Conditions & Treatments

Conditions



  1. Fractures around the Shoulder & Elbow

    Many fractures around the shoulder and elbow can be treated without surgery. Common fractures include clavicular fractures, often caused by sporting injuries, which may need plate fixation if displaced (insert X-ray), displaced upper humeral fractures which can be treated with either plate fixation or replacement (insert X-ray). Internal fixation allows a rapid return to function, correction of deformity, pain relief and a return to work.

  2. Frozen Shoulder

    Frozen shoulder is a common condition which affects mainly middle aged people. It presents with a gradual onset of shoulder pain, followed by increasing stiffness (loss of movement). After a few months the shoulder can become “locked”. The loss of movement can make it difficult to raise the arm above shoulder height, dress etc. It can improve spontaneously without treatment, but recovery may take two years or more. Arthroscopic surgery (keyhole surgery), can restore the arc of shoulder movements and improve pain. It is usually possible to re-gain a virtually full arc of movement within two weeks of operation. Post-operative physiotherapy is required to prevent the shoulder from re-stiffening.

  3. Rotator Cuff Injuries

    The rotator cuff is a cuff of tendons that surround the humeral neck. The four components of the rotator cuff originate from the shoulder blade and both power and control the movements of the shoulder. In late middle age the tendons can become worn and may rupture, either through minor trauma, or spontaneously. This results in pain and loss of movement. The main problems are difficulty in raising the arm above shoulder height, weakness and pain on movement. Often people have severe night pain and cannot lie on that side in bed. The diagnosis is made by either ultrasound or MRI scanning. Most tears can be repaired by re-attaching the torn end of the tendon to the head of the humerus, using bone anchors. This can be done either with an arthroscopic or mini-open technique. After the operation the arm is supported in a sling for four to six weeks while awaiting healing of the tendon. During this period the patient receives gentle physiotherapy. It may take up to six months before a full recovery has been achieved. Some rotator cuff tears in the elderly are too extensive to be repaired, and on occasions, a new type of shoulder replacement is needed (reverse shoulder replacement).

  4. Shoulder Impingement

    Rotator cuff impingement affects mainly middle aged people. It can be caused by trauma, but often occurs spontaneously. Sportsmen, athletes and people who do strenuous overhead work are most often affected. The problem is characterised by shoulder pain induced by raising the arm away from the side, when the patient experiences a painful arc, with the pain being most severe between about 80 degrees and 120 degrees of sideways elevation. It is often painfree at rest. The problem is caused by part of the rotator cuff tendon rubbing against the bone of the outer point of the shoulder blade (acromion). The diagnosis is based on clinical findings, supplemented by either ultrasound or MRI scanning. Sometimes a simple injection placed between the rotator cuff tendon and the overlying bone will be sufficient to control the pain, but if that does not provide a permanent solution, then keyhole surgery (arthroscopic subacromial decompression) may provide a more permanent solution. The surgery is usually done as a day case under general anaesthetic. Patient do not normally need a sling afterward and are encouraged to move the arm at the earliest opportunity. No suture are used and the stab incisions are closed by Steristrips which are removed at a week post-operatively. Recovery from the surgery (usually two 0.5cm incisions) is rapid, but a full recovery may take several months and a course of physiotherapy. Most sedentary workers will be off work for no more than two weeks.

  5. Tennis Elbow

    About 10% of the population will have a tennis elbow at some time in their life, but only a small proportion will need surgery. It may be caused by repetitive straining of the arm and does indeed often affect tennis players ! The condition is characterised by very localised pain and tenderness around the outer point of the elbow (lateral epicondyle) and is made worse by gripping, but elbow movements are maintained. It is most commonly between the ages of 40 and 60. Many cases will respond to physiotherapy, anti-inflammatory gels and pain killers and usually settle within six months of onset. In more severe cases, when the pain persists for more than six months, despite conservative measure having been adopted, injections and sometimes surgery can be beneficial. The operation is done as a day case under a general anaesthetic. A bandage is worn for two days and the patient is encouraged to mobilise the elbow as soon as possible. Most sedentary workers are off work for no more than two weeks after the operation, but a full recovery may take several months. No driving is allowed for at least two days after the operation.

  6. Golfer’s Elbow

    Golfer’s elbow often affects golfers ! This condition is less common than a tennis elbow and is characterised by pain and tenderness over the inner point of the elbow (medial epicondyle) and pain on gripping. It affects mainly middle aged people and is of gradual onset. Many cases will resolve with simple measures, including physiotherapy, anti-inflammatory gels, pain killers and time. In more severe cases, with persistent pain a steroid injection can provide good, but often temporary pain relief. When the symptoms have been present for more than six months, despite conservative measures, then surgery may offer a solution. The operation is performed under general anaesthetic as a day case. The elbow is place in a bandage for two days and early movement is encouraged. The sutures are removed at ten to fourteen days. Most sedentary workers will need one to two weeks of sick leave but a full recovery may take up to three months. No driving is allowed for at least the first few days after the operation.

  7. Tendon Injuries

    The most common tendon injury around the elbow is a rupture of the biceps tendon. Often this occurs in middle aged men who suddenly lift a heavy weight and feel something “go” in the elbow. The elbow becomes swollen, bruised and tender. The tendon usually detaches from the radial tubercle and the muscle bunches in the upper arm. The diagnosis is established on clinical examination and ultrasound scanning. Early repair is recommended, ideally within two weeks of injury. The operation is performed as a day case under general anaesthetic. Sometimes the arm is rested in a plaster cast for about two weeks. Gentle physiotherapy is then advised and a return to normal function usually occurs within three months. During that period heavy lifting is avoided.

  8. Rheumatoid & Osteoarthritis

    Shoulder osteoarthritis is relatively uncommon and normally affects people over the age of 60. The pain comes on gradually and the joint becomes increasingly stiff. Shoulder movement result in a grating feeling. Often there is severe night pain. The diagnosis is made on X-ray and MRI scanning.

  9. Acromioclavicular Joint Pain

    The acromioclavicular jont lies at the top of the shoulder.  It can be injured by a direct fall onto the point of the shoulder, a causing partial or complete dislocation.  Minor dislocations (subluxations) can be treated with physiotherapy but more severe dislocations may need surgery to restore the contour of the shoulder and to relieve pain.  In suitable cases, operation is advised ideally within two weeks of injury.  Long-standing dislocations can be treated with a synthetic ligament.

    Osteoarthritis of the acromioclavicular joint is common after the age of 40, but is often asymptomatic.  Sometimes a minor injury can make the arthritic joint painful.  The pain is localised to the top of the shoulder and is made worse when the arm is placed in the fully elevated position and when touching the opposite shoulder.  A steroid injection mixed with local anaesthetic if usually given as a primary intervention and may settle the pain.  If the pain persists, then surgery is advised.  The operation entails trimming the outer 0.5cm of the outer clavicle.  This can be done either key hole (arthroscopic) or open.  The operation involves a general anaesthetic.  The patient is advised to wear a sling for two or three days after the operation and may need to have physiotherapy.

  10. Shoulder & Elbow Instability & Dislocation

    Dislocation of the shoulder is a common sporting injury but can occur at any time of life.  The humerus usually comes out to the front of the joint.  The joint is usually re-located in A&E and a sling applied for a week or two.  In young people, there is a high probability that it might recur (mainly men aged 15 to 25).  In the event of recurrence, further investigation by way of an MRI arthrogram (an MRI following injection of a dye into the joint to highlight the internal structures).  A common finding is detachment of the cartilaginous rim to the front of the socket of the shoulder (Bankart lesion).  This may need to be re-attached to the bone of the shoulder socket.  This operation is done as a day case under general anaesthetic, normally keyhole (arthroscopic), using bone anchors.  Post-operatively the arm is rested in a sling for between four and six weeks before starting physiotherapy.

 

Surgical Procedures & Treatments


  1. Shoulder Replacement (anatomic & reverse)

    Shoulder osteoarthritis is relatively uncommon in regard to hip and knee arthritis.  It usually presents with a gradual onset of shoulder pain, loss of movement and often a grinding sensation on shoulder movement.  The diagnosis is made by X-ray (see X-ray) and often supplemented with either a CT or MRI scan.  The treatment is conservative if the symptoms are mild, but in  severe cases, joint replacement may be advised.  If the rotator cuff of shoulder muscles is intact, then the joint can be re-surfaced (anatomic replacement), but if the rotator cuff is badly damaged, then a reverse replacement may be indicated (X-ray).   The operation should achieve good pain relief and an improved arc of shoulder movements.  Typically the operation is performed under a general anaesthetic and involves a three day hospital stay.  Post-operatively a course of physiotherapy extending over about six weeks is needed.  A sling is used for the first week or so.  The risks of the operation include nerve damage, infection, blood clots, dislocation (less than 1%), but in the longer term there is a potential for the implant to loosen or to wear out.

  2. Shoulder Re-surfacing

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  3. Arthroscopic Frozen Shoulder Surgery

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  4. Arthroscopic Decompression & Rotator Cuff Repairs

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  5. Shoulder Stabilisation

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  6. Arthroscopic Acromioclavicular Joint Excision

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  7. Arthroscopic Labral Repair

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  8. Biceps Tendon Repairs

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  9. Elbow Replacement

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  10. Elbow Arthroscopic Surgery

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  11. Golfer’s & Tennis Elbow Release

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  12. Internal Fixation of Shoulder, Humeral & Elbow Fractures

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