Minimizing Shoulder Incisions to Maximize ResultsThere was a time when every United States dollar was backed by an equal amount of gold. That was called the "gold standard." In medicine, when something is the tried and true method of treatment, doctors call this a gold standard. Surgery to cut open the shoulder was once the gold standard of treatment for shoulder impingement. Like the gold that used to back up the dollar, this has changed over time.
Shoulder impingement is a condition more common as we age. Soft tissues can get pinched or pressed by the moving shoulder bone. This often results in a painful loss of shoulder motion.
The cause commonly occurs while working with the arms overhead. In more than half of all cases, there is a large tear in one of the shoulder tendons. Sometimes, these injuries occur as a result of trauma, such as a car accident.
An operation to cut open the shoulder and make the needed repairs became the gold standard in the early 1970s. Now many doctors use an arthroscope to do the same thing. In arthroscopy, a slender instrument is inserted into the joint. It has a tiny TV camera on the end. This allows the doctor to see inside the joint.
Small surgical tools are passed into the joint. Fixing the torn tendon and releasing the impinged tissues by this method isn't easy. Doctors must learn how to do it and train properly. A new study reports an easier way around this.
One orthopedic doctor at a sports medicine center tried something new. He used a small incision directly through the skin and the acromioclavicular (AC) joint. The AC joint is on top of the shoulder, where the collarbone connects to the shoulder blade (the scapula). The incision makes a small opening. The doctor repairs the torn tendon through this small opening.
Results with this method were just as good as with arthroscopy. About 90 percent of the patients had excellent results. They were pain-free and could use the arm overhead. The patients had most of their motion back and could complete daily activities. The authors of this study think that with a 90 percent success rate, surgery should be done sooner than later.
Anthony Cabot, MD, and Jennifer C. Cabot. Minimal Incision Acromioplasty. In Orthopedics. December 2002. Vol. 25. No. 12. Pp. 1347-1350.
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