Shoulder pain is common among individuals with spinal cord injury. As wheelchair users rely on their arms to independently perform their day-to-day activities, the shoulder joint is subject to very heavy, and in some cases unphysiological strain..
A look at the everyday life of a wheelchair user suggests that the shoulder muscles are fatigued due to excess strain, primarily during transfer, meaning that the dynamic centring of the humeral head during movement is no longer guaranteed. This results in rapidly advancing joint damage.
Unfortunately, when a consultation takes place, the pain is often already permanent and it is no longer possible to treat it with non-surgical forms of therapy, or a significant loss of function has already taken place. In most cases, this means a disability in physical transfer, the process that determines independence in a paralysed individual.
Many years of experience
The Spinal Surgery/Orthopaedics department at the Swiss Paraplegic Centre (SPC) Nottwil has been offering standalone consultations for joints by Dr. med. Jacek Kerr since 2005. All surgical and non-surgical measures can be performed. Surgical interventions include arthroscopic (“keyhole technique”) reconstruction of tendons and ligaments, care for broken bones, implantation of endoprostheses, and the treatment of other injuries and illnesses of the upper and lower extremities. We provide comprehensive support and constant dialogue, working in collaboration with the Orthopaedics department of the Balgrist University Hospital in Zürich. Consultations, non-surgical therapy, and surgical therapy at the SPC are also available to patients who are not paralysed, but who may benefit from the Department’s particular experience in treating “challenging” shoulders.
Treatment and diagnosis
Our treatment focuses both on surgical care for acute injuries of the locomotor system, and the treatment of degenerative damage to major joints. We predominantly use minimally invasive surgical techniques on the knee, shoulder, elbow and ankle joints.
In contrast to open techniques, arthroscopic procedures involve very little surgical trauma, which has multiple advantages. The proprioceptive function which is essential to an intact joint is retained, with the result that sporting capacity can be quickly restored to the previous level. Furthermore, mobilisation can take place earlier, and the period of inpatient hospitalisation is much reduced. The minimally invasive procedure results in a lower level of morbidity, less post-surgical pain, and a more successful cosmetic result.
Diagnosis and treatment are performed in accordance with the latest findings in medical research. Close collaboration with Sarnen Cantonal Hospital and the Swiss Paraplegic Centre enables cutting-edge imaging procedures to be used, including magnetic resonance imaging, for example, which is particularly helpful for diagnosing injuries in shoulders, knees and ankles.
Elbow and hand
In recent years, elbow arthroscopy has seen a particularly high level of development due to technical progress. This results in improved treatment options and a broader range of use. Diagnostic elbow arthroscopy is now able to represent all sections of the joint – which years ago was only possible by making multiple skin incisions. In the elbow, constriction arising from loose bodies, and stress-induced pain due to arthrosis make arthroscopic treatment necessary in most cases. There are further treatment options for cartilage and bone defects (including the assessment of bone breakages), in particular on the radial head but also in the other sections of the elbow joint. Loosening adhesions with significant restriction of movement, and the removal of inflamed joint mucosa (synovitis), particularly in the event of rheumatic illness, often represent good indications for shoulder joint endoscopy.
Carpal tunnel syndrome is also referred to as median nerve compression syndrome. It is the most frequently occurring entrapment syndrome, accounting for approximately 20% of all peripheral nerve damage that occurs. Women are affected significantly more frequently than men, and symptoms most often occur between the ages of 40 and 60, with the frequency of carpal tunnel syndrome currently increasing. One reason for this upward trend is the increased time individuals spend working at computers, and the associated keyboard and mouse operation. If other treatment methods have failed to cure or alleviate symptoms, or if the illness is at an advanced stage, surgery should be performed. In particular, surgery is necessary if initial indications of paralysis have occurred, and it should not be delayed too long. Functional restriction to the damaged nerve regresses only slowly, and may persist for some time even after successful surgery. In the event of severe nerve damage, complete restoration of the nerve function cannot always be achieved.
Treatments we offer:
- Rotator cuff
- Impingement syndrome
- Tendinitis calcarea (calcareous shoulder)
- Shoulder instability
- Pathologies of the long biceps tendon (SLAP lesion)
- Osteoarthritis of the shoulder joint
Osteoarthritis of the hip joint (coxarthrosis)
The most frequent cause of disorders affecting the hip joint is cartilage wear, which can result in osteoarthritis, or “coxarthrosis”. The joint increasingly loses its fit, the bone forms deposits around its edges, and the resulting wear causes pain on an ongoing basis. The loss of cartilage results in increasing stiffening of the joint. At the same time, pain occurs after periods of activity, on exertion, late at night, and at rest, resulting in reduced walking distance and ultimately restriction of quality of life.
Hip endoprosthesis (total hip replacement)
When non-surgical treatment measures (physiotherapy, complementary measures, massages, anti-inflammatory indications) no longer help and pain has become too great, it’s time for surgical intervention.
A hip endoprosthesis is the longest-established joint replacement in common use. However, surgical techniques and the material used have been improved so much in the last 20 years that the useful life of a hip prosthesis can now be measured in decades. Both the femoral head and the acetabulum need to be replaced in the event of hip osteoarthritis.
This procedure has become one of the most frequently employed and most successful routine operations in orthopaedic surgery (with approximately 400,000 taking place across Europe each year).
The prosthesis is modelled on the structures as they naturally occur in people, i.e. it consists of a socket and a shaft onto which a spherical head is attached. With the aid of pre-surgical planning diagrams, the prosthesis size and position are determined, taking into account individual patient needs (such as age, gender, bone shape, bodyweight, and other factors).
The knee is the largest joint in the human body. It is made up of three bones: the femur, tibia and patella. It is stabilised by the surrounding muscles and ligaments (cruciate and lateral ligaments). In addition, the meniscae go through the joint, stabilising it, serving as shock absorbers, and distributing pressure. As is the case with all other joints, the knee is also covered by a layer of cartilage.
Treatments we offer:
- Cartilage damage
- OATS (Osteochondral Autologous Transfer System)
- MACI / ACT
(Matrix Associated Chondrocyte Implantation / Autologous Chondrocyte Transplantation)
- Microfracturing (“Pridie- drilling”)
- Corrective osteotomy
Ankle and foot
Treatments we offer:
- Hallux valgus
- Hallux rigidus
- Hammer toe / claw toe
- Tailor’s bunion/bunionette (bunion on the little toe)