Shoulder arthroscopy in children and adolescents

Shoulder arthroscopy or αρθροσκοπηση ώμου is being used more and more frequently to treat a wide spectrum of pathologies in children and adolescents. Since it is a minimally invasive technique and is used to treat infections, contractures resulting from brachial plexus palsy, instability due to trauma. Or sometime multidirectional instability without trauma, hemophilia or rotator cuff injuries, among others.

The increasing use of this technique is largely due to the growth of acute and chronic injuries that children suffer during sports practice. Although arthroscopy is a tool of great relevance in many other pathologies not derived from the practice of sport at these ages.

This surgical procedure has proven its effectiveness in the diagnosis and treatment of joint diseases. The arthroscopic technique allows viewing, by inserting video cameras, thanks to specific instruments, through small incisions, without the need to perform a complex open surgery.

Αρθροσκόπηση ώμου derives from the greek term αρθρο+σκοπία meaning the inside view of the shoulder joint. Technological improvements and decreased instrument size have made it possible to treat pediatric joint diseases. Children have small joints, with continually growing bone and cartilage. Therefore, the need to treat these complex injuries, to avoid further damage in the future. There are several factors that are unique to children and should always be considered before an arthroscopic intervention:

    Equipment of the appropriate size is necessary for intra-articular access.

    Severe joint contractures due to conditions such as cerebral palsy and/or arthrogryposis may prevent arthroscopy or limit its use.

    Underlying bone dysplasia can increase the risk of intraoperative chondral damage, prohibit access to the joints, and severely distort the surgeon’s vision.

    The ability or not of the patient, or even the family, to complete the postoperative instructions can be decisive and in some cases it will be necessary to wait for the patient to be more mature or cooperative.

PEDIATRIC PATHOLOGIES TREATED BY ARTHROSCOPY

1. Acute joint infection

In cases of acute shoulder infections, to eliminate infectious waste and wash the joint. It must be as soon as possible to more effectively stop the destructive action of the germ.

2. Contractures derived from paralysis of the brachial plexus.

The brachial plexus is the arrange of nerves that sends signals from the spinal line to the bear, arm, and hand or knee. Αρθροσκοπηση γονατος (knee arthroscopy) is also important in this case. Brachial plexus injuries occur when we stretch, compress or tear or severe these nerves from the spinal cord. Incomplete recovery from brachial plexus palsy at birth can lead to inability to move and muscle imbalance.

In many cases it will be treated with open surgery, but due to some deficiencies in the concrete application of this method to treat this pathology, several surgeons prescribe arthroscopic means to treat internal rotation contracture and posterior humeral head subluxation associated with plexus paralysis. brachial.

3. Labral injury and shoulder instability resulting from trauma.

Many of the pediatric or adolescent injuries involve instability in the man. In most cases they divide into two groups: (1) unidirectional instability and (2) multidirectional instability.

Anterior shoulder dislocations from trauma account for more than 90% of shoulder dislocations in children and adolescents, while post-traumatic unidirectional instability as a result of a bankart injury is more common in patients with closed growth plates and, therefore, Therefore, it is more common in adolescents.

We should repair then more stretches or tears in labrum and the anterior capsule of the shoulder joint. The operation involves reinserting and suturing the torn labrum and ligaments of the shoulder. This is usually by using sutures and small non-metallic bone anchors.

4. Atraumatic multidirectional instability

This type of instability can include several factors such as genetic characteristics, alteration of the viscoelastic properties of the tissues, poor bone configuration and weakness of the rotator and scapular muscles that produce poor neuromuscular control.

5. Congenital hemophilia

Congenital hemophilia results from the absence or deficiency of factor VIII (hemophilia A) or factor IX (hemophilia B) and the intra-articular bleeding leading to pain, functional limitation, and ultimately, degenerative joint disease.

Joint hemorrhages (hemarthrosis) are the most typical manifestations of hemophilia. When hemarthroses are frequent and/or intense, the synovial membrane is not capable of reabsorbing all the blood. To compensate for such reabsorptive deficiency, the synovium will hypertrophy, and results in chronic hemophilic synovitis.

In these cases, when performing arthroscopy – αρθροσκοπηση ωμου, it needs special care since the use of tourniquets is not possible and bleeding can lead to visualization problems.

6. Rotator cuff pathology

The rotator sleeve could be a bunch of muscles and their ligaments that shape a sleeve over the bear joint. Hence these muscles and tendons support the arm at the shoulder joint and help the shoulder move in different directions. Instead the tendons in the rotator cuff can tear when overload or in injuries.

Rotator Cuff Repair:

    None the less the edges of the muscles meet. The ligament connects to the bone with sutures. Little bolts (called suture stays) assist join the ligament to the bone. The grapples are of metal or plastic and do not obligatory evacuate after surgery.

OTHER USES: DIAGNOSTIC ARTHROSCOPY

Unlike adults, in the case of children it is not the most common to use the arthroscopic technique as a diagnostic tool, although there are cases in which it may be necessary to correctly visualize the rotator cuff in older adolescents.