Hombro

Shoulder

The diagnosis and treatment are determined after an initial examination and a series of diagnostic tests.

The shoulder is the joint that connects the torso to the arm and is made up of three bones: the scapula or shoulder blade, clavicle, and humerus. Surrounded by cartilage that allows for smooth, painless movement, the shoulder is divided into two joint cavities: the subacromial space (where the rotator cuff tendons are located, whose function is to stabilise the shoulder joint when raising the arm and performing flexion and external rotation of the arm) and the glenohumeral joint (where the ligaments are located that act as reinforcement and provide stability to the shoulder, preventing joint dislocation).

After an initial examination, the specialist may request diagnostic tests (X-ray, MRI, etc.) to confirm the diagnosis and determine the treatment to be followed, depending on whether the patient is dealing with:

Traumatic injuries
- Contusions
  Contusions are injuries caused by low-energy trauma in which there is superficial damage to the skin and/or muscle.
- Fractures
  Fractures are injuries caused by high-impact trauma that results in a break in the bone. Fractures in the shoulder joint can occur in any of the three bones in the joint:
  
  Clavicle fracture: these are usually caused by a fall onto the shoulder, which transmits the deforming force to the clavicle, causing it to fracture.
  
  Scapula or shoulder blade fracture: these are rare and usually occur in high-energy trauma affecting the shoulders, chest and spine.
  
  Humeral head fracture: these also involve high-energy trauma. This injury occurs more frequently in elderly people due to decreased bone density.
  
  The damage and type of fracture will determine the treatment to be followed (rest, medication, etc.). If the fracture is severe, surgery will be necessary to put the bones back in their normal position.
- Dislocations
  Dislocations are injuries caused by a high-energy mechanism that results in the separation of two bones in a joint.
  
  In a situation of shoulder instability, contact is lost between two of the joint cavities, the subacromial space and the glenohumeral joint. When this separation is not very long-lasting, we refer to it as a subluxation, but when it is long-lasting, it is a dislocation.
  
  Depending on which parts of the joint are separated, we can talk about different types of dislocations:
  
  Glenohumeral instability (known as shoulder dislocation): the head of the humerus is projected forward and pops out of the anterior glenoid. This is the most common type of dislocation and is almost always caused by an impact to the arm that is transmitted to the shoulder, causing it to dislocate.
  
  Acromioclavicular dislocation: trauma to the shoulder causes a separation between the collarbone and the acromion.
  
  Clavicle dislocation: following trauma caused by a fall onto the shoulder, injury to the clavicle ligament occurs, resulting in dislocation and elevation of the clavicle.
  
  Most dislocations occur in people who play contact sports or who perform continuous and intense joint movements. Depending on the degree of dislocation, the patient may only report pain and discomfort in their shoulder. In these cases, conservative treatment may be chosen, which, after intensive rehabilitation, can yield excellent results.
  
  Once an objective dislocation has occurred, there is a greater chance that it will happen again (recurrent dislocation), in which case surgical treatment will be necessary. This surgery is usually performed arthroscopically, but in cases of recurrence after individualised analysis, it may be necessary to perform further arthroscopic surgery or open surgery.
- Tendon injuries
  The rotator cuff consists of four tendons that surround the head of the humerus (supraspinatus, infraspinatus, teres minor, and subscapularis). Depending on the type of injury and the location of the joint, there are several different types of injuries:
  
  Tendinitis: inflammation of a tendon that can be caused by repeating the same movement or posture. The most common types of tendinitis, depending on the tendon affected, are:
  
  Supraspinatus tendinitis: repeated shoulder lifting movements cause impingement between the head of the humerus and the acromial arch. It is the main cause of subacromial syndrome or painful shoulder, which often results in tendon rupture.
  
  Calcific tendinitis: inflammation of the tendons of the rotator cuff, particularly the supraspinatus tendon, caused by the deposit of calcium within it.
  
  Tendinitis due to shoulder instability: elongated ligaments that do not hold the joint securely in place and cause slight instability of the shoulder between the humeral head and the shoulder blade can lead to tendinitis with persistent shoulder pain.
  
  When dealing with tendinitis, the usual treatment involves rest and rehabilitation. If conservative treatment does not work, shoulder arthroscopy may be necessary. After surgery, the patient will need to undergo physiotherapy treatment.
  
  Tendon ruptures: a tendon rupture can occur due to the deterioration of tendinitis. Partial tears allow some movement of the joint but with pain, some cracking and decreased strength. However, if it is a complete tear, the patient will experience pain and be unable to lift their arm, or they may be able to lift it but with pain. In these cases, the usual treatment is surgery to repair the damage.
Degenerative injuries
What is a degenerative injury?
The wear and tear of the bones, cartilage, and ligaments of the joint over the years is also a cause of problems related to this joint. In these cases, the patient profile is usually elderly, and they come to the clinic because of pain and lack of mobility in the area.

Some of the most common pathologies related to wear and tear on different parts of the joint are:
- Shoulder arthrosis
  This degenerative disease entails a loss of the cartilage covering joint surfaces. Depending on the area in which this loss occurs, it may be:
  
  Glenohumeral osteoarthritis: loss of cartilage between the humeral head and the glenoid cavity of the shoulder blade, resulting in loss of joint space and hardening of the bone surfaces with the formation of osteophytes. In the early stages of osteoarthritis, conservative treatments (painkillers, physiotherapy, etc.) are recommended. In more advanced cases, where the patient is experiencing pain and limited functionality, or where conservative treatment has not worked, shoulder arthroplasty may be performed, which involves replacing the affected area with a prosthesis. The specialist will choose the prosthesis model based on the patient and the specific condition. The results of shoulder replacements are usually satisfactory: pain is eliminated and the patient regains mobility.
  
  Osteoarthritis of the acromioclavicular joint: caused by trauma or as a degenerative process, this involves the loss of cartilage between the acromion and the tip of the collarbone. It causes significant pain in the upper shoulder area. Conservative treatment includes rest, medication, and physiotherapy. If symptoms persist, arthroscopy may be performed to resect the distal end.
- Frozen shoulder
  Also known as retractile capsulitis. This is a progressive decrease in passive movement of the shoulder due to inflammation and retraction of the ligaments of the glenohumeral joint. The cause of this condition is unknown, and it is more common in women and diabetic patients. The natural progression of the disease is spontaneous recovery, and its duration varies from three months to a year and a half.
Teknon, the most advanced techniques from the best specialists
Centro Médico Teknon has a team of highly specialised traumatologists and orthopaedic surgeons who offer a wide variety of options and treatments for patients, depending on the traumatic or degenerative condition they suffer from. In cases where surgery is necessary, our specialists work, whenever possible, with minimally invasive techniques, which reduce the risks of the procedure, shorten the hospital stay, allow the patient to recover more quickly, and offer better aesthetic results.

In any surgical procedure, it is essential to choose not only the team of specialists, but also the centre. The centre's excellence in all medical and healthcare procedures and treatments has been recognised by the renowned Joint Commission International. This seal, one of the most important internationally, guarantees the highest quality, safety and precision in all treatments. Centro Médico Teknon is currently one of the few centres to have this distinguished accreditation.

Shoulder

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