Because shoulder problems are complex and greatly affect quality of life, to help everyone better understand shoulder injuries and their treatment, Police Lieutenant Colonel Dr. Wichan Kanchanathawan, an orthopedic surgery specialist, has some valuable knowledge to share.
Shoulder injuries can be divided into two main groups: injuries in young people and injuries in working-age to elderly individuals.
1. Shoulder injury problems in the young age group In reality, there are not many shoulder diseases in this group, but almost all patients who come to see a doctor have issues related to “shoulder dislocation or shoulder instability”, which in our country is mostly caused by sports and most commonly by accidents.
Regarding the specific characteristics of shoulder dislocation or instability, it can be summarized as follows: the shoulder has a wide range of motion because the body is designed to be highly flexible. However, once the shoulder dislocates, the chance of recurrent dislocation after the first episode is very high, especially in younger patients. For example, in 20-year-old patients, the chance of recurrent shoulder dislocation within one year is as high as 80%. For those aged 30 or 40 and older, the recurrence rate decreases. It can be said that the chance of recurrence is related to age.
Regarding treatment approaches, the doctor will consider the appropriateness. Treatment may include medication and learning physical therapy exercises in cases of early-stage shoulder instability. However, if conservative treatment cannot resolve the problem or if there is clear recurrent dislocation, the patient must undergo surgery. Currently, arthroscopic surgery is popular and provides good treatment outcomes.
“Arthroscopic shoulder surgery uses a camera only 4.5 millimeters in size, making 3-4 small holes around the shoulder to insert instruments and a high-magnification camera to perform internal surgery. The doctor views the details on an external monitor, resulting in less muscle damage, smaller wounds, faster recovery, and quicker return to daily life compared to traditional surgery.”
2. Shoulder injury problems in the working-age to elderly group Mostly, there are two main problems: rotator cuff tendons and frozen shoulder (Frozen shoulder/Adhesive capsulitis). Many people think that shoulder injuries and frozen shoulder are common diseases, but in reality, rotator cuff injuries are much more common, about 80%, while frozen shoulder accounts for only 20%. This is an important reason why whenever there is a shoulder problem, it must be diagnosed and treated by a specialist to ensure correct treatment that truly matches the disease. Incorrect diagnosis can lead to treatments that may worsen health.
“Rotator cuff” – a disease anyone can get!!
Rotator cuff injuries can be caused by inflammation, calcific deposits, and tears. If patients see a doctor early, conservative treatment can begin with anti-inflammatory medication, injections, and physical therapy. However, if patients come with severe symptoms, long-standing conditions, or if a rotator cuff tear or rupture is detected, these patients need arthroscopic surgery to repair the tendon.
“Rotator cuff disease can be said to be a degenerative condition related to aging. Therefore, it is common in people aged 60 and above. This disease is also associated with activities that require frequent or continuous overhead arm movements (Overhead Activity), which are risk factors for rotator cuff disease. In other countries, occupations at risk include ceiling installers and painters, but in Thailand, I have seen cases such as teachers and people who enjoy playing golf, tennis, badminton, etc.”
However, rotator cuff injuries with tears can also occur due to severe shoulder accidents, in addition to age-related degeneration.
Frozen shoulder.. another disease that occurs and resolves on its own
Regarding “frozen shoulder” , a popular term among the general public, medically it is a disease that can occur and resolve on its own but takes about 2 years. This means patients may suffer for a long time. To better understand frozen shoulder, it is important to know that the disease is divided into 3 stages as follows:
- Stage 1 (first 3 months) is the “painful phase” causing severe pain and intense inflammation in the shoulder joint.
- Stage 2 (3-9 months) is the stiffening phase where the shoulder becomes more restricted, and the “range of shoulder motion decreases”. Patients find it harder to perform activities such as combing hair or fastening a bra hook behind the back in women, but the pain starts to improve.
- Stage 3 (12-24 months) overall, “pain and stiffness gradually ease” but this phase lasts quite long. Most pain improves by the second year, but shoulder movement is still not fully restored.
“I always tell my patients that not everyone with frozen shoulder needs treatment but must receive proper care and management. Some patients come to me with frozen shoulder, and by the third month, pain improves but they wonder why the shoulder feels stiffer and harder to move. I explain the three stages clearly so they understand the disease progression and symptoms at each stage. Sometimes, when I examine patients with less pain and mild stiffness, I tell them the shoulder may still be slightly stiff but not severe, and with recommended exercises for about 4-5 more months, symptoms will improve without any special treatment.”
What type of frozen shoulder symptoms should prompt a doctor visit?
Although shoulder health problems cannot be prevented, everyone can avoid risk factors and take care of themselves to increase the chances of successful treatment if shoulder problems occur. I would like to share how to recognize shoulder injuries as follows: “If symptoms last more than 2 weeks, and lying on the affected shoulder causes pain, such as left shoulder pain when lying on the left side, or some patients feel uncomfortable lying on their back,” these are warning signs that require prompt medical consultation. Currently, there are still few specialized shoulder clinics.
For cases that may require treatment for shoulder injuries, arthroscopic surgery is now the standard and yields good results. Hospital stays are short, and recovery time is less than traditional surgery. The cost of arthroscopic surgery varies depending on the patient’s age and the specific condition.
