Center for Special Joint and Trauma Surgery

The most common causes of osteoarthritis of the shoulder joint include changes in wear and tear (aging process), consequences of accidents involving fractures of the humeral head, and late effects of rotator cuff damage (rotator cuff defect arthropathy).

Regardless of the cause of the osteoarthritis, there is destruction of the articular cartilage at the humeral head and glenoid cavity. This results in an inflammatory reaction with pain and increasing restriction of movement of the affected shoulder joint.

If conservative treatment has not led to the desired success, surgical intervention must be considered. If limitation of movement is the primary concern, joint-preserving surgery with removal of excess bone attachments and release of the thickened joint capsule can be performed. If pain is the main concern, an artificial joint replacement should be considered.

Is an artificial shoulder joint an option for you?

You will benefit from an artificial shoulder joint if the following complaints are present:

• severe pain that interferes with your everyday life (e.g. when dressing, combing your hair or performing personal hygiene)
• Pain at rest, which especially disturbs your night's rest
• Restriction of shoulder mobility and loss of strength
• Persistent complaints despite exhaustion of conservative treatment options (anti-inflammatory and analgesic drugs, cortisone injections, physiotherapy)

Various shoulder endoprosthesis models are available, from which we will select the most suitable model for you:

• Total joint replacement (anatomic total shoulder arthroplasty):
  The prerequisite for an anatomic total shoulder arthroplasty is an intact rotator cuff. In an anatomic joint replacement, the destroyed joint surfaces are removed. The humeral head is replaced with a metal hemisphere and the glenoid cavity with a plastic socket. In recent years, bone-saving stemless shoulder prostheses have increasingly replaced the larger stem-anchored prostheses, as this allows the individual anatomy and thus the shoulder function to be restored even more accurately.
• Reverse shoulder joint replacement (inverse total shoulder arthroplasty):
  Reverse joint replacement is used in cases of large, irreparable rotator cuff defects (rotator cuff defect arthropathy), non-reconstructible fractures of the humeral head or endoprosthesis replacement surgery.
  In reverse joint replacement, the ball and socket are interchanged. That is, the metal ball is attached to the scapula, and the socket is attached to the humeral head. With the help of the hooded muscle, the arm can then be raised or spread apart again, even with a defective rotator cuff.
• Endoprosthesis replacement surgery:
  Although artificial shoulder joints (total shoulder arthroplasties) function just as reliably as artificial hip or knee joints, shoulder arthroplasty failure can occur, as with other artificial joints. This is most often due to loosening, infection or a secondary defect in the rotator cuff. In such a case, replacement of the artificial shoulder joint may be necessary.

After artificial shoulder joint replacement, immobilization of the arm is necessary. During the day, however, the operated arm can be used as early as the second postoperative day, for example for feeding. Since the artificial joint must grow into the bone, rehabilitation measures are not advisable until the sixth postoperative week.

The elbow is the second most dislocated joint after the shoulder. Depending on the severity of the injury, dislocation can result in rupture of the lateral collateral ligament (LUCL), the capsule, the medial collateral ligament (MUCL) and/or fractures of the coronoid process and the radial head. If only ligamentous structures are injured and the elbow is stable after dislocation, the injury can be treated conservatively in a humeral splint. More extensive injuries or additional fractures should be treated surgically.

Chronic ligament injuries of the elbow do not necessarily manifest as instability, but rather as decreased weight-bearing capacity and pain.

Clinical examination leads the way in acute or chronic elbow injury. Magnetic resonance imaging can be used to visualize the injured structures and identify the extent of the injury. In the case of bony injuries, a computer tomography may also be necessary.

An endoscopy of the elbow can confirm the diagnosis, especially in inconclusive cases. Depending on the extent of the injury, stabilization of the elbow is performed through one or two incisions, which are used to reattach the capsule and collateral ligaments to the bone, as well as stabilize any fractures.

In chronic injuries, the collateral ligaments may need to be reinforced with an endogenous tendon (e.g., gracilis or palmaris longus tendon).

The stabilization procedure is performed under inpatient conditions. The arm is immobilized in an upper arm splint for six weeks after the operation, and movement exercises must be performed daily.

After injuries, circulatory disorders of the bone or due to changes in wear and tear, free joint bodies may form and the movement of the elbow may be restricted.

Physical therapy can treat movement restrictions that exist over a short period of time well. If there are free joint bodies with recurrent entrapment or if there is a prolonged high-grade restriction of elbow motion, surgery is indicated.

The procedure can be performed arthroscopically. The inflamed joint mucosa, the free joint bodies, excessive bony attachments and the severing of the scarred joint capsule are removed. In the case of severe movement restrictions, the ulnar nerve (sulcus ulnaris syndrome) must also be detached.

The procedure can be performed on an outpatient basis. Intensive physiotherapy over six weeks is necessary.

After injuries, bone fractures, in the context of inflammatory diseases or due to movement restrictions of the elbow, irritation of the ulnar nerve with pain and sensory disturbances in the ring and little finger can occur.

If conservative treatment does not lead to the desired result or the neurologist can determine a higher degree of damage to the ulnar nerve, surgery is indicated.

Through a small skin incision on the inside of the elbow, the ulnar nerve is accessed and scarring is released. Depending on the pathology, the nerve is moved out of the bony bed to the flexor side.

The procedure can be performed on an outpatient basis.

A fracture of the olecranon process is a common injury from falling on the elbow. Undisplaced fractures can be treated conservatively.

Due to the pull of the triceps muscle on the fractured olecranon process, there is a high risk of the fracture ends coming apart. Surgical setting up of the fracture is indicated if the fracture ends have moved apart. The fracture is reduced via a skin incision on the extensor side and stabilized by a plate with screws.

Immobilization is only necessary for the first few days, and weight-bearing is possible again after six weeks.

Golfer's elbow is the counterpart to tennis elbow. Prolonged overuse of the wrist and finger flexor muscles causes painful inflammation of the tendon insertions at the inner humeral cartilage of the elbow.

The condition responds well to conservative treatment (cooling, physiotherapy with stretching and detonation of the muscles, epicondylitis orthosis).

Only if conservative treatment is unsuccessful can surgery be considered. During surgery, tendon attachments of the flexor muscles are released and inflamed tendon tissue is removed. The procedure is performed through a small incision on the elbow.

The treatment can be performed on an outpatient basis. The operated arm should be rested for six weeks.

Calcified deposits in the rotator cuff cause distension of the tendon with secondary bursitis and shoulder tenderness. In most cases, these are smaller calcific deposits that can be treated well conservatively.

However, conservative treatment often fails for large calcific deposits. In these cases, arthroscopy is performed. The distended tendon attachment is superficially slit in the area of the calcific deposit before the calcific deposit can be cleared out. Removal of the inflamed bursa is obligatory, and bony expansion of the acromion may also be required.

Immobilization of the operated arm is not required. The operated arm should be rested for six weeks. The follow-up treatment after calcific deposit evacuation is somewhat more protracted, so that complaints may persist for up to six months after the operation.

Fractures of the humerus distal to the body (supracondylar humerus fractures) occur particularly in children. Undisplaced or slightly displaced fractures can be treated conservatively. Displaced fractures require surgical stabilization. Childhood fractures can usually be reduced in a closed fashion. For stabilization, small wire pins are inserted through mini-incisions in the inner and outer humeral cartilages to stabilize the fracture.

The humerus must be immobilized in a splint for four weeks, and the wire pins can be removed after six weeks.

In adults, distal fractures of the humerus are usually displaced, requiring surgery. The surgery is performed through a skin incision on the extensor side. The fracture is set up open and usually stabilized by two plates. Depending on whether the articular surface is involved, it may be necessary to remove the olecranon process to visualize the joint fracture. The fracture can then be set up anatomically, stabilized with plates, and the olecranon process subsequently refixed.

After surgery, immobilization in an upper arm splint is required for four weeks. Daily range of motion exercises must be performed. Weight bearing can be done after six weeks at the earliest.

Immobilization of the operated arm is not required. The operated arm should be rested for six weeks. The follow-up treatment after calcium depot removal is somewhat more protracted, so that complaints may persist for up to six months after the operation.

The long biceps tendon attaches over the upper cartilaginous joint lip (biceps tendon anchor, SLAP) at the glenoid top and runs through the top of the shoulder joint at the front. Tears of the long biceps tendon or injuries to the biceps tendon anchor (SLAP) can result from an accident, overuse, or changes in wear and tear, causing strain pain over the anterior shoulder segments.

Leading the way in finding a diagnosis is the clinical examination. Magnetic resonance imaging is helpful, but often cannot provide a definitive diagnosis.

The diagnosis can often only be made unequivocally with surgery. If the condition is still stable, smoothing of loose parts of the joint lip is sufficient. If the biceps tendon anchor is unstable, stabilization is necessary. Fresh lesions are reattached to the upper glenoid rim using special suture anchors (SLAP repair). In chronic degenerative lesions, however, reattachment does not produce satisfactory results. In chronic lesions, the biceps tendon is often not affected in isolation but is associated with other shoulder pathologies (rotator cuff lesion). In these cases, the long biceps tendon is simply detached at the superior glenoid rim (biceps stenotomy) or the tendon is anchored outside the joint at the humeral head (biceps stenodesis). Which of the above procedures is used depends on the pathology present as well as your personal requirements and wishes.

The operation is performed arthroscopically. Immobilization is only required for a SLAP repair.

Bony avulsions of the rotator cuff (greater tuberosity fractures) are often the result of shoulder dislocation. If the fracture ends are not displaced, the injury can be treated conservatively by immobilization in a shoulder brace. Displaced fractures must be set up and stabilized surgically (arthroscopically or openly).

Fractures of the head of the humerus (subcapital humerus fractures) occur especially in older people with osteoporosis (bone loss). Undisplaced fractures can be treated conservatively by immobilization in a shoulder brace. Displaced humeral head fractures, on the other hand, should be treated surgically. The bone fractures are then set up open and stabilized with a plate or nail and screws. If the articular surface of the humeral head is shattered, it may not be possible to restore it, so the installation of an artificial shoulder joint may be necessary.

Accidents or changes in wear and tear can cause rotator cuff tendons to tear. A torn tendon does not grow back on its own.

Untreated tears increase in size over time, i.e. the tendon stumps retract and the associated muscles become irreversibly fatty. Defects that have existed for a longer period of time may then no longer be able to be closed.

Magnetic resonance imaging (MRI) shows the extent of rotator cuff damage and makes it possible to assess whether a tear has already existed for a longer period of time and whether the defect can still be closed surgically.

Conservative treatment may be considered only in cases of low functional demand, older patients, or defects that cannot be reconstructed.

Rotator cuff damage should be treated surgically. The procedure is performed arthroscopically. First, the tear configuration is determined, then the tendon stumps are mobilized before being reattached to the bone via special suture anchors.

If the tear exists over a longer period of time (years) and several tendons are affected, the defect may not be able to be completely closed. In this case, partial closure of the defect is performed to restore the best possible force closure between the individual muscles (margin convergence). Recently, a patch can also be inserted into the remaining defect, thus closing the joint to the acromion (superior capsular reconstruction).

The procedures are usually performed arthroscopically. Only in the case of very large defects is the tendon repaired via a small skin incision.

The clavicle is the only bony connection of the shoulder to the rib cage. A clavicle fracture significantly impairs shoulder function. Most clavicle fractures can be treated conservatively (without surgery). The injury is then immobilized in a shoulder brace. Surgery is necessary when the broken bones are far apart or threaten to impale the skin. In such a case, the fracture is surgically set up and stabilized with a nail or plate with screws.

After surgery, immobilization of the shoulder is required for a maximum of four weeks. However, the arm can be used from the first postoperative day out of the bandage without weight bearing.

Fractures of the scapula are rare injuries. Most of these fractures can be treated conservatively. Because the scapula is surrounded by strong muscles, fractures of the scapula usually heal without problems by immobilizing the arm in a shoulder brace. Only in cases of pronounced displaced fractures or involvement of the glenoid portions of the scapula (glenoid), surgical setting up of the fracture and stabilization may be required. Glenoid fractures in particular can be set up and stabilized arthroscopically.

Shoulder pain during abduction movements of the arm is often due to bursitis resulting from shoulder tendinitis. Treatment of shoulder tendinitis is the domain of conservative therapy with rotator cuff strengthening exercises and cortisone injections if necessary.

If conservative treatment fails, surgery may be necessary. In a procedure called subacromial decompression, the inflamed bursa is removed and the sliding space under the acromion is widened.

The procedure is performed arthroscopically. Immobilization of the arm is not necessary. Nevertheless, the operated arm should be rested for four weeks after the operation.

The clavicle is the only bony structure that connects the shoulder to the trunk via the acromioclavicular joint (AC joint). Every movement with the arm exerts a great force on the acromioclavicular joint, which explains the susceptibility to the development of osteoarthritis. Pain is particularly present during overhead activities or when supporting oneself with the arm and is usually localized directly over the acromioclavicular joint.

Osteoarthritis of the acromioclavicular joint often responds poorly to conservative treatment because of a mechanical problem involving narrowing of the acromioclavicular joint space. During arthroscopy, the articular surfaces of the clavicle and acromion are smoothed and the acromioclavicular joint space is widened to restore proper joint space.

Immobilization is not required after surgery. However, the arm should be rested for six weeks postoperatively.

The shoulder is the joint in the human body that dislocates most frequently. In the case of dislocation (shoulder luxation), typical damage occurs to the shoulder:

• Tear of the capsule and the cartilaginous lip of the joint
• rupture of the glenoid rim
• indentation of the humeral head (Hill-Sachs dent)

Any shoulder dislocation should be reduced as soon as possible. Any damage that has occurred can be detected on X-ray and MRI (magnetic resonance imaging). Depending on the joint damage that has occurred, your age and your requirements, we will choose the most suitable therapy for you individually.

One-time dislocations may be treated conservatively. However, a recurrence of dislocation proves shoulder instability, so that surgery is then indicated.

During surgery, the torn cartilage lip (labrum) and capsule are reattached with special suture anchors (Bankart repair). Acetabular fractures sheared off with the labrum or capsule can also be reconstructed in this way (Bony-Bankart repair). Chronic bony acetabular rim defects are reconstructed by a bone chip from the iliac crest (Bone block) or stabilized by an offset of the coracoid process to the anterior inferior acetabular rim (Latarjet coracoid transfer). In large, centrally extending, hooking Hills-Sachs defects, it may also be necessary to suture the posterior joint capsule into the defect to prevent the Hill-Sachs dent from hooking again (remplissage).

The procedures can usually be performed arthroscopically. After surgery, immobilization of the shoulder is required for four weeks.

Frozen shoulder can develop after accidents, operations or spontaneously. The symptoms are pain, especially at rest, and an increasing restriction of shoulder movement. The disease leads to shrinkage, scarring and thickening of the joint capsule.

Frozen shoulder usually responds well to conservative treatment with physiotherapy and cortisone tablets.

If symptoms persist or there are contraindications to cortisone treatment, shoulder mobility can be restored surgically. This involves releasing the thickened and scarred joint capsule of the shoulder, thus restoring the mobility of the joint. The procedure is performed arthroscopically.

Immobilization is not required. After the operation, movement exercises must be performed consistently for the first few weeks.

Fractures of the radial head occur in the course of a fall and interception with the outstretched arm. The fractures also frequently occur in combination with elbow dislocation.

Undisplaced fractures can be treated conservatively by short-term immobilization in a humeral splint. Displaced fractures, on the other hand, should be treated surgically. Through a small skin incision on the outside of the elbow, open setup and stabilization with screws or a plate is performed for fractures of the radius neck. If the bone is shattered, the head of the radius usually cannot be reconstructed. In this case, implantation of a radial head prosthesis (radial head prosthesis) may be required.

After open fracture or implantation of a radial head prosthesis, only short-term immobilization of the arm is required. Weight bearing should be avoided for six weeks.

The clavicle is the only bony structure that connects the shoulder to the trunk via the acromioclavicular joint (AC joint). A fall on the shoulder can cause the acromioclavicular joint (AC joint) to move apart with tearing of the ligaments between the clavicle and the coracoid process.

The diagnosis and extent of instability (Rockwood classification) is made from radiographs held. Mild injuries (Rockwood I+II) can be treated well conservatively. For more severe injuries (Rockwood III-V), surgical stabilization is indicated. Under arthroscopic view, a special suture system is inserted between the coracoid process and the clavicle, which reduces the acromioclavicular joint, allowing the torn ligaments to heal (AC repair). In the case of chronic injuries (accident more than three weeks past), the torn ligaments must also be replaced with an autologous tendon (for example, gracilis tendon) (AC reconstruction).

After the operation, the shoulder must be immobilized for six weeks. Weight bearing is possible after three months at the earliest.

Prolonged overloading of the extensor muscles of the wrist and fingers can

lead to painful inflammation of the tendon insertions at the outer humeral cartilage of the elbow.

The condition usually responds well to conservative treatment (cooling, physiotherapy with stretching and detonation of the muscles, epicondylitis orthosis).

Only if conservative treatment is unsuccessful can surgery be considered. During surgery, the tendon attachments of the extensor muscles are released and inflamed tendon tissue is removed. The procedure can be done arthroscopically or through a small incision.

The treatment can be performed on an outpatient basis. The operated arm should be rested for six weeks.