Published on 27. November 2020

Shoulder – a sensitive all-rounder

The shoulder joint is the most mobile joint in the human body and an all-rounder. Its special and complex anatomy provides a target for acute injuries as well as degenerative diseases, as PD Dr. Stephan Pauly, Senior Physician Shoulder Surgery at the Clinic for Special Orthopedic Surgery and Trauma Surgery at Vivantes Auguste-Viktoria Hospital, explains.

Whether we are combing our hair, putting dishes in the cupboard, throwing a ball or scratching our back - the respective differentiated movement is created by the finely controllable motor function of our shoulder. The shoulder joint maintains a demanding balance between the controlling of the fine motor skills and power transmission from the trunk to the upper extremity, the arm. Many muscles, ligaments, tendons, bursae and bones work together in a very confined space.

Why the shoulder is an anatomical weak point

Almost everyone is affected by shoulder pain at some point in their lives; along with back and neck pain, it is one of the most common orthopedic complaints: For example, the arm cannot be raised, movement in the upper body is severely restricted, and sleeping on the side causes intense pain. Shoulder pain can originate in all tissues of the shoulder joint. Posture, lifestyle, age, inflammatory processes and metabolism, as well as the particular weak points of the anatomical components of the joint, all interact here.

Specialized examination necessary

Various causes can trigger similar symptoms, that is why a specialized examination of the painful shoulder is generally necessary. In order to be able to classify the pain, it must first be clarified: When does it occur and how does it feel? Was there a cause or stimulus, such as overuse, an injury or an accident? How long have the complaints lasted?

The subsequent physical examinations include several tests, and imaging such as ultrasound, X-ray and magnetic resonance imaging may follow, depending on the case. Only in this way can the responsible triggers be identified from a complex of disorders in order to initiate a suitable therapy or, for example, a recommended surgical intervention.

Dr. Pauly, what kind of shoulder complaints do patients come to you with?

Dr. Stephan Pauly: Persistent pain during movement, at rest, or restrictions in active and passive mobility bring patients to our outpatient clinic. These include acutely injured patients, but also people who have been active in sports for many years or who work hard.

Are the patients you consult already conservatively treated, i.e. have they already undergone all conceivable non-surgical therapies?

Pauly: The majority of patients present themselves to us regularly through colleagues in private practice and have already undergone a conservative therapy trial without any noticeable improvement, for example, through injections or consistent physiotherapy. But we also advise patients who are at the beginning of a therapy and often do not yet have a deeper knowledge of their disease. Above all, however, we advise individually: with regard to modern and targeted conservative measures as well as surgical therapy. Patients should decide for themselves depending on the stage of the disease, their level of suffering and their life situation.

Which operations do you perform most frequently?

Pauly: A distinction must be made between slowly developing degenerative diseases such as tendon ruptures, cartilage damage, shoulder arthrosis with bursa irritation, nerve entrapment, etc.. Acute injuries, such as bone fractures, dislocations of the shoulder and shoulder joint, as well as tendon ruptures, must be distinguished from these.

Do you treat acute injuries immediately?

Pauly:Yes, acute injuries are often treated first in our emergency department and, if necessary, operated on the same night if this is of benefit to the patient. Our advantage is that we have an interdisciplinary and shoulder-specialized setup and can do excellent work in terms of both trauma surgery and orthopedics.

"We don't operate on anyone who could be treated just as conservatively according to scientific literature and objective guidelines."

Does surgery sometimes take precedence over conservative therapy?

Pauly: No. We don't operate on anyone who could be treated just as conservatively according to scientific literature and objective guidelines. Knowing this relieves many skeptical people who read in the press that surgery is generally performed too often.

What special procedures do you use?

Pauly: We aim to achieve the goal of the respective reconstruction as gently, cleanly and elegantly as possible using minimally invasive, so-called keyhole surgical techniques. If this is not possible, for example in the case of bone fractures or prostheses, the most modern and least invasive implants are used.

What is the aftercare and physiotherapy like?

Pauly: After one to two days, when the first physiotherapeutic exercise sessions have been completed and the wounds are free of irritation, we usually go home. This is accompanied by a specific aftercare regimen for the resident physicians and physiotherapists. The duration of "healing" - a biological process - depends on the underlying injury or disease.

"We meet our patients personally and at eye level."

How important is the exchange with your patients for you?

Pauly: Exchange is essential for me, because our specific offer is from people to people and requires mutual trust. We do not engage in "mass processing", but meet our patients personally and at eye level: the 18-year-old professional handball player as well as the 82-year-old rheumatic.

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