[전문의에게서 듣는다] Joo-han Oh Professor of Orthopedic Surgery at Seoul National University Bundang Hospital
Oh Joo-han, professor of orthopedic surgery at Seoul National University Bundang Hospital, said, “Just because the shoulder pain disappears after a rotator cuff tear doesn’t mean it’s completely cured, so it’s better to get surgery at an appropriate time.” Provided by Seoul National University Bundang Hospital
In the shoulder, a space (socket) made of a muscle-tendon complex surrounds the round part (ball) at the top of the arm bone, and the arm moves with the help of the ‘rotator cuff’. Because it moves freely within the socket, the possibility of injury is high. After middle age, the amount of blood going to the tendon decreases and the elasticity drops, making the tendon more likely to rupture, leading to degenerative shoulder diseases such as frozen shoulder (adhesive capsulitis).
I met Oh Joo-han, a professor of orthopedic surgery at Seoul National University Bundang Hospital, a ‘shoulder disease treatment expert’. Professor Oh said, “Most of the degenerative shoulder diseases such as frozen shoulder, rotator cuff tear, and shoulder impingement syndrome fall into one category.
– Frozen shoulder is a representative disease of the shoulder.
“Frozen shoulder, which is said to occur mainly in the 50s, occurs frequently even at a young age, so it is sometimes called ’30 shoulder’. This is because you use your computer or smartphone in the wrong posture for a long time. Frozen shoulder is the correct name for the disease to be called ‘frozen shoulder’, because it is difficult to move because the shoulder is stiff and painful even without trauma. Last year, more than 2.3 million people were treated for shoulder diseases such as frozen shoulder and 130,000 hospitalizations, ranking 8th in the most frequent disease.
Most of the degenerative shoulder diseases begin with a ‘shoulder impingement’ in which the shoulder tendon (rotator cuff) collides with the shoulder blade. Frozen shoulder, rotator cuff tear, and arthritis are easy to think of as separate diseases, but in fact they belong to one category. Inflammation of the rotator cuff due to a shoulder impingement results in stiffening of the shoulder (freeze tendon). If the freeze tendon worsens, a rotator cuff tear or shoulder arthritis may occur.
Frozen shoulder can improve without surgery, but it must be treated. Natural healing is so difficult that there is a study showing that half of the patients continue to be sick after 10 years and their life is limited. In particular, although the joint is still stiff, there are many patients who neglect it because there is no pain. Then, the joints become stiff and can worsen into arthritis, so it needs to be treated early.”
– When should shoulder surgery be performed?
“If more than half of the rotator cuff is torn, surgery is required to restore it to its original position with sutures. Surgery includes acromioplasty, which cuts the shoulder blade that causes a collision, as well as rotator cuff tear restoration and artificial joint surgery. 90,000 to 100,000 cases are implemented annually.
Recently, there are many young people who have ruptured their rotator cuff while doing sports with a large swing angle, such as tennis, badminton, or swimming. It is often seen in occupations where people lift their shoulders, such as car maintenance and beauty work. Among young patients, shoulder pain is not taken seriously and suffers from neglect for a long time. According to the research team at Seoul National University Bundang Hospital, if the rotator cuff tear is operated before the age of 70 or before the rotator cuff tear exceeds 2.5 cm, the chance of a rotator cuff tear is reduced to 1 in 3 minutes. This is why early treatment is so important.
If the rotator cuff is torn, even if the pain subsides to some extent, it does not recover. A ruptured tendon becomes more and more damaged over time, causing severe pain and inability to lift the arm properly. There is a high chance of recurrence even after rotator cuff repair.”
-Why do you need treatment, such as surgery, quickly?
“If the operation is delayed for a rotator cuff tear, treatment will be more difficult, and you may suffer from arthritis in a severely stiff shoulder. Then you will have to undergo artificial joint surgery. Fortunately, the prognosis has improved significantly with the development of techniques. In particular, more than 5,000 patients a year recover shoulder function with a retrograde artificial joint.
The shoulder moves with the help of the rotator cuff, where the space (socket) at the end of the shoulder blade wraps around the upper arm bone. On the other hand, the retrograde artificial joint makes a socket in the upper arm and attaches a ball-shaped artificial joint to the end of the shoulder blade, so it can rotate the arm well even if the rotator cuff is weak.
As the technique has improved, the number of shoulder arthroplasty surgeries has increased by more than 60% in the past five years. Compared to the 8% increase in knee and hip arthroplasty over the same period, it is very fast.”
– How to prevent shoulder disease.
“You have to stretch regularly and maintain a good posture. If you hear a sound when you move your arm at a specific angle, it means a collision has occurred, so even if there is no inflammation or pain, you should check your shoulder at the hospital and correct your lifestyle.
In addition, the shoulder internal rotation and external rotation strength exercises to strengthen the rotator cuff should be continued. For young people who do a lot of weight training, the weight should be lowered so as not to put strain on the shoulders when doing bench presses with arms raised above 90 degrees (their eye level).”
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Kwon Dae-ik medical journalist dkwon@hankookilbo.com
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