Ultrasound examinations don’t involve the use of X-rays. Their particular advantage is that structures can be viewed and diagnosed in motion. For instance, while an MRI (magnetic resonance imaging) shows an injury as a snapshot in time, sonography allows us to observe in real time what happens when the shoulder is moving. When an arm is moved and muscles are extended, we can see whether the tendon is only partly torn, gets pinched during the movement, or is fully torn and retracts.
SHOULDER MRI (NUCLEAR SPIN)
Magnetic resonance imaging doesn’t involve X-rays. For this type of examination, the patient lies in a sort of open tube. Tissues such as tendons, muscles, ligaments and fluids are displayed in layers that would not be visible in an X-ray image. Cartilage and labrum are visible on different planes. Areas that cannot be reached by ultrasound waves, are shown in MRI.
A CT (computed tomography) scan also examines planes, but using X-rays. It shows mainly bones, and not tendons, muscles and ligaments.
X-rays have been used to make images of bones for more than a hundred years. They show fractures and are important for diagnosing arthrosis and tumours.
Tendons, muscles and ligaments aren’t visible on X-ray images; they can only be shown by ultrasound or MRI.
A CT scan produces X-ray images in several planes and shows bones, but not tendons, muscles or ligaments.
Pain killers, hyaluronic acid, drugs or a person’s own centrifuged blood cells may be injected, depending on pain level and therapeutical need. Tendons, bursa sacs and cartilage can be treated, within and outside of the joint.
MINIMALLY INVASIVE ARTHROSCOPY
A cosmetically improved result through tiny incisions is one of many advantages of minimally invasive surgery and arthroscopy: patients of any age and fitness level can regain their functionality quickly because essential tissue doesn’t have to be compromised during the operation. There’s no need to detach muscles from a bone to make space, as in a completely open operation. The risk of bleeding is minimised, and the time under anaesthesia is shorter.
For an arthroscopy, the camera and tools used are thinner than a ballpoint pen; they slide between the muscle fibres without causing serious damage. Some instruments and materials are so small that they can’t be distinguished with the naked eye. Several screens are used for multiple magnification. This makes arthroscopy the most sophisticated microsurgery through state-of-the-art medical technology.
HAND SURGERY AND MICROSURGERY
When working on delicate structures in shoulders, elbows and hands, we use microscopes, magnifying glasses and camera magnification. Surgery on nerves and vessels requires precision instruments and materials which often can’t be used with the naked eye. Some sutures we use are thinner than a human hair.
When bones are subjected to stresses exceeding their natural elasticity, they break. Anatomic reconstruction is often required to regain full functionality, but also because the broken ends of a bone need to be re-joined to allow healing. In fact, some fractures cannot heal without medical treatment. Minimally invasive surgery isn’t primarily about cosmetic benefits; its main purpose is to allow patients of any age and fitness level to regain their functionality and performance as soon as possible. Minimally invasive procedures also have the advantage that muscles remain attached to the bones and other tissue remains intact; unlike open surgery, where tissue has to be severed to make space. When minimally invasive operations are performed for fractures, small incisions allow for the bone position to be restored without tissue, muscles, ligaments or skin being affected…
As for the collarbone (clavicle), the upper arm (humerus) and the shoulder blade (scapula), there are various procedures and materials that have to be chosen for treatment of the individual fracture. The classification of the AO Foundation (working group for bone fusion issues) is used worldwide to diagnose fractures. It forms an important basis for decision-making on whether and how to operate. Sometimes fractures can produce sharp splinters that may injure vessels or nerves if not treated correctly. If fractures heal in the wrong position, they can also result in destruction of joints (post-traumatic arthrosis). Without the right treatment patients might, in the long run, experience pain, restricted mobility and significantly reduced quality of life.
ARTHROSIS, LOSS OF CARTILAGE
Like every joint, the shoulder consists of what could be described as gliding surfaces. These cartilaginous surfaces ensure that movements are smooth and almost frictionless, and may become damaged as a result of earlier tendon injuries or muscular instability after bone fractures or accidents. If cartilage gets thinner, like used car tyres or worn-down shoe soles, there is increased friction in the joint. With bones rubbing against each other, every movement eventually becomes painful. Unlike other types of tissue, like muscles, tendons and bones, cartilage does not regenerate. Various physical treatments and injections often offer considerable improvement of symptoms; in some cases, an artificial joint (endoprosthesis) is the best therapy to regain mobility and put an end to pain.
ENDOPROSTHESIS (ARTIFICIAL JOINT)
An endoprosthesis is an artificial joint. The worn-down, painful joint surfaces are removed, and a new surface replacement is implanted. In practice reverse shoulder prostheses have good results, even after a loss of tendons or after previous operations. The material used is adapted to the person’s individual needs and conditions such as nickel intolerance and osteoporosis.
The objective of a new joint is the restoration of free mobility without pain.