. This anatomical prosthesis allows a good restoration of mobility if the muscles and tendons of the rotator cuff are in good condition.
When there is a significant and irreparable rupture of the rotator cuff associated with osteoarthritis of the shoulder, the placement of an anatomical prosthesis does not allow the mobility of the joint to be recovered. Indeed, during the attempt to raise the arm, the head of the humerus is no longer stabilized by the rotator cuff, does not remain centered facing the glenoid and can no longer turn around the center of rotation to allow arm elevation. One can then opt for a total reverse prosthesis which stabilizes the humerus in front of the glenoid by articulating a humeral cup with a sphere fixed to the scapula.
