Exploring the latest advancements, techniques and
innovative approaches in Shoulder Surgery

Dr. Chintan Desai - MS Ortho, Shoulder Surgeon (USA, Australia, Korea, Portugal)
www.desaishoulders.com
desaishoulders@gmail.com
Appointments - 70453 47654

Shoulder pain has often always been labeled as a frozen shoulder. This incorrect diagnosis is the
reason why shoulder pain becomes long-standing and the standard approach to its treatment
fails. However, let’s try and understand here that not all shoulder pain is due to a frozen shoulder.

Let’s breakdown why your shoulder is painful

The following are some causes where the shoulder is painful but the problem is elsewhere

• A heart attack – Chest pain that radiates to the left shoulder
• Cervical spondylosis – Neck pain that radiates to the shoulder arm and the arm with associated tingling numbness
• Gallbladder inflammation – Irritation of the diaphragm due to an inflamed gall bladder radiate to the right shoulder

The following are causes of shoulder pain and restriction of shoulder movements where the
problem is in the shoulder itself. The shoulder joint is made up of the ball and socket joint, the
capsule and the rotator cuff muscles and tendons. Conditions affecting any of these structures
cause shoulder pain.

• Adhesive capsulitis or frozen shoulder
• Shoulder Dislocations
• Rotator cuff Tendonitis or tendon inflammation
• Rotator cuff tears
• Shoulder joint arthritis

The first step toward treatment is to understand the cause of pain
Clinical examinations and investigations like X-rays and MRIs help us get an accurate diagnosis.

Frozen shoulder or adhesive capsulitis

This is a common cause of pain in the 40 – 60-year-old age group. These patients also have
associated diabetes or hypothyroidism. The reason for stiffness is the thickening of the capsule. The
muscles and labrum structure are normal in MRI. It is only then that a diagnosis of a frozen
shoulder is confirmed. Traditional treatment in the form of physiotherapy and medication is time-consuming and takes up to 2 years for the shoulder movements to return. The latest and most
successful treatment is keyhole surgery. The thickened capsule is released. The advantage is that
the movements return in 1 week and strength in 1 month.

Shoulder Dislocation

In a patient with shoulder dislocation, the ball slips out of the socket. This is an emergency
situation when it happens and requires immediate treatment to put the ball back into the socket.
However, this is not the final treatment. Once the shoulder dislocates it causes a tear in the
labrum (meniscus-like tissue in the shoulder). Hence the shoulder always remains unstable and has
a 90 percent chance of repeat dislocation.

This condition can be permanently solved today with surgery. There are several procedures
described in studies, however, the latest treatment that gives the best results where the
dislocations stop and the movements return normally are the following. Most patients return
back to the sport after this treatment.

• Shoulder arthroscopy and Bankart repair This is the latest keyhole surgery technique to repair the torn labrum after a dislocation. This is most successful if done early after the first dislocation when the quality of the labrum is good.

• Latarjet This is the most successful operation in patients with recurrent dislocations and high-demand athletes like wrestlers or kabaddi players. This involves transferring a small piece of bone to the front of the socket.

Rotator Cuff

The rotator cuff is 4 muscles and tendons in the shoulder

• Rotator cuff tendonitis/inflammation This is the commonest cause of shoulder pain. The overhead movements are painful. The best way to treat is with an Ultrasound guided injection to allow the medicine to be delivered exactly to the inflamed tissues. Physiotherapy is recommended after the injection to improve strength.

• Rotator cuff tendon tears Tendon tears cause significant shoulder dysfunction. They occur after an injury like lifting weight or after falls. They may also be age-related wear and tear. Complete tears and >50% partial thickness tears are best treated by a keyhole surgery called arthroscopic rotator cuff repair. The results are excellent if done early. If these tears are left alone, they worsen and the quality of the tissue deteriorates with time. This is when shoulder joint wear and tear begins and this condition is call rotator cuff tear arthritis. Once a patient reaches this stage of the disease, the only option is shoulder replacement.

Shoulder Arthritis

A patient who is over 60 years of age with a painful and stiff shoulder should be investigated for
shoulder joint arthritis.

Yes SHOULDERS can also be successfully REPLACED.

Shoulder replacements are the only way to permanently treat a worn out joint. Shoulder arthritis or
wear and tear is of 2 types.

1. Arthritis with normal muscles and tendons
2. Arthritis with torn muscles and tendons

The material or implant required for a successful surgery is different for these 2 types of arthritis

Broadly

1. Anatomical shoulder replacements mean the ball is replaced with a ball and the socket
   with a socket, which is used for patients with worn-out joints but have normal muscles and
   tendons. Stemless shoulder replacements are a type of anatomical shoulder replacement
   with a smaller implant to preserve native bone.
2. Reverse shoulder replacements are the latest advance in shoulder replacement technology.
   A reverse shoulder means a ball is implanted in the socket and a socket at the ball side of the
   joint. This reverses the geometry of the shoulder joint. This is required to bring back function in
   a patient’s joint which has arthritis and torn rotator cuff tendons.

These new techniques and advances are now studied for over 20 years of research and are
improving the patients’ outcomes and the overall quality of life.

IASES Visiting Fellows 2022 Report

• The 2022 IASES Traveling Fellowship is complete! Dr. Chintan Desai (Mumbai) and Dr. Balaji Sambandam (Tiruchirappalli) were able to visit 7 physicians across 7 cities while attending both the OSET and ASES conferences. Regarding the experience, Dr. Sambandam said that what he learned in the operating room during his visit was “only part of the learning.”
• The fellows started in Dallas where they visited Dr. Sumant Krishnan at The Shoulder Center at Baylor University. They observed 11 arthroscopic rotator cuff repairs with Dr. Krishnan as well as a total reverse shoulder arthroplasty by Dr. Eddie Lo. The fellows additionally attended lectures by Dr. Krishnan on the history of reverse arthroplasty and shoulder implant removal.
• They continued on to Chicago, where they observed Dr. Nikhil Verma. In two days of surgery the fellows experienced 6 knee scopes, 7 rotator cuff repairs and an elbow arthrolysis. After an additional day in the clinic, Dr. Desai and Dr. Sambandam were given the weekend to explore the Windy City.
• After 5 days in the midwest, the fellows traveled over to the East Coast. They spent an entire week in Boston, spending the first four days with Dr. Andrew Jawa at New England Baptist Hospital and Dr. Arun Ramappa at Beth Israel Deaconess Medical Center. Seven shoulder operations were viewed during their visit. Dr. Sambandam specifically recalls an interesting case of a bucket handle tear of the glenoid labrum, and a mini open deltopectoral subscapularis repair. On top of viewing procedures, the fellows were able to attend a journal club.
• After four days of observation, the fellows participated in the Orthopaedic Summit and Evolving Techniques Conference at the Encore in Boston Harbor. The fellows attended the shoulder and elbow arthroscopy as well as the upper limb trauma sessions.
• Following the conference, they took a train from Boston into New York City, spending three days with Dr. Mandeep Virk at NYU Langone Orthopedic Hospital. They saw a total of 9 operations with Dr. Virk as well as Dr. Joseph Zuckerman, Dr. Andrew Rokito and Dr. Young Kwon. While in New York, the fellows attended a Resident’s conference at NYU, where Dr. Sambandam presented his paper on extra auricular scapular fractures.
• After a shorter train ride, the fellows arrived in Greenwich to visit Dr. Paul Sethi and the Orthopaedic & Neurosurgery Specialists. Dr. Sethi was joined by Dr. Seth Miller on the first day, where the fellows saw three shoulder arthroplasties performed. The fellows gained valuable experience and knowledge in techniques to perform a BIO reversed shoulder arthroplasty. On the second day, they learned the suture bridge technique while observing three rotator cuff repairs.
• Dr. Sambandam returned to India following Greenwich while Dr. Desai continued on his journey to visit Dr. Uma Srikumaran at Johns Hopkins in Baltimore. Dr. Desai observed 5 surgeries with Dr. Srikumaran before attending his first baseball game at Camden Yards. In Baltimore, Dr. Desai stayed at the home of Dr. Srikumaran said that he “certainly felt part of his [family].”
• The last stop of the program was the American Shoulder and Elbow Society Conference in Atlanta. There, the IASES members met for a dinner where Dr. Desai presented his experiences throughout his journey. He was extremely fortunate to meet and speak with all of the shoulder “superstars” as well as the sponsors that made his trip possible.
• Looking back at the fellowship, Dr. Paul Sethi said, “It was a thrill to share this exchange of learning. The visiting fellows contributed as much to my education as I hope we did to theirs. I hope that this is just the beginning of a healthy exchange of knowledge across the continents.”
• Dr. Desai noted, “I wish that the many who come after me will benefit from this program even more than what I did.” He is extremely fortunate for the opportunity stating the, “nostalgia attached with this trip is going to be a lifelong memory. Memories to cherish.”
• The program was able to operate within 5% of the expected budget and was a rewarding experience for all. We are excited to continue the program and send out applications for the 2023 Traveling Fellowship.
• Finally, thank you to our sponsors for their generous donations which allowed this program to flourish. Thank you to DePuy Synthes, Arthrex, Zimmer BioMet, Pacira, Dr. Joseph Zuckerman, Exactech, FX Shoulder Solutions, and Envois.

Today we’re going to talk about a condition that affects most of the population. It affects women more than men.

On average it’ll affect you when you are in your 50s this particular condition is called a frozen shoulder.

Frozen shoulder is characterized by a gradual loss of motion at the shoulder joint with unfortunately a significant amount of pain. Now the motion loss in a frozen the shoulder is going to be, all movements of the shoulder.

Characteristics of Shoulder Joint

• The gradual loss of motion and an increase in pain
• Contracture and adhesion within the joint capsule
• 3:1 ratio, women to men
• Medical age 50
• The capsular pattern is a definitive diagnosis.

So what we mean is you won’t be able to reach behind your back, you won’t be able to reach across your body, you won’t be able to reach up all of those movements will be lost.

That is the true characteristic of a frozen shoulder. Let’s look at the clinical term of frozen shoulder, the clinical term for frozen shoulder is adhesive capsulitis.
So what does that mean, adhesive means getting stuck together,
Capsulitis, tis means inflammation. The shoulder joint is inflamed and its end is getting adhered or stuck together thus you start losing motion at the shoulder.

What’s interesting about a frozen shoulder is that we really don’t
know what causes it often will come on spontaneously.

Causes

Primary Frozen Shoulder

• Causes Unknown
• Occurs without injury

Secondary Frozen Shoulder

• Fracture/ Surgery
• Impingement
• Stroke
• Link to Parkinson’s and diabetes.

There isn’t really any injury that occurs we do know that it is more more
commonly seen in people with diabetes or in people with Parkinson’s.

Another very interesting thing about a frozen shoulder is that if you do nothing about it, meaning you don’t seek out any treatment, the frozen shoulder will actually get better.

Stages

Stage 1: Freezing

• Most painful stage
• Acute inflammation
• All movements painful
• A gradual loss of motion
• 6 weeks to 9 months

Stage 2: Frozen

• Stuck arm
• No longer losing motion, slow reduction in pain
• 4-9 months

Stage 3: Thawing

• Minimal to no pain
• The gradual return of motion
• 5-26 months

All frozen shoulders go through these three phases. Now the time
frame for how long these stages are varies person to person.

Putting all those numbers together, a frozen shoulder at its quickest will resolve in ten months at its longest, it will resolve in three years.

This is where physical therapy comes into play.

Treatment

Freezing Stage

• Anti-inflammatories
• Modalities for pain control
• Very gentle motion
• Minimal physical therapy

Frozen Stage

• Physical therapy for joint mobilization

Thawing Stage

• Home exercise maintenance

Shoulder pain may be resulting from a lot of issues. This is due to the fact the shoulder is comprised of several critical blocks, including tendons, cartilage and the bone. The shoulder itself is a ball-and-socket joint, which allows a wide variety of movement.

Shoulder pain can range from pain just with moving the shoulder to the inability to raise the arms overhead or feeling weak. Here are five potential reasons for such shoulder ache:

Top Reasons for Shoulder Pain

Shoulder Arthritis: This can be because of regular wear and tear.
Frozen Shoulder: If you have a frozen shoulder, the inner lining of your shoulder has become infected and tight. This is stopping you from having full motion and additionally causing pain.
Shoulder Dislocation: A dislocation is when the ball slides out of the socket. Athletic harm or falls most generally causes shoulder Dislocation.
Shoulder Fractures: A shoulder fracture is another word for a broken shoulder. It may be due to breaking of the ball, socket or scapula.
Rotator Cuff Injuries: The rotator cuff is in which the four tendons that encompass the ball of the shoulder meet. Injuries to the rotator cuff can reason shoulder pain.

Treatment for shoulder pain depends on your situation. It could include medication, rehabilitation or surgery. Find a hand surgeon near you to speak about your ache with a doctor. Hand surgeons can deal with all kinds of injuries, from the fingertip to the shoulder.

Dr. Chintan Desai, top shoulder arthroscopy and replacement surgery specialist surgeon in mumbai and Manasi Rajadhyaksha, Sports Physiotherapist conducted a shoulder rehabilitation workshop for physiotherapist at Nirmala Hospital, Lower Parel, Mumbai. The worksop focussed on the surgeon therapist interaction and when they work together it leads to better patient outcomes.

Dr Chintan Desai, Best Orthopaedic Sports Medicine and Shoulder Surgeon were invited to the Norwegian School of Sports Medicine for the International Olympics Committee Sports Medicine Diploma final exam and workshop. It was a great academic feast to learn about sports injuries and sports medicine.

Dr Chintan Desai, best-frozen shoulder doctor in Mumbai, performed a shoulder arthroscopy and tissue release procedure on this patient suffering from severe frozen shoulder. The patient has severe shoulder pain and stiffness for several months.

He had done exercises and physiotherapy but did not improve much. Dr Chintan Desai, best shoulder arthroscopy and sports medicine doctor in Mumbai, examined the patient and determined that he had a severe frozen shoulder.

After the treatment patient got back to his normal activities in just 1 week. The patient talks about his experience in the video below.

Dr Chintan Desai, Best Shoulder Surgeon and Sports medicine specialist and best arthroscopy surgeon in Mumbai, performed a shoulder arthroscopy and rotator cuff repair on this patient. The patient had a large rotator cuff tear which required repair. She had severe pain in her shoulder for several years.

Physiotherapy and exercises done earlier did not help her with her pain. Dr Chintan Desai, best shoulder arthroscopy surgeon and best-frozen shoulder specialist, examined her and determined that she had a rotator cuff tear.

This was confirmed on an MRI and shoulder arthroscopy was planned. In the video below, the patient talks about her experience.

Dr. Chintan Desai, Best Shoulder Surgeon and Sports Medicine Specialist practising in Mumbai performs shoulder arthroscopy for frozen shoulders. The results speak for themselves.

Dr Chintan Desai, Best Shoulder Surgeon and Sports Medicine Specialist practising in Mumbai gave a talk on Shoulder conditions and their treatment with the doctors of the “A” ward Medical Association at Hotel Diplomat.