Shoulder treatments

→ when damage to the tendons around the shoulder is corrected with surgery.

What and where is my rotator cuff?

The rotator cuff is a set of muscles and tendons that sits around each of our shoulder joints, rather like the cuff of a shirt. Their chief function is to keep the ball (humeral head) of the upper arm bone in its socket (humerus), and to allow free movement of the arm.  The muscles at the front and back of the shoulder generate rotational movement and the muscle at the top of the shoulder (supraspinatus) elevates the arm.

Why might I need treatment for my rotator cuff?

There are several reasons why you might develop problems with your rotator cuff. A key one is a tendon tear. This is often the result of general wear and tear, particularly if you have a job or pastime that involves heavy lifting; repetitive overhead activities may cause rotator cuff tears, though they can also occur after trauma, such as in a fall, or during heavy lifting.

Shoulder impingement occurs when, for a range of possible reasons, the acromion starts to rub or catch the tendon directly underneath. This may cause tendinitis, when one of the tendons into the shoulder becomes irritated, or bursitis, when the protective, fluid-filled sac under the shoulder bone (acromion) becomes inflamed.  The pain associated with rotator cuff damage varies, but typically you would be experiencing an ongoing, dull ache around the shoulder which is worse during reaching out, rotational or elevational activities.

How can surgery help a damaged rotator cuff?

Partial rotator cuff injuries can sometimes heal naturally, especially with physiotherapy. But others may require an operation to fix the problem. There are several options available if this happens. With tears, the goal is to re-stitch the torn tendon: depending on the severity of the injury, this can be performed either with traditional open surgery, or with keyhole surgery (arthroscopy). For shoulder impingement, we use a technique called Subacromial Decompression (SAD), where the underside of the acromion is carefully shaved back, to prevent rubbing and allow the inflammation to resolve and the tendon to heal. This procedure is usually performed arthroscopically.

How long does it take to recover?

As with all operations, recovery times vary between patients – and of course according to the type of surgery involved. You will normally need to wear a sling for six weeks after a rotator cuff repair, until the tendon starts to heal, but most patients are able to return to office work within two to four weeks of their operation.

→ when a loose or dislocated shoulder joint is corrected to restore its stability.

Why might I need Shoulder Stabilisation?

The shoulder is a complex structure with many working parts. Many of those parts provide stability as well as flexibility. The muscles and tendons in the rotator cuff, for example, draw the arm firmly into the socket (glenoid). The labrum, an area of flexible tissue at the edge of the socket, enables the ball of the arm (or humeral head) to ‘dock’ tightly with the glenoid. During an awkward fall or a fierce impact – a big tackle in a rugby game, for instance – the humeral head can pop out of the glenoid. This sudden movement may damage or tear other parts of the joint and loosen the overall structure of the shoulder which is why dislocations may recur once they have happened the first time. While physiotherapy can help rebuild the muscles around the dislocation, surgery is sometimes needed to restore stability to the shoulder. Shoulder Stabilisation is also used for damage to the Superior Labrum Anterior and Posterior (SLAP), when the top (ie superior) part of the labrum becomes torn. This is known as a SLAP Repair.

How does Shoulder Stabilisation work?

Essentially, Shoulder Stabilisation aims to re-tighten the parts of the shoulder that have become loosened. Depending on the injury, we would usually reattach the damaged labrum to the bone. Sometimes we will also repair the socket with bone taken from the shoulder blade. SLAP repairs normally involve reattaching the tear with stitching, or removing the torn section of labrum entirely. Stabilisation procedures take place under general anaesthetic, and are usually performed as day surgery, meaning that you can go home the same day as your operation. Where possible they are also performed using keyhole surgery, though traditional open surgery is sometimes required for more extensive repair. These operations normally take one to two hours to perform.

How long will it take to recover?

The time it takes to recover from Shoulder Stabilisation varies from patient to patient and according to the surgery that has been performed. In most cases you will need to wear a sling for two or three weeks while the shoulder begins to heal. You will generally be able to return to work within two to eight weeks, depending on the type of work involved. We advise most people to wait for six months before resuming contact sports.

How can I help my recovery?

Carefully programmed exercise is an important part of the recovery process in Shoulder Stabilisation. In the early stages you will need to avoid twisting your arms, but you will begin to rebuild the muscles with gentle exercise. These movements increase as the weeks progress and as the shoulder strengthens. We can refer you for one-to-one physiotherapy to help the process along, and provide you with specific exercises to work on at home.

→ when a damaged or diseased shoulder is replaced with an artificial joint.

Why might I need a shoulder joint replacement?

Though less common than knee or hip replacements, shoulder replacement surgery can be a very effective way of dealing with ongoing, painful problems in the shoulder joints. It was first developed for fractures, but is now used to treat a wide range of other conditions. One of the most common reasons is osteoarthritis, when the joint cartilage thins and creates friction between the shoulder bones. Similar conditions include arthritis caused by trauma (PTA), and rheumatoid arthritis, an autoimmune disease that causes inflammation of joints around the body. Severe fractures, complicated rotator cuff tears and avascular necrosis (loss of blood supply to the bones) are also treated with shoulder replacements. Candidates for surgery tend to be experiencing long-term pain – pain that affects everyday actions like stretching or reaching, or may even be present during rest.

How does the procedure work?

This depends on the type of surgery being performed, since there are several different approaches to shoulder replacement. The two principle operations are Total Shoulder Replacement and Partial Replacement (also known as hemiarthroplasty). In the former, we replace both the ball of the upper arm (humeral head) and the socket (glenoid) with two prosthetic parts. With a Partial Replacement, the upper arm bone is replaced with a prosthetic implant while the socket joint is left intact.

How long does it take to recover?

Shoulder Replacement is major surgery and it will take some considerable time to make a full recovery. The exact time period varies, of course, from patient to patient, but as a general rule you can expect to wear a sling for around a month after the operation. During this time you will very gradually build up the strength in your shoulder area. The whole area will be quite painful to begin with, and for the first week or so you will need help around the home with daily tasks such as washing and dressing. But as the weeks go by, and with the help of carefully planned exercises and a pain management programme, the soreness should begin to recede considerably and you will start to regain the use of your shoulder.

How can I help my recovery?

Regular, planned exercise is a very important part of recovery from Shoulder Replacement surgery, and the evidence suggests that patients who stick to their exercise programmes tend to recover more swiftly. We will supply you with an exercise plan for the weeks following your operation; these will begin with very mild movements before progressing gradually towards fuller, more vigorous movements. We also recommend that you book in time with a physiotherapist, who will be able to help you keep track of your progress and adapt the exercises if needed.

→ when an injured shoulder is repaired with a surgical operation.

Why might I need Shoulder Trauma Surgery?

Shoulder injuries are common – particularly for people with very active lifestyles, or who play regular contact sports. They can happen in many different ways. You might fall badly on the tennis court, or suffer a high-impact collision in a football match. The most common shoulder injuries are dislocations, fractures and muscle or tendon tears, and all of these can be treated with surgery if necessary. After taking x-rays, we will be able to assess the extent of the damage and outline the best solutions.

How does Shoulder Trauma Surgery work?

This very much depends on the kind of injury, and which bones or soft tissues have been affected. Fracture surgery usually involves mending the damaged bone with plates or screws. A dislocation might need initial, speedy treatment in the emergency room, where it can be reduced back into place. That might be followed by a course of physiotherapy, or with a further corrective procedure such as Shoulder Stabilisation. Soft tissue tears can be treated in a number of different ways, too; the general goal with this type of surgery is to stitch and reattach the torn muscle, tendon or ligament to regain the structure and function of the shoulder.

How long will it take to recover?

This obviously depends on the severity of the injury, and the type of operation used to help your recovery. Keeping the shoulder immobile is the main priority for the first few days after surgery; you will wear a sling, which will usually remain in place for two to six weeks. Dressings will usually be removed after two weeks. After that the emphasis shifts to gradual and progressive rehabilitation, using exercises and physiotherapy to rebuild your shoulder strength. A return to pre-operation activities may take several months. For high-impact sports, the timespan may be even longer. We can talk through all the possibilities both before and after your surgery.

Is there anything I can do to help my recovery?

The bottom line is that all healing is helped along by carefully planned exercise and physiotherapy regimes. Depending on the trauma involved, we will sit down together and work out the best plan for getting you back to fitness. Sportsmen and women  can have a particular advantage when it comes to recovery time, in that they tend to be enthusiastic and determined exercisers. This is something we can harness to great effect in your own recovery plan.