Shoulder procedures

A significant proportion of shoulder procedures can be performed using modern, minimally invasive arthroscopic techniques. More complex injuries, advanced joint damage or cartilage degeneration may require reconstructive surgery or shoulder joint replacement. The appropriate surgical procedure is always selected on an individual basis, taking into account the patient’s symptoms, the condition of the shoulder and the findings of imaging studies.

Arthroscopic Shoulder Surgery

Arthroscopic shoulder surgery is a modern, minimally invasive procedure in which conditions affecting the shoulder joint are treated using a camera and specialised instruments inserted through several small incisions. The advantages of the procedure include less surgical trauma, reduced postoperative pain, faster recovery and favourable cosmetic results.

Most procedures are performed as day-case surgery under general anesthesia or regional nerve block, allowing most patients to return home on the day of surgery. Our surgeons’ continuous professional training, together with the collaborative approach and teamwork of our seven shoulder surgeons, also supports the treatment of more complex cases.

Arthroscopic techniques can be used to treat, among other conditions:

• rotator cuff tears,
• shoulder joint instability and recurrent dislocation,
• frozen shoulder syndrome,
• subacromial impingement syndrome (subacromial decompression),
• removal of calcium deposits.

Rotator Cuff Tendon Repair

The rotator cuff is a group of muscles and tendons responsible for stabilising the shoulder and enabling movement of the arm. Rotator cuff repair restores torn tendons that stabilise the shoulder joint and facilitate arm movement. The aim of the procedure is to relieve pain and restore the shoulder’s range of motion and strength, allowing the patient to return to everyday activities without pain. Another long-term benefit of repairing the rotator cuff is that it may help prevent premature degenerative changes in the shoulder joint.

The procedure is performed exclusively using arthroscopic techniques.

Shoulder Joint Replacement

In cases of advanced cartilage degeneration, severe joint damage or irreparable injuries, shoulder joint replacement may provide a lasting solution.

During open surgery, the damaged joint surfaces are removed and replaced with a modern shoulder prosthesis. The aim of the procedure is to relieve pain, improve the shoulder’s range of motion and significantly enhance quality of life. We use modern, internationally recognised shoulder prosthesis systems. Precise surgical planning is supported by 3D planning software, and patient-specific guides are used where necessary.

Biceps Tenotomy / Tenodesis / Rerouting

Inflammation or instability of the long head of the biceps tendon can cause persistent shoulder pain and loss of strength. In athletes, it may interfere with swimming, throwing or other overhead activities even at a young age. In middle age, it can make everyday activities more difficult, while in older patients it may also cause symptoms at night.

During a tenotomy, the long head of the biceps tendon is released arthroscopically within the shoulder joint. The procedure mimics the pain-relieving effect that often occurs when the tendon ruptures spontaneously and, in appropriate cases, can provide a rapid and effective solution.

In younger, physically active patients, where preserving muscle strength and the cosmetic appearance of the biceps are important, a tenodesis may be performed. After the tendon is released, it is reattached to the humerus. This can help minimise loss of strength and, in most cases, prevent the so-called “Popeye deformity”.

In cases of massive rotator cuff tears, the biceps tendon can, in certain circumstances, also be used to reinforce the reconstruction. During biceps rerouting, the tendon is repositioned arthroscopically to provide additional support to the repaired rotator cuff.

Arthroscopic procedures involving the biceps tendon require precise surgical planning and advanced shoulder surgery expertise. The optimal approach is selected individually, based on the patient’s age, activity level, and the condition of the tendon and rotator cuff.

Arthroscopic Shoulder Stabilisation (Bankart Repair)

A Bankart lesion most commonly develops following an initial shoulder dislocation, when the labrum and the ligaments attached to it become detached from the rim of the shoulder socket. This can lead to pain, recurrent shoulder dislocations and, in some cases, persistent shoulder instability.

During a Bankart repair, the joint is examined arthroscopically and the detached labrum, together with the attached ligaments, is reattached to the bony rim of the shoulder socket. We use modern, metal-free suture anchors and knotless suture techniques, which may help reduce the risk of postoperative degenerative changes.

In certain cases, a bony defect in the humeral head may also need to be treated. During a Remplissage procedure, additional posterior stabilisation is performed using suture anchors, further reducing the risk of recurrent dislocation. The aim of the procedure is to restore shoulder stability and full function.

Latarjet Shoulder Stabilisation

The Latarjet procedure is used to treat recurrent anterior shoulder instability and recurrent shoulder dislocation when arthroscopic stabilisation alone is unlikely to provide sufficient stability.

During the procedure, an approximately 6-7 cm incision is made at the front of the shoulder to expose the coracoid process of the scapula. The coracoid process, together with the tendons attached to it, is detached and transferred to the anterior rim of the shoulder socket, where it is secured with two screws.

The transferred bone acts as a bony block, preventing the humeral head from dislocating, while the attached tendons and the reconstructed joint capsule provide additional stabilisation. When appropriately indicated, the procedure can significantly reduce the risk of recurrent dislocation compared with arthroscopic stabilisation.

Stabilisation of Chronic AC Dislocation

Following an AC joint dislocation, the injured ligaments are no longer able to heal adequately after approximately 2-3 weeks, and scar tissue develops in the surrounding soft tissues. This is referred to as a chronic AC dislocation.

If persistent pain or instability remains, abnormal movement of the scapula is observed, or the affected shoulder has reduced load-bearing capacity compared with the opposite side, reconstructive surgery may be necessary.

During surgery, the stability of the acromioclavicular joint is restored using a synthetic ligament or a plate-and-suture system. Where necessary, the reconstruction may be supplemented with an autologous tendon graft harvested from the wrist or knee area to support healing.

The aim of the procedure is to relieve pain, restore AC joint stability and improve shoulder function.

Stabilisation of Acute AC Dislocation

An acute acromioclavicular (AC) joint dislocation typically occurs as a result of a high-energy fall directly onto the shoulder. It is therefore particularly common in contact sports, skiing accidents, and motorcycle or bicycle accidents. The injury causes partial or complete rupture of the ligaments that stabilise the AC joint. As a result, the clavicle is pulled upwards by the muscles attached to it, while the scapula is pulled downwards.

Whenever possible, acute surgery should be performed within 14 days of the injury. The aim is to restore the anatomical position of the shoulder girdle, promote healing of the injured ligaments in the correct position, relieve pain, and restore full shoulder function.

The surgical technique is selected according to the severity of the injury (Rockwood classification) and the extent of ligament disruption. Modern implants are used during the procedures.