5.JAN.2017 5 MIN READ | 5 MIN READ

Not all shoulder problems need to be solved by surgery. When there is pain, however, it should not be ignored.

Dr Tan Chyn Hong, an orthopaedic surgeon practising at Mount Elizabeth Novena Hospital, explains how many shoulder problems can be effectively treated with minimally invasive surgery.

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

With minimally invasive keyhole techniques, patients experience less pain and faster recovery, and have small surgical scars that are cosmetically pleasing.

Frozen shoulder

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

Mrs X is a 50-year-old who came to me complaining of right shoulder pain and stiffness for the past 3 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.

Frozen shoulder is a condition where the connective tissues around the shoulder joint contract. The shoulder then stiffens up, resulting in difficulty and pain during movement. Patients can feel very helpless with this condition.

On its own, frozen shoulder can take about 2 years to get better. 

With minimally invasive keyhole surgery, patients experience less pain and faster recovery, with cosmetically pleasing surgical scars. The surgery involves putting a small camera into the shoulder and releasing all the tight connective tissues responsible for the stiffness.

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.

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 was as high as 90%.

Having the torn labrum repaired via keyhole surgery could reduce the dislocation risk to less than 10%, and patients may be able to return to their former level of activity in a few months.

Tan Chyn Hong
Orthopaedic Surgeon
Mount Elizabeth Hospital

Dr Tan Chyn Hong is an orthopaedic specialist practising at Mount Elizabeth Novena Hospital, Singapore. He has a special interest in the treatment of shoulder, knee and elbow problems.