MINIMALLY INVASIVE OPERATIONS TO SOLVE ALL THE MAIN SHOULDER PROBLEMS

The Shoulder Surgery staff of the Clinica San Francesco has got experience and skill in the treatment of all main shoulder pathologies both with arthroscopic and traditional procedure.

The mainly treated pathologies are: tendon lesions of rotator cuff, shoulder impingement syndrome, shoulder instabilities (relapsing dislocation and articular laxity), removal of articular mobile bodies. The arthroscopic and minimally invasive approach is realized with a greater respect and conservation of tissues, translating into quicker rehabilitation time for patient.

There is a wide range of operations dedicated to traumatic pathologies as head, humerus proximal third, acromion, shoulder blade and clavicle fractures, acromio-clavicular and sternoclavicular dislocations, missed fracture consolidations treated by advanced osteosynthesis procedures (angular stable titanium plaque, intramedullary nails, reabsorbable materials, etcetera).

Arthroscopic shoulder surgery

The shoulder arthroscopy is a procedure performed by an image transmission tube, introduced in the articular cavity through a small cutaneous incision. A videocamera connected to the arthroscope allows surgeon to watch enlarged on a screen the various inner joint structures.

In case of rotator cuff lesions, the tendons are sutured by threads and small screws or anchors (metal or reabsorbable), introduced in the humeral head; in some cases only suture threads, passed into the bone tunnel of humeral head, can be used. Even in the articular instability (recurring dislocations) mini-anchors for sticking again the bone articular capsule are used; in some cases the capsular plastic surgery to reduce amplitude (plicatures) is carried out.

Prosthetic shoulder surgery

Partial and total shoulder prosthetic surgery is carried out. This kind of operation represents the most significative advance of shoulder surgery in the last 50 years.

The main objectives of shoulder prosthesis are the elimination of pain and recovery of superior limb good movement arch, such as to allow patient to perform the essential movements for daily life (for example, carrying hand to the mouth, cleaning face, combing hair, etcetera). This operation is performed in cases of shoulder arthrosis, particular neck and humeral head fractures or not recognized dislocations; it consists in the articular substitution, implanting a metal stem in the humerus which ends with a spherical head able to articulate depending on the circumstances with the corresponding anatomic portion of shoulder blade (glena) and congruent concave component, introduced in the osseous part.

Even in selected cases coating prostheses covering the worn out humeral head exist. These kind of implants need a tendinous structure (rotator cuff) to support the articular movement. The “inverse” prostheses (because they work biomechanically inside out) are used in massive and irreparable ruptures of rotator cuff.

The Shoulder Surgery team is specialized in the following diseases:

• repair of tendon rotator cuff
• removal of intra-articular calcifications
• removal of mobile bodies
• acromioplasty for subacromial impingement syndrome
• arthrolysis for frozen shoulder
• treatment for scapulohumeral and instability dislocations (arthroscopic-traditional)
• cephalic prosthesis (humeral head)
• total prosthesis
• inverse prosthesis
• tendon muscle transferences
• acromio-clavicular dislocations with ligament reconstruction (also synthetic)
• osteosynthesis of shoulder blade proximal humeral extremity and clavicle fractures    
   

Postoperative antalgic treatment

In postsurgical phase the patient is followed by an anesthetist who takes care of prevention and treatment of prosthetic painful symptomatology, turning to the most innovative procedures (selective block of nervous branch, peridural tubes, continuous administration of analgesic minidoses, etcetera) and the use of state of the art drugs.