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Аrthroscopy of shoulder joint

Аrthroscopy of shoulder joint

The shoulder joint is one of the most mobile in the human body and the most involved in everyday life. Accordingly, there are a large number of problems associated with it. The most common diagnosis is a humeropathy periarthrosis (arthritis). This concept often implies a different pathology - impingment-syndrome, adhesive capsulitis, acromioclavicular arthrosis, etc.

Subacromial impingment-syndrome - infringement of the tendon of the supraspinatus under the acromial process of the scapula. It is accompanied by pain, restriction of movements, the symptoms intensify after physical exertion. The causes are often the consequences of acute and chronic trauma, arthrosis of the acromioclavicular joint, congenital features of the structure.

SLAP-syndrome - separation of the articular lip of the scapula at the attachment point of the biceps tendon of the shoulder. Patients with SLAP-syndrome report complaints of "deep" pain in the shoulder during exercise, crunching and clicking during movement. Damage occurs as a result of dislocation, a direct blow to the shoulder area or fall on the straight arm. Athletes have a different mechanism of damage - as a result of chronic microtraumatism. In such cases, the patient does not remember the 
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For small lesions, conservative treatment is possible. With large detachments of the joint of the joint accompanied by a severe pain syndrome, a surgical correction is needed - the reflexion of the joint lip with anchor fixators. Such an operation takes place under the control of the endoscope through punctures without incisions. Damage to the rotator cuff - damage to the tendons of the shoulder rotator muscles (subscapular, supraspinous, subacute and small circular muscles). Most often, the tendon of the supraspinous muscle is damaged. Damage can occur as a result of acute injury - dislocation, impact in the shoulder area, falling on an elongated arm. Similarly, the rupture of tendons can occur in the presence of chronic trauma, for example, when the tendon of the supraspinatus is infringed under the acromial process of the scapula. This can be due to both previous traumas and the peculiarities of the anthomotic structure of the acromion.

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With partial damage to the rotator cuff, movements in the shoulder may be retained but pain is accompanied when attempting to withdraw. Full gaps are often accompanied by pain and inability to withdraw the upper limb. Treatment of such damage requires surgical treatment since only stitching of the tendon rupture can restore a full volume of movements and relieve pain. Adhesive capsulitis or "frozen shoulder" syndrome

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Capsule is a diffuse lesion of the capsule and synovial membrane of the shoulder joint, often leading to a prolonged disability of the patient. In most cases, capsulitis occurs in persons aged 50 to 70 years. The disease is rare until age 40, almost always a secondary form (induced by other diseases). Women are sick more often than men (ratio 3: 1-5: 1). The beginning usually spontaneous, without any previous events, is subacute. It begins with pain in the shoulder joint, which eventually grows. In this case, the pain is little associated with any particular movement, often amplified at night and lying on the affected shoulder. Then the pain gradually decreases, and the phase of "stiffness" begins - the actual painless limitation of the volume of movements in the joint. A characteristic type of patient during this period of the disease and gave the name of the disease - "ankylosing" or "frozen shoulder". This phase is followed by a period of resolution, during which the volume of movements in the joint is gradually restored. In most cases, the disease ends with recovery, but half of patients do not fully return to their original volume of movements, which, however, does not prevent them from daily life. If the conservative methods of treatment are ineffective, arthroscopic manipulations on the affected shoulder joint are indicated.

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Indications: absolute indications for arthroscopy of the shoulder joint are absent. There are a number of diseases in which arthroscopy of the shoulder joint can help in diagnosis and treatment:

-          chronic pain syndrome of the shoulder joint

-          partial or complete damage to the rotator cuff

-          impidge-shoulder joint syndrome

-          damage to the cartilaginous lip of the articular process of the scapula

-          instability of the shoulder joint

-          presence of intraarticular bodies (chondromatosis)

-          synovitis in rheumatoid arthritis

-          damage to the long head of the biceps arm

Contraindications: Infectious changes on the skin of the shoulder joint


Advantage of arthroscopy:

-          absence of large cuts;

-          there is no need for prolonged hospitalization;

-          absence of trauma of soft tissues around the joint;

-          the possibility of a more thorough examination of the joint (especially the posterior sections, inaccessible to inspection during a routine operation);

-          more delicate handling of intraarticular formations;

-          the possibility of early recovery of movements after surgery.

It is possible to treat this pathology with the help of medical-diagnostic arthroscopy of the shoulder joint.