The shoulder is one of the most flexible and complex joints in the body that allows a wide range of movements including, forward flexion, abduction, external and internal rotation, etc. It is supported by a bundle of ligaments, muscles, and tendons that provide the required stability to the hand.
Unfortunately, its extensive movements are also responsible for its early wear and tear, leading to injuries and degenerative diseases. Our shoulder specialist in Mumbai offers specific nonsurgical and surgical treatments that are discussed in detail below.
The shoulder is a ball and socket joint formed by the humerus, scapula, and clavicle bones. These three bones form two sub-joints; the glenohumeral joint, formed by the humerus and scapula bones, and the acromioclavicular (AC) joint, formed by the clavicle of the scapula bone.
All articulating bones are covered by smooth tissue layers called articular cartilage. Similarly, the glenohumeral joint is stabilized by a ring of fibrous cartilage called the glenoid labrum. And finally, a network of thick strands of fibrous ligaments connect and hold all the joint bones together. The primary shoulder ligaments include the Coraco-clavicular ligaments, the Acromioclavicular ligament, the Coraco-acromial ligament, and the Glenohumeral ligaments.
The rotator cuff is the main group of muscles that forms a sleeve around the joint to enable and restrict its movements within its limits. In addition, there are four types of muscles bonded to the joint bones with adhering tissue strands called Tendons.
The shoulder joint also hosts a bundle of nerves and blood vessels called the brachial plexus. The main nerves of the brachial plexus are the musculocutaneous, axillary, radial, ulnar, and median nerves.
Adhesive capsulitis, commonly known as frozen shoulder, causes restriction of motion in the shoulder joint with varying pain. It is primarily caused due to stiffness and thickening of ligaments due to adhesive developments. People with a shoulder injury, shoulder surgeries, or whose shoulder was immobilized for a long period are more prone to develop this condition. Moreover, people with systemic disorders such as diabetes, cardiovascular disease, hypothyroidism, hyperthyroidism, etc., also require specialized frozen shoulder treatment in Mumbai.
The most common symptoms of frozen shoulder condition are pain and stiffness with a limited range of motion.
The condition is usually diagnosed through range-of-motion tests and diagnostic imaging procedures such as X-rays or MRI scans. Then, depending on the patient’s age, condition, lifestyle needs, and several other factors, the shoulder specialist will suggest one of the following frozen shoulder treatments in Mumbai at our clinic.
Any traumatic shoulder injury or overuse of the shoulder joint can cause labral tears. The labrum is the soft cartilage that lines the shoulder socket, which weakens over time due to aging anyways. This condition makes it prone to tear injuries that lead to severe pain, reduced range of motion, instability, and a locking sensation in the shoulder joint.
Our shoulder pain specialist in Mumbai always starts with conservative treatment approaches such as prescribing NSAID medications and rehabilitation exercises to strengthen rotator cuff muscles. If the symptoms do not respond to these approaches, the doctor orders X-ray or MRI scans to diagnose the extent of labral damage and suggests arthroscopic surgery to repair the labrum.
During arthroscopic surgery, the shoulder surgeon removes the loose labrum flaps and secures the tendons if broken.
Shoulder instability is a general weakness and loosening of the soft tissues in the joint that lead to frequent dislocations of the shoulder joint. As the adhesive tissues weaken, the humerus bone head easily moves out of the glenoid socket partially or entirely, also known as subluxation or complete dislocation, respectively. Chronic shoulder instability typically develops after a person experiences one of the following scenarios:
The instability is indicated by a popping or grinding sensation within the shoulder in the initial stages. But the dislocations are always visibly diagnosable as they cause severe swelling, deformity, and complete loss of shoulder function.
Shoulder instability can be improved through conservative treatments like NSAID medications and closed reduction therapy for restoring stability, strength, and range of motion of the joint.
However, if the conservative treatment options fail, our shoulder surgeon in Mumbai may recommend shoulder stabilization surgery.
A shoulder dislocation is when the humerus head slides out of its glenoid socket, which can easily occur when playing more overhead sports. Dislocations also occur due to repeated use of the shoulder joint. The shoulder joint often dislocates towards the front (anterior instability) though it can dislocate backward or downward as well. Even if the shoulder dislocates partially (subluxation), the resultant deformity of the joint is always apparent and often diagnosed by the swelling, numbness, and bruising it causes.
In the case of shoulder dislocation without any soft tissue damage, it is treated with closed reduction therapy. The ball of the upper arm is manually moved back into the socket under anesthesia. However, shoulder dislocations that cause ligament or tendon tears and nerve damage in the joint may require arthroscopic surgery for restoring joint functions.
A shoulder fracture is a crack or complete break in any bones that form the shoulder joint. Such fractures usually occur in the clavicle and the humerus bones of the shoulder. They are most commonly caused by a direct external impact on the joint during an accident, collision, or fall. While the scapula bone is covered with extra soft tissues, it can also be fractured by high-energy trauma.
Fractures cause instantaneous symptoms like pain, swelling, bruising, numbness, and loss of movement, so diagnosing them is quite easy. But minor fractures require a thorough physical examination and imaging studies such as X-rays and CT scans for final diagnosis.
Depending on the type and extent of the fracture, our shoulder surgeon in Mumbai may treat the shoulder through immobilization or surgery. Nonsurgical treatments also include pain medications during immobilization and physical therapy after the fracture heals.
If the fracture breaks off or dislocates a shoulder bone completely, it re has led to the displacement of the bones, then surgery may be required to correct and fix them with pins, plates, or screws. As part of the post-surgery program, physical therapy may be recommended to aid recovery and improve the arm’s range of motion and strength.
Shoulder stabilization aims to improve the stability and function of the shoulder joint, preventing recurrent dislocations. There are many shoulder operations procedures for stabilization. This MISS surgery is done with an arthroscope’s and tiny camera mounted on it to guide the device through small incisions in your shoulder called portals. The camera placed in the portals accesses the interior space and helps perform the surgery. The following are among the other commonly performed surgeries.
This procedure aims to repair labrum tears using the arthroscope. First, the labral tear is conjoined with heavy sutures and suture anchors and secured to the labrum into the socket. Bankart repair in mumbai requires utmost patience and diligence while performing, which is very skilfully performed by Dr. Abhijeet Savadekar.
Another exemplary shoulder stabilization MISS procedure was performed by Dr. Savadekar. Sometimes, it is performed in addition to the Bankart repair procedure to repair deep impaction fracture on the ball of socket rim.
This procedure aims to mitigate bone loss from sockets due to recurring dislocations. In this, a small bone called a bone graft is taken from another shoulder part and replaced in the worn-away area of the shoulder socket. Then finally, the bone graft is secured with screws, and the incision is closed with dissolvable sutures.
In this procedure, your surgeon tightens the capsule and conditions ligaments to stabilize the shoulder. This procedure is analogous to a real-life situation when a tailor tucks loose fabric to sew the two parts by overlapping a cloth piece. By tightening the ligaments, they are then able to perform their stabilizing function.
Major injuries can cause rotator cuff tears. A rotator cuff is tendons in the shoulder, providing support and enabling shoulder joint mobility. A rotator cuff tear is a common cause of shoulder pain among adults and old.
Our shoulder pain specialist in Mumbai recommends conservative treatments such as rest, pain medications, shoulder sling, steroidal injections, and specific exercises. However, surgery may be required in severe conditions to fix the tendon back with shoulder bone.
Surgery to repair the rotator cuff, done traditionally through a large 6-10 cm long shoulder incision. This surgery aims to separate muscles from the above rotator cuff. Latest surgical techniques are devised for minimum pain and recovery time.
The same traditional or open surgery procedure is done through the MISS approach, making 1- 1 ½inch incisions in the shoulder. For this, an arthroscope( tiny camera device) mounted on the surgical device is inserted into the surgery site. The surgery is done through better visualization of the site through a panning camera displaying inner cartilage, ligaments, and the rotator cuff visuals on the monitor. The process helps the shoulder specialist in Mumbaito determine injury severity and surgery accordingly.
Surgical Treatment of Shoulder Labral Tears This is an arthroscopic procedure for repairing SLAP tears. In this, the surgeon specialist in Mumbai examines the labrum and biceps tendon, and if only the labrum is damaged without tendons involvement, then the torn labrum flap is removed. On the other hand, If the tendon is involved, detached, then the surgeon repair and rejoins the tendons with absorbable wires or sutures.
In the case of bankart lesion, is repaired through a specialized Bankart operation in which bankart tear is repaired by rejoining the labrum and capsule to the glenoid cavity’s margin. For this, the shoulder surgeon in Mumbai makes a few small incisions around the joint. Through one incision, an arthroscope is inserted in the shoulder to better see-through the shoulder joint site. Next, the surgical instruments are inserted through another incision site to re-attach the labrum with the glenoid with anchoring devices or sutures. Then, the arthroscope and surgical instruments are withdrawn, and finally, the incisions are closed.
It is an intricate procedure done under regional or general anesthesia. The surgery is performed both with open surgery( a large incision is made) and minimally invasive method(small incisions with an arthroscope( thin tube with a camera and light source) and surgical tools).
An incision is made over the affected shoulder. Then, the underlying muscles are gently pushed away to expose the shoulder joint. The upper arm bone, the humerus, is separated from the glenoid socket intact in the shoulder bone. The damaged humeral head is cut, and the socket is internally hollowed and filled with cement. A metal ball with a stem is gently pressed- fits into the humerus.
Next, the humerus part of the socket is prepared. Then the plastic glenoid component is fixed in the shoulder bone. Finally, the artificial component is implanted, and the joint capsule is stitched, and the incision is sutured and closed.
Reverse total shoulder replacement is an advanced surgical technique for rotator cuff tear arthropathy, a condition where the patient suffers both from arthritis and a rotator cuff tear.
As the name suggests, the procedure is the reverse of total shoulder replacement. In this, the placement of the artificial components is essentially reversed. Or, in other words, the humeral ball is fitted in the glenoid cavity of the shoulder blade or scapula, and then the plastic socket is placed on top of the arm bone. This technique efficiently uses the deltoid muscle(the large shoulder muscle) to repay the torn rotator cuff.
Because there are many different types of shoulder bones, shoulder fractures treatment varies depending on the severity of the fracture.
Types of shoulder fracture surgeries include:
This fixation surgery is applicable when bones dislocate, or an open fracture (where the bone has come through the skin) occurs. The surgery essentially repairs the fracture and any damaged ligaments, muscles, and tendons. For fracture repair, shoulder specialists in Mumbai lock the bones back into their respective normal position with the help of specialized hardware such as screws, plates, or pins. In some cases, Dr. Savadekar also does bone grafting to repair soft tissues such as ligaments and tendons. In some severe fractures, complete or partial shoulder joint replacement is recommended.
Dr. Abhijeet Savadekar is the only shoulder specialist in Mumbai who treats diverse shoulder fractures such as glenoid rim fracture, lateral end clavicle fracture, tuberosity avulsion fracture, Hill Sachs impaction fracture by using the specialized arthroscopic (keyhole) technique.
In some cases of severe bone or shoulder joint dislocation, our shoulder specialist in Mumbai may recommend a partial shoulder replacement. A conventional shoulder replacement device with a metal ball and stem replaces the damaged ball or upper arm bone portion. Individuals having partial shoulder replacement experience comparatively lesser pain, with improved functionality and increased range of motion that offers a better quality of life.
As per diagnosis, some cases require reverse total shoulder replacement. In a reverse total shoulder replacement, the socket and the metal ball are swapped. The plastic cup is fixed to the humerus, and a metal ball is attached to the socket, and the structure is made intact. Individuals who undergo the treatment experience reduced pain and improved mobility of the shoulder joints.
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