Surgery of the shoulder has advanced significantly over the last decade. Major advances have been made in the treatments that can be offered to patients suffering from shoulder complaints, and also in surgical procedures that utilise "minimally invasive" or "keyhole" surgical techniques. In my practice the majority of shoulder conditions that require surgery can be managed arthroscopically. Arthroscopic or "keyhole" surgery involves the use of a camera and "arthroscope" that can be passed into and around the shoulder joint though cuts smaller than a button hole. Other small cuts can be used to pass instruments into the shoulder joint so that surgery can be carried out. The most common arthroscopic surgical procedures performed are; Arthroscopic subacromial decompression/acromioplasty arthroscopic rotator cuff repair arthroscopic shoulder stabilisation arthroscopic capsular release arthroscopic SLAP repair. For more information on arthroscopic surgery click on the condition you have on my healthpoint page, or click here Some surgical procedures still need to be performed "open", the most common of these would be for "massive" rotator cuff tears, or shoulder joint replacement.

The "rotator cuff" is made up of the combined tendons of some of the smaller muscles around the shoulder joint to allow fine movements of the shoulder, and also to enable the large deltoid muscle to perform the more powerful "gross" movements. The three main muscles that make up the rotator cuff are the supraspinatus, the infraspinatus and the subscapularis. They are attached to the scapula, and run out over the front and top of the shoulder bone (humerus) and attach to it. Tears to the rotator cuff are common and patients are often unaware they have one as they have no pain and the shoulder continues to function normally. Most tears are due to "wear and tear" on the tendon, but some are due to trauma such as a fall. Tears, either traumatic or due to age, can be painful, and can also limit the motion of the shoulder joint. Most patients complain of pain at the front of the shoulder with an inability to lift the arm up to the front. Some tears will settle down with physiotherapy, steroid injections and time. Some need to be repaired. Most of the repairs done in my practice are done arthroscopically ("keyhole surgery"), but with bigger or older tears the repair may need to be done "open". The aim of the repair is to fasten the rotator cuff tendons back onto the bone usually using "suture anchors" which are small barbs made of metal, special plastic or absorbable materials with sutures attached. The anchors are inserted into the bone of the humerus and the cuff tendon is tied down onto them. Recovery can be a long process, particularly if you have a job that is "heavy" in nature with lots of lifting. If you have a predominantly sedentary job your can be back at work very quickly but will be restricted to desk duties only. You will be in a sling for six weeks resting as the shoulder heals. The following six weeks will involve lots of exercises to strengthen the shoulder with a gradual return to full function. For more information about shoulder arthroscopy click here For more information about rotator cuff tears click here For more information on surgery to repair rotator cuff tears click here

The shoulder is an inherently unstable "ball and socket" joint. This allows the shoulder to have a wide range of motion, but does mean that it is more at risk of dislocation. Unlike the hip, where boney congruity maintains the stability of the joint, the shoulder relies on soft tissues to hold it in joint. Dislocation of the shoulder is common, usually anterior, and most commonly due to trauma to the shoulder such as a fall or a mis-timed rugby tackle. Most shoulder dislocations can be reduced without the need for surgery. However, in a young person with a single, traumatic, anterior dislocation, the chances of dislocating again, especially if engaged in contact sports, is greater than 90-95%. Dislocations in other directions are also seen, and can be managed in a similar fashion to anterior ones. Surgery has an accepted role as a way of stabilising the shoulder to prevent further dislocations. The most common surgery done in my practice is an arthroscopic shoulder stabilisation ("keyhole surgery"). The aim of the surgery is to repair the structures at the front of the joint to "tighten then up" and prevent further dislocations. The success of this surgery is greater than 90%. You may also hear of this surgery referred to as a "Bankhart repair" in reference to the name surgeons give to the damaged tissues at the front of the shoulder. If there is more substantial damage to the joint then a bigger surgical procedure may be necessary. This usually involves restoring damaged bone at the front of the joint by transferring a tendon-bone block from elsewhere in the shoulder to the front of the joint. This is known as the Laterjet procedure. For more information regarding shoulder arthroscopy or "keyhole" surgery click here For more information on shoulder dislocation click here For more information on shoulder stabilisation click here

Shoulder joint arthritis can be due to inflammation such as in rheumatoid arthritis, or due to wear and tear on the joint where it is called osteoarthritis. In some situations where there has been damage to the joint from a fracture a patient can develop "post traumatic" arthritis. With people living longer surgeons are also seeing arthritis from untreated rotator cuff tears, this is known as "cuff tear arthropathy". Whatever the cause, shoulder arthritis is much less common than that affecting the knee or hip so shoulder joint surgery for it is usually done by orthopaedic surgeons specialising in shoulder/upper limb surgery. Pain and decreased motion in the shoulder joint are what most people with shoulder arthritis notice. The pain can be so bad that it wakes them at night from sleep. The pain and decreased range of motion in the shoulder can become so bad that surgery is indicated to replace the joint. Shoulder joint replacement/arthroplasty is a specialist procedure that involves replacing the damaged surfaces of the joint with special metal and high density plastic implants. For "cuff tear arthropathy" this is even more specialised with "reverse" total shoulder joint replacement where the ball and socket joint are "switched around" to allow the shoulder to function better without the aid of the rotator cuff. In my practice shoulder arthroplasty is done as an inpatient procedure and you will stay usually one, occasionally two nights in hospital. For more information about shoulder arthritis click here For more information on shoulder replacement click here

The carpal tunnel is located at your wrist. The flexor tendons to your fingers as well as the median nerve pass through this space. The median nerve can become compressed as it passes through the carpal tunnel, and this in turn can lead to numbness or a feeling of "pins and needles" in your thumb, index and middle fingers as well as waking at night with a numb hand. Carpal Tunnel Syndrome (CTS) as it is called can lead to difficulty driving, sleeping and doing manual tasks as the wrist may ache and the fingers involved can become numb. Eventually some of the small muscles in the hand that power the thumb can weaken, leading to difficulties manipulating small objects. Treatment can be surgical or non-surgical. Non-surgical management involves the use of splints, or injections into the carpal tunnel. These will often only provide temporary relief. Surgical management is directed at "decompressing" the carpal tunnel to take the pressure off the median nerve. This can be done as an "open" or as a "keyhole" procedure. Open - a cut is made in the palm at the level of the wrist and the ligament that forms the roof of the carpal tunnel is divided to release pressure on the nerve Endoscopic or "keyhole" - a small cut (~1cm) is made just proximal to the wrist and a small TV camera/scope combination is passed into the carpal tunnel and the ligament is divided from below using a small blade. Recovery of the nerve and relief of symptoms is usually rapid if the damage to the nerve is not too severe. For more information click here

For elderly patients joint replacement surgery is commonly required to treat damaged joints from wearing out, arthritis or other forms of joint disease including rheumatoid arthritis. In these procedures the damaged joint surface is removed and replaced with artificial surfaces normally made from metal (chromium cobalt alloy, titanium), plastic (high density polyethelene) or ceramic which act as alternate bearing surfaces for the damaged joint. These operations are major procedures which require the patient to be in hospital for several days and followed by a significant period of rehabilitation. The hospital has several ways of approaching the procedure for replacement and the specifics for the procedure will be covered at the time of assessment and booking of surgery. Occasionally blood transfusions are required; if you have some concerns raise this with your surgeon during consultation.

The division of a crooked or bent bone to improve alignment of the limb. These procedures normally involve some form of internal fixation, such as rods or plates, or external fixation which involves external wires and pins to hold the bone. The type of procedure for fixation will be explained when the surgery is planned.

Over the last 30 years a large number of orthopaedic procedures on joints have been performed using an arthroscope, where a fiber optic telescope is used to look inside the joint. Through this type of keyhole surgery, fine instruments can be introduced through small incisions (portals) to allow surgery to be performed without the need for large cuts. This allows many procedures to be performed as a day stay and allows quicker return to normal function of the joint. Arthroscopic surgery is less painful than open surgery and decreases the risk of healing problems. Arthroscopy allows access to parts of the joints which can not be accessed by other types of surgery.

In many cases tendons will be lengthened to improve the muscle balance around a joint or tendons will be transferred to give overall better joint function. This occurs in children with neuromuscular conditions but also applies to a number of other conditions. Most of these procedures involve some sort of splintage after the surgery followed by a period of rehabilitation, normally supervised by a physiotherapist.

Most surgical metalware that is put in by Orthopaedic Surgeons to treat an injury is designed to stay in the patient permanently. Modern surgical "hardware" is made of materials that are well tollerated by the body. In some situations the implants can be irritating especially where they lie just under the skin or where they are subject to pressure, ie about the knee when kneeling. Once the injury the implants were put in for has healed the implants can be removed. In my practice this is usually dome as a "daystay" procedure.