Bicep Tendinitis

 Bicep Tendinitis:

This is by far the most common shoulder problem I see.  As you can see in the picture, the long head of the bicep tendon has to curve sharply as it enters the shoulder.  This is one of the only tendons in the body that bends at a sharp angle.  It probably explains why people get irritation and swelling on the portion of the tendon that rubs on the "corner" of the shoulder.  This causes a sharp pain in the front of the shoulder.  The pain can radiate down into the bicep muscle and occasionally into the forearm.  

These symptoms can be relieved with a bicep tenodesis surgery.  This is an arthroscopic surgery that fixes the damaged bicep tendon to the humerus so it can no longer rub and cause pain.  

Rotator Cuff Tear

 Rotator Cuff Tear:

This is probably the second most common injury of the shoulder I see.  The deep layer of shoulder muscles is called the rotator cuff.  People can tear one or more of these tendons leading to pain and weakness.  Patients describe this pain as a sharp or achy pain that emanates from the lateral side of the shoulder.  

We use an arthroscopic technique to repair the torn tendon.  We place bone anchors with sutures that secure the torn tendon back to the original position on the bone.  The tendon is held there by the suture tape while it heals.  It takes about 12 weeks for the tendon to fully adhere to the bone.  

Labral Tear

 The shoulder usually dislocates to the front, or anteriorly.  The rim of the socket, called the labrum, tears off the glenoid bone.  This torn labrum and the attached ligament is called a Bankart lesion.  It often will not heal, leading to further instability or dislocations of the shoulder.  

When we repair this type of lesion, we use an arthroscope to visualize the damage.  We then use suture anchors to repair the damaged ligaments and labrum.  This can lead to very satisfying results.  The chance of future dislocations is greatly reduced after a surgery like this. 

Subscapularis Tear

 One of the more common injuries I see is a tear of the upper subscapularis tendon.  The subscapularis is a part of the rotator cuff.  It is located in the front of the shoulder and is responsible for internally rotating the shoulder.  When the subscapularis tendon is injured, the adjacent long head of the bicep tendon can slip into the torn "corner" of the tear.  This can lead to weakness and pain in the front of the shoulder.

PASTA Lesion

Among the many fun acronyms of the shoulder is the PASTA lesion.  PASTA stands for Partial Articular-sided Supraspinatus Tendon Avulsion.  It occurs when the undersurface of the supraspinatus tendon tears from the greater tuberosity.  This type of tear can only be seen from inside the joint since the outer portion of the tendon is still intact.  Although this is not a full thickness tear, it can cause significant pain and weakness of the shoulder.  There are arthroscopic options for fixing this problem, allowing for an accelerated recovery.  

We can repair these tears arthroscopically using percutaneous anchors.  This avoids detaching the intact outer portion of the tendon.  In some patients who have diseased or frayed tendon edges, a bovine collagen implant can augment the tendon thickness.  The Regeneten patch has been shown to integrate with the native tendon and restore function.