The ageing shoulder: imaging, functional assessment and arthroscopic interventions

Due to its unique anatomy and biomechanics, the shoulder shows some distinctive patterns while ageing. Several controversies are ongoing in the field of imaging, clinical testing, and existing and trending treatments for ageing patients with shoulder pain. Part 1 is an MRI study about osteoarthritis of the outer collar bone joint. Part 2 of the thesis has several studies about the function of rotator-cuff tendons and the evaluation of surgical techniques. One of these analyses shoulder movements of patients with a torn rotator cuff compared to a control group. Several specific movement patterns were shown including hyperactivity of the biceps muscle. If non-operative treatment of rotator cuff tears fails, and the tendon can not be repaired, a dissection of the biceps tendon with key-hole surgery can be a solution. After surgery, the majority of the patients gain function and have less pain. This biceps tendon, which runs partially through the shoulder joint, can be used as a graft in rotator cuff surgery. Based on the literature this seems to be a good option. Based on these results a novel technique is developed to use the biceps tendon as an enforcement of the rotator cuff during arthroscopic surgery. Clinical results are described in a pilot study. Part 3 describes several trends in the Netherlands on the treatment of shoulder pain after the publication of the guideline in 2016. The results of this thesis will help caregivers to give patients with shoulder pain the best treatment