Shoulder Pain :Symptoms,Diagnosis and Treatements

Nature-friendly surgery for joint & muscle problems

Arthroscopic Surgery with Coblation Technology

Dr Keyur A. Buch MSOrth,MChOrth(UK), FRCSEd(Tr & Orth)

Consultant Upper Limb Arthroscopic Surgeon, Wockhardt Hospitals

Description of the shoulder

The Commonest Cause of Shoulder/Arm Pain: Subacromial Impingement

What is Shoulder Impingement Syndrome?

Friction between muscle/gliding tissue on one side and the bone on the other side- around the shoulder

Symptoms & Signs of Impingement Pain Shoulder

Pain around the shoulder, upper or lower arm/hand, neck or chest

More pain at night Difficulty in lifting the arm above the head Difficulty changing clothes or reaching the back

for personal toilet hygiene purposes Stiff shoulder Weakness of shoulder/arm

Diagnosis of Shoulder/Arm/Hand Pain

• If your pain has not improved with medication and physiotherapy, then the most important, essential, first requirement is seeing a specialist orthopedic surgeon with specific, high quality training and experience in assessment and treatment of shoulder/arm/hand pain problems

How Does a Specialist Upper Limb Surgeon make an accurate Diagnosis?

This question is the same as a non-pilot asking how exactly a specialist pilot flies a sophisticated airplane!

In general, the specialist relies on skilled clinical assessment, certain x-rays and scans such as an MRI or an ultrasound scan

Mrs. Rina Gupta

An active and otherwise healthy home-maker, with shoulder/arm pain and stiffness; no benefit with medication and physiotherapy

After a thorough clinical assessment, the diagnosis was- impingement pain shoulder with collar-bone arthritis and frozen shoulder

Treatment administered

Key-hole (arthroscopy) technique with coblation technology to remove inflamed tissue from the shoulder

Post surgery – movement of her shoulder

What is Coblation Technique

Coblation or controlled ablation works on the principle of bipolar radio-frequency from a voltagerather than power) driven source, generating a plasma layer around tip of the instrument in the joint.

This plasma layers dissolves rather than burn the target tissue within 1/10 of a mm area at body temperature, thus no damage is caused to other tissues.

How Does Coblation work?

Coblation increases interleukin-8, which is associated with angiogenesis and tissue healing, through elimination of harmful interleukin-1. Tendinosis, caused by 'failed tendon healing’, can be effectively treated using RF-based technology to induce an angiogenic response in order to promote healing

Coblation Vs Conventional Techniques

Unlike the laser, cautery or mechanical means of removing diseased tissue, Coblation works at low temperature, removes only diseased tissue, no harm to normal tissues, no heat damage or mechanical damage to cartilage in shoulder or knee

Coblation promotes healing of tendon and selected cartilage problems, too. This is not possible with conventional, current methods used predominantly in India at present

Coblation Video

Coblation: Patient Benefit

Treatment of smallest areas of damaged tissue, muscle, tendon or damaged cartilage, with no harm to normal tissues; most natural form of technique compared to laser, cautery or mechanical methods

The most nature-friendly way of operative treatment of shoulder-arm pain, frozen shoulder, tennis elbow, heel pain

Natural and speedy recovery

What Clinical & Technical expertise is needed to use coblation technology?

Extensive and lengthy super-specialist training & experience in upper limb orthopedics and arthroscopic techniques –currently in India such expertise is available only in a few centres

Specific training at specialist centres( currently outside India)

Coblation- Bipolar Radiofrequency for various orthopaedic problems

• With BRF we can treat patients suffering not just from shoulder/arm pain, but also tennis elbow, golfer’s elbow, heel pains, knee cartilage damage reconstruction (chondroplasty), to name but a few conditions

Treatment of Shoulder/Arm Pain

First Line of treatment: Anti-inflammatory/pain killers, local spray/cream, physiotherapy

Second Line of treatment: Injection

If pain &/or stiffness are persistent, key-hole (arthroscopy) surgery of shoulder to remove inflamed tissue and trim any overgrown, arthritic bone: this allows muscles and joint to move freely without pain

Arthroscopy/Coblation: Who is eligible for treatment?

• Decision must be made on the merits of each case individually

• These treatments are reserved for those patients whose pain and disability have not improved with medication and/or physiotherapy

• Correct decision can only be made by a specialist with extensive training and experience in these methods

The Future of Arthroscopic & Upper Limb Surgery in India

With increasingly westernised life-styles, we will import their diseases, too

There will be increasing need for treatment of shoulder/arm, elbow, wrist, thumb pains from arthritis, carpal tunnel syndrome, worn and painful tendons etc

Key-hole surgery for wrist, and joint replacements for thumb arthritis, cartilage repair treatment, will become more common

Prevention is better than cure!

Stretch your arms, shoulder, fingers, back and neck every 20 to 30 minutes

Avoid food and drink that release damaging free radicals in your body; so avoid smoking, alcohol and non-veg food at all times; “moderation” in drinking alcohol is a harmful myth

Alcohol, smoking and meat are linked with gout, weak bones, poor circulation, stiff joints and higher risk of cancers

There is no minimum safe amount when it comes to alcohol, smoking or non-veg food!

Thank You