Don't ignore a painful shoulder

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I once had a teenage patient, D, who came to my office with her concerned mother. She demonstrated to me her ability to "dislocate" her shoulder voluntarily.

The horror and disgust on her mother's face were a great source of amusement to D.

This is a classic example of an attention-seeking behaviour, so I took some time to convince the mother that there was no need for her daughter to undergo any surgery.

They should instead spend more time together and that should address the real issue of her daughter's attention-seeking behaviour.

This incident shows that not all shoulder problems can be solved by surgery. When there is pain, however, it should not be ignored.

If you have a painful or stiff shoulder, you will find it difficult to swim or play tennis. Some patients may even have difficulty with simple tasks like sleeping, dressing and combing their hair.

Generally, younger patients tend to have sports injuries, which result in repeated dislocations, while older patients tend to suffer from frozen shoulder or tendon tears.

Many shoulder problems can be effectively treated with new, minimally-invasive keyhole techniques. Patients experience less pain and faster recovery, and have cosmetically-pleasing surgical scars.

FROZEN SHOULDER

Mrs X is a 50-year-old who came to me complaining of right shoulder pain and stiffness for the past three months.

She tried to live with the pain and stiffness but the final straw came when she couldn't put on her bra. She couldn't reach the clips at the back and had to ask her maid to help dress her.

I suggested: "Why don't you buy bras with clips in front? Or you can clip your normal bra in front and rotate it 180 degrees."

I am no longer embarrassed about teaching my female patients with shoulder problems how to overcome this very challenging activity. I told her that she had frozen shoulder and it will take about two years for it to get better on its own.

Frozen shoulder is a condition with no known cause. It causes the connective tissues around the shoulder joint to contract. The shoulder will then stiffen up.

Mrs X was devastated as she could not imagine being so helpless for two years.

She tried working with a physiotherapist but the sessions were so painful that she gave up.

I had to perform keyhole shoulder surgery for her. It involved putting a small camera into the shoulder and releasing all the tight connective tissues responsible for the stiffness. She couldn't believe how mobile her shoulder was the morning after surgery.

I should have done this earlier, she told me with a stern look in her eyes. I wasn't sure if she was thanking me or scolding me for not performing the procedure sooner.

ROTATOR CUFF TEAR

"Doctor, I can't sleep. I keep waking up with this terrible pain in my left shoulder."

Mr Y is a 60-year-old who had a torn tendon in his left shoulder. He was visibly distressed by the constant pain at night. He would wake up from the sharp pain when he turned to sleep on his left side.

The muscles surrounding the shoulder joint are collectively known as the rotator cuff muscles.

Mr Y was very puzzled when the ultrasound scan showed a torn tendon as he couldn't remember sustaining any injury to his shoulder.

I explained that there was a bone spur in his shoulder and it would cut into the tendon whenever he raised his arm. The constant attrition eventually caused the whole tendon to tear through.

Unfortunately, a torn tendon doesn't heal by itself. I performed keyhole surgery on him, removing the bone spur and repairing the torn tendon.

A few months later, he sent me a picture of himself swinging a golf club with the caption: "Won a golf tournament. Thanks, doc."

SHOULDER DISLOCATION

Student Z, 17, plays rugby for his school. His right shoulder was dislocated during a rugby tackle. The blow caused the top of his arm bone to pop out of the shoulder socket.

His coach pushed it back into the shoulder socket and Z managed to finish the game.

However, his shoulder started feeling "loose" and it dislocated again when he was doing pull-ups.

An MRI scan showed that there was a tear in his shoulder labrum, which is the stabilising structure in the shoulder joint.

The chance of Z having recurrent episodes of dislocation is as high as 90 per cent.

The best treatment is to have the torn labrum repaired. That will reduce his dislocation risk to less than 10 per cent.

Z underwent keyhole surgery to repair the torn labrum. Six months after that, I allowed him to return to playing rugby.

•Dr Tan Chyn Hong is an orthopaedic surgeon specialising in the shoulder, knee and elbow at The Orthopaedic Centre (Novena) at Mount Elizabeth Novena Specialist Centre.


This article was first published on Dec 20, 2016.
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