The Health September 2022 - Page 11

The shoulder joint plays a significant role in our daily activities with its ability to provide a considerable range in motion

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SEPTEMBER , 2022 | THE HEALTH

11

BONE TO PICK
BY DR JONAS FERNANDEZ

THE other day while we were seated at the dining table , my wife suddenly turned to me and said ,“ Eh , you got so many aunts with shoulder pain , why don ’ t you write something about it ?”. I looked at her , nodded and continued to gobble up my dinner .

She was right , though , you know . Looking back , I recall doing many such “ consultations ” for family members .
So why not ? Let ’ s discuss why shoulder pain is such a problem , especially amongst ladies in the “ golden age group ”.
Many structures around the shoulder could be a potential pain generator . Chief among the culprits that cause patients ’ ailing is the rotator cuff tendons . They are a group of four tendons , namely the supraspinatus , infraspinatus , subscapularis and the teres minor .
These muscles / tendons are responsible for various types of movements of the shoulder joint . Thus , when they become injured , shoulder movement is also limited . Patients often complain about specific limitations in activities , such as difficulty in combing their hair and reaching out for objects in high places . And for ladies , hooking on or off their undergarments .
Each muscle / tendon is responsible for a particular type of shoulder motion . So , to elicit which tendon is causing the pain , your doctor will have to perform a physical examination .
The doctor may ask you to move your shoulder in various ways . It might seem like you are doing the Macarena dance during one of these examinations .
These “ injuries ” to the tendons are usually not caused by a single event or trauma . Instead , they have been described as a spectrum of diseases .
Muscle paterning
One thing leads to another , and so forth . Often , there is degeneration and inflammation of the tendon , which leads to them being worn down to the point that they eventually tear .
This tear can be a partial tear or a complete tear . Another way these tendons get injured is when they come into contact with the bone overlying them . The friction between the tendon and the bone causes pain and wears down the tendon . This condition is known explicitly as impingement syndrome , where the tendons are impinged by the acromion bone .
If this condition is left untreated and unchecked , it can lead to further destruction within the shoulder joint .

Doing the Macarena dance

The shoulder joint plays a significant role in our daily activities with its ability to provide a considerable range in motion

Because the rotator cuff tendons / muscles are not functioning like they are supposed to , the stability of the shoulder joint is also affected .
This is because this joint is an inherently unstable one . Being a “ ball and socket ” joint , stabilising the head of the humerus ( the ball ) on the glenoid ( the socket ) is like a seal balancing a ball on its nose or a golf ball balancing itself on a tee .
Because of how unstable it is , the muscles and tendons play a critical role in maintaining a balance . Medically , this balancing act of the shoulder is called muscle patterning .
So what happens when there is a loss of said muscle balance ? Because the humerus head is now not articulating or gliding how it ’ s supposed to against the glenoid , it predisposes the shoulder joint to develop arthritis .
Options for treatment
This is why this condition is called a spectrum of diseases . Initially , what may have seemed like a benign inflammation of the tendon has led to it being torn . This , in turn , leads to a loss of balance within the joint and has finally resulted in shoulder osteoarthritis .
As in any other medical condition , history and examination play the most prominent role in diagnosis . However , your doctor might order an ultrasound or MRI scan to confirm it .
These scans will show the presence of tears , the size of the tears and if any
Dr Jonas Fernandez is an Orthopaedic Surgeon at Putrajaya Hospital . He is also a member of the Malaysian Arthroscopy Society ( MAS ). muscle atrophy might have occurred as a result of prolonged misuse . All of this information plays an integral part in decision-making in terms of treatment plans .
So how do we treat this ? For small tears , treatment will usually be focused more on physiotherapy for pain control , muscle strengthening and a range of motion exercises . A steroid injection into the shoulder joint also plays a significant role in relieving pain symptoms of those with impingement of the tendon .
As in any other medical condition , history and examination play the most prominent role in diagnosis . However , your doctor might order an ultrasound or MRI scan to confirm it .”
However , in cases where the tear is large , one might need to go under the knife . The repair is usually done via a “ keyhole surgery ”, whereby specialised sutures called anchor sutures are used to secure these torn tendons . In the final step of the disease , when arthritis has set in , joint replacement surgery might be indicated .
The shoulder joint plays a significant role in all our daily activities , owning much to its ability to provide a considerable range in motion . These movements are well illustrated in the Macarena dance .
So , to continue dancing at the next big wedding event or dance festival , you would be well advised to look after that shoulder of yours . – The Health