Shoulder

Specialist in upper limb surgery of the shoulder.

Fellowship at Sydney Shoulder Research Institute in Shoulder surgery.

Subpectoral Biceps Tenodesis

Subpectoral biceps tenodesis is a surgical procedure designed to address issues with the biceps tendon, typically due to tears or chronic inflammation. Here’s what you need to know:

What is Subpectoral Biceps Tenodesis?
Subpectoral biceps tenodesis involves reattaching the biceps tendon to a lower position on the humerus bone, below the pectoralis major muscle. This technique is used to relieve pain and restore function when the biceps tendon is damaged or inflamed.

Why is it Performed?

To alleviate pain caused by tendon degeneration or tears.
To improve shoulder function and range of motion that may be limited due to biceps tendon issues.

Procedure Details

Preparation: The patient is placed under anesthesia.
Incision: A small incision is made in the shoulder region.
Reattachment: The damaged tendon is relocated and secured to the bone using screws or other fixation devices.
Recovery: Patients typically wear a sling for about six weeks and start physical therapy two weeks post-surgery. Full recovery and return to sports or intense activities may take up to three months.

Recovery and Rehabilitation

Initial Phase: Rest and sling usage for about six weeks.
Rehabilitation: Physical therapy focuses on restoring movement and strength, starting around two weeks after surgery.

Potential Risks

Infection
Bleeding
Tendon re-rupture
Shoulder stiffness

This procedure aims to improve shoulder function while minimizing the complications and recovery time associated with other methods.

Subacromial Decompression:
A Patient's Guide

Understanding the Anatomy:
The shoulder joint is a complex structure made up of bones, muscles, tendons, and ligaments. The acromion is a bony projection on the scapula (shoulder blade) that forms the top of the shoulder. The space beneath the acromion, known as the subacromial space, can become narrowed, leading to compression of the rotator cuff tendons and causing pain and limited movement.

Diagnosis:
Subacromial impingement is often diagnosed through a combination of physical examination and imaging studies such as X-rays or MRI. Symptoms typically include pain when lifting the arm, especially overhead, and difficulty sleeping on the affected shoulder.

Surgical Procedure:
Subacromial decompression is a minimally invasive procedure performed arthroscopically. During the surgery, the surgeon removes or shaves down part of the acromion and possibly other soft tissue structures to widen the subacromial space. This reduces pressure on the rotator cuff tendons and allows for smoother movement of the shoulder.

Possible Complications:

Although subacromial decompression is generally safe, potential complications include infection, bleeding, stiffness, or damage to nearby nerves or blood vessels. There is also a possibility that symptoms may not completely resolve, or further surgery may be needed.

What to Expect Post-Surgery:

Recovery involves a period of rest followed by physical therapy to restore strength and range of motion in the shoulder. Pain and swelling are common initially but typically subside with time. Most patients can expect to return to normal activities within a few months, though full recovery may take up to a year depending on individual circumstances.

Arthroscopic Bankart Repair: What Patients Should Know

Understanding the Anatomy:
The shoulder joint is a ball-and-socket joint, stabilized by the labrum, a ring of cartilage that surrounds the socket. A Bankart lesion occurs when this labrum is torn due to shoulder dislocation, leading to instability.

Diagnosis:
A Bankart lesion is typically diagnosed after a shoulder dislocation, especially in younger, active individuals. Diagnosis involves a physical examination and imaging tests like MRI or CT scans to confirm the labral tear and assess the extent of damage.

Surgical Procedure:
Arthroscopic Bankart repair is a minimally invasive surgery performed to fix the torn labrum. During the procedure, small incisions are made around the shoulder, and an arthroscope (a small camera) is inserted to guide the surgeon. The torn labrum is then reattached to the socket using anchors and sutures, restoring stability to the shoulder joint.

Possible Complications:

As with any surgery, there are risks involved. Potential complications include infection, stiffness, nerve injury, or a re-tear of the labrum. There may also be some loss of shoulder motion or strength post-surgery.

What to Expect Post-Surgery:

Recovery from arthroscopic Bankart repair involves wearing a sling for several weeks to protect the shoulder, followed by physical therapy to restore motion and strength. Full recovery can take several months, and adherence to the rehabilitation plan is crucial for optimal outcomes.

Rotator Cuff Repair: What Patients Should Know

Understanding the Anatomy:
The rotator cuff is a group of four muscles and tendons that stabilize the shoulder and allow it to move. These tendons attach the muscles from the shoulder blade to the top of the arm bone (humerus), helping you lift and rotate your arm.

Diagnosis:
Rotator cuff injuries are often diagnosed through a combination of physical examinations, patient history, and imaging tests like MRI or ultrasound. Common symptoms include shoulder pain, weakness, and limited range of motion.

Surgical Procedure:
Rotator cuff repair is a surgical procedure to repair a torn tendon in the shoulder. The surgery can be done arthroscopically, using small incisions and a camera, or through open surgery. The torn tendon is reattached to the bone using sutures or anchors. The goal is to restore function and relieve pain.

Possible Complications:

Complications from rotator cuff surgery may include infection, stiffness, re-tear of the tendon, and nerve injury. Adherence to post-operative care is crucial to minimize these risks and ensure optimal recovery.

What to Expect Post-Surgery:

Recovery from rotator cuff surgery includes a period of immobilization followed by physical therapy. Full recovery can take several months, and patients may need to avoid heavy lifting and overhead activities during this time. The success of the surgery greatly depends on the patient’s commitment to rehabilitation exercises.

Open Latarjet Procedure: What Patients Needs To Know

Understanding the Anatomy:
The shoulder is a ball-and-socket joint, where stability is maintained by the labrum and surrounding muscles. When recurrent shoulder dislocations occur, especially due to bone loss or soft tissue damage, a surgical procedure called the Latarjet can be recommended.

Diagnosis:
The need for an Open Latarjet procedure is typically diagnosed after recurrent shoulder dislocations, often with a history of failed non-surgical treatments. Imaging tests like X-rays and CT scans are used to assess bone loss and damage to the labrum and other soft tissues.

Surgical Procedure:
The Open Latarjet procedure involves transferring a piece of the coracoid bone, along with its attached tendon, to the front of the shoulder socket. This increases the stability of the shoulder by enlarging the glenoid surface and providing a physical barrier against dislocation. The procedure is done under general anesthesia and typically requires a hospital stay.

Possible Complications:

While the Open Latarjet procedure is generally successful, it carries risks like any surgery. Potential complications include infection, nerve injury, persistent shoulder pain, and incomplete healing of the bone graft. There’s also a small chance of recurrent instability.

What to Expect Post-Surgery:

Recovery involves wearing a sling for several weeks to protect the shoulder, followed by physical therapy. Full recovery can take several months, during which strength and range of motion exercises are gradually introduced. Patients are usually advised to avoid heavy lifting and contact sports for up to a year post-surgery.

Shoulder Replacement:
A Patient's Guide

Understanding the Anatomy:
The shoulder is a ball-and-socket joint, where the humerus (upper arm bone) fits into the glenoid, a shallow socket in the scapula (shoulder blade). The joint is stabilized by muscles, tendons, and ligaments, which allow for a wide range of motion. In cases of severe arthritis or damage, this joint may require replacement.

Diagnosis:
Shoulder replacement surgery is typically recommended for patients with severe pain and reduced mobility due to arthritis, rotator cuff tear arthropathy, or a severe fracture. Diagnosis is made through physical examination, medical history, and imaging studies like X-rays or MRIs to assess the extent of joint damage.

Surgical Procedure:
In a shoulder replacement surgery, the damaged parts of the shoulder joint are replaced with artificial components. This typically involves replacing the head of the humerus with a metal ball and the glenoid cavity with a plastic socket. Depending on the condition, the surgery may be a total shoulder replacement, partial replacement, or reverse shoulder replacement.

Possible Complications:

As with any major surgery, complications can occur. These may include infection, blood clots, nerve or blood vessel damage, or issues with the prosthetic components such as loosening or dislocation. Additionally, there may be risks of stiffness or incomplete pain relief.

What to Expect Post-Surgery:

Recovery from shoulder replacement surgery involves a combination of rest, pain management, and physical therapy. Initial recovery may take a few weeks, with gradual improvement in pain and mobility. Full recovery and return to daily activities can take several months, and patients are often encouraged to follow a physical therapy regimen to regain strength and motion in the shoulder.

Arthroscopic Arthrolysis:
A Guide for Patients

Understanding the Anatomy:
The shoulder joint, or glenohumeral joint, is a ball-and-socket joint surrounded by a capsule of ligaments and soft tissue. Sometimes, after an injury or surgery, the capsule can become stiff and scarred, limiting the shoulder’s range of motion. This condition is often referred to as "frozen shoulder" or adhesive capsulitis.

Diagnosis:
Arthroscopic arthrolysis is typically recommended for patients who have significant shoulder stiffness that does not improve with non-surgical treatments like physical therapy or corticosteroid injections. Diagnosis is made through a physical examination and imaging studies like X-rays or MRI scans to assess the severity of the condition.

Surgical Procedure:
Arthroscopic arthrolysis is a minimally invasive procedure where a surgeon uses an arthroscope (a small camera) and specialized instruments to cut and release the tight and scarred tissue within the shoulder joint. This procedure aims to restore the shoulder's range of motion and function.

Possible Complications:

As with any surgery, there are potential risks. These include infection, bleeding, nerve injury, persistent stiffness, or the possibility that the shoulder may not regain full motion. In some cases, additional procedures may be needed.

What to Expect Post-Surgery:

Post-operative care is crucial for a successful outcome. After surgery, the patient will likely need physical therapy to maintain the motion gained during surgery and to strengthen the shoulder. Pain management and gradual return to activities are also part of the recovery process. Most patients can expect to resume normal activities within a few months, though full recovery might take longer depending on the individual case.

Understanding AC joint stabilisation

AC (acromioclavicular) joint stabilisation is a surgical procedure to correct instability or dislocation of the AC joint, which connects the clavicle (collarbone) to the scapula (shoulder blade).

Here are key aspects of AC joint stabilisation:

Indications:

This surgery is typically performed for patients with severe AC joint dislocations or chronic instability that causes pain and functional impairment.

Procedure:

A small incision is made over the AC joint.
The torn ligaments are repaired or reconstructed, often using a graft.
Sometimes, the clavicle is secured to the coracoid process of the scapula using screws or a button system to maintain joint stability.

Techniques:

Open Surgery: Traditional method with a larger incision.
Arthroscopic Surgery: Minimally invasive method using small incisions and a camera for guidance

Recovery:

Post-surgery, patients typically wear a sling for a few weeks to immobilize the shoulder. Physical therapy follows to restore range of motion and strength. Full recovery can take several months.

Outcomes:

Successful AC joint stabilisation can significantly reduce pain and improve shoulder function, allowing patients to return to their daily activities and sports.

Understanding the Difference Between:
Total Shoulder Replacement and Reverse Shoulder Replacement

Total Shoulder Replacement:

Reverse Shoulder Replacement:

In a total shoulder replacement, the surgeon replaces the damaged parts of the shoulder joint with artificial components. The ball of the humerus (upper arm bone) is replaced with a metal ball, and the socket of the scapula (shoulder blade) is replaced with a plastic socket. This procedure is typically recommended for patients with severe arthritis or fractures, where the rotator cuff is still intact and functioning.

Key Points:

Designed to mimic the natural anatomy of the shoulder.
Best for patients with intact rotator cuff tendons.
Relieves pain and restores motion in cases of arthritis or trauma.

In a reverse shoulder replacement, the position of the ball and socket is reversed: the ball component is attached to the scapula, and the socket is attached to the humerus. This procedure is often used when the rotator cuff is severely damaged or torn beyond repair, as it allows other muscles (mainly the deltoid) to compensate for the lost function of the rotator cuff.

Key Points:

Ball and socket positions are reversed to improve shoulder stability.
Ideal for patients with severe rotator cuff damage or failed previous shoulder surgery.
Provides improved function and pain relief when rotator cuff tendons are not functional.

Deciding Between the Two

The choice between a total shoulder replacement and a reverse shoulder replacement depends on the condition of the rotator cuff, the level of shoulder damage, and the specific goals for recovery. Your surgeon will consider these factors when recommending the best option for you.

Pros and Cons of
Biceps Tenotomy vs. Biceps Tenodesis

Biceps Tenotomy:

Biceps Tenodesis:

Pros:

Preservation of Function: Maintains muscle strength and avoids the cosmetic deformity associated with tenotomy.
More Stable: Provides a more stable fixation of the biceps tendon, which can be beneficial in cases of biceps tendon pathology.
Reduced Risk of Muscle Deformity: Avoids the "Popeye" deformity, which can be a cosmetic concern with tenotomy.

Cons:

Complexity: More complex than tenotomy, requiring precise surgical technique and potentially longer operation times.
Cost: Higher cost due to the need for more specialized equipment and techniques.
Recovery: May involve a longer recovery period and more postoperative pain compared to tenotomy.

Pros:

Simplicity: Biceps tenotomy is a simpler procedure compared to tenodesis, which can result in shorter operation times and less technical difficulty.
Cost-Effective: Generally less expensive due to its simplicity and reduced need for specialized equipment
Recovery: Often involves a shorter recovery period with less postoperative pain compared to tenodesis.

Cons:

Cosmetic Issues: Can result in a noticeable muscle deformity, often referred to as a "Popeye" muscle.
Reduced Strength: May lead to decreased arm strength, particularly in tasks involving elbow flexion or supination.

Understanding the Difference Between:
Arthroscopic Subacromial Decompression and Distal Clavicle Excision

Arthroscopic Subacromial Decompression:

Distal Clavicle Excision:

Purpose:

This surgery is performed to alleviate pain and improve function in patients with acromioclavicular (AC) joint arthritis or other conditions affecting the distal end of the clavicle.

Procedure:

Technique: Typically done arthroscopically. The outer end of the clavicle is removed to reduce irritation and pain.
Indications: Often combined with subacromial decompression when both conditions are present.

Recovery:

Post-Operative Care: Includes managing pain and undergoing physical therapy to regain shoulder strength and mobility.
Expected Results: Improved shoulder function and reduced pain in the affected areas.

Purpose:

This procedure aims to relieve shoulder pain caused by subacromial impingement. It is often used to treat conditions such as tendinitis or bursitis when conservative treatments have not been effective.

Procedure:

Technique: Performed arthroscopically through small incisions using an arthroscope, a thin tube with a camera.
Steps: The surgeon removes inflamed bursa and any bone spurs or other structures causing impingement.

Recovery:

Rehabilitation: Physical therapy is essential for restoring movement and strength.
Outcome: Aims to reduce pain and improve shoulder function.

Understanding the Difference Between:
Total Shoulder Replacement and Reverse Shoulder Replacement

Total Shoulder Replacement:

Key Points:

Designed to mimic the natural anatomy of the shoulder.
Best for patients with intact rotator cuff tendons.
Relieves pain and restores motion in cases of arthritis or trauma.

Reverse Shoulder Replacement:

Key Points:

Ball and socket positions are reversed to improve shoulder stability.
Ideal for patients with severe rotator cuff damage or failed previous shoulder surgery.
Provides improved function and pain relief when rotator cuff tendons are not functional.

Deciding Between the Two

Understanding the Difference Between:
Arthroscopic Subacromial Decompression and Distal Clavicle Excision

Arthroscopic Subacromial Decompression:

Purpose:

Procedure:

Technique: Performed arthroscopically through small incisions using an arthroscope, a thin tube with a camera.
Steps: The surgeon removes inflamed bursa and any bone spurs or other structures causing impingement.

Recovery:

Rehabilitation: Physical therapy is essential for restoring movement and strength.
Outcome: Aims to reduce pain and improve shoulder function.

Distal Clavicle Excision:

Purpose:

This surgery is performed to alleviate pain and improve function in patients with acromioclavicular (AC) joint arthritis or other conditions affecting the distal end of the clavicle.

Procedure:

Technique: Typically done arthroscopically. The outer end of the clavicle is removed to reduce irritation and pain.
Indications: Often combined with subacromial decompression when both conditions are present.

Recovery:

Post-Operative Care: Includes managing pain and undergoing physical therapy to regain shoulder strength and mobility.
Expected Results: Improved shoulder function and reduced pain in the affected areas.

Pros and Cons of
Biceps Tenotomy vs. Biceps Tenodesis

Biceps Tenotomy:

Pros:

Simplicity: Biceps tenotomy is a simpler procedure compared to tenodesis, which can result in shorter operation times and less technical difficulty.
Cost-Effective: Generally less expensive due to its simplicity and reduced need for specialized equipment
Recovery: Often involves a shorter recovery period with less postoperative pain compared to tenodesis.

Cons:

Cosmetic Issues: Can result in a noticeable muscle deformity, often referred to as a "Popeye" muscle.
Reduced Strength: May lead to decreased arm strength, particularly in tasks involving elbow flexion or supination.

Biceps Tenodesis:

Pros:

Preservation of Function: Maintains muscle strength and avoids the cosmetic deformity associated with tenotomy.
More Stable: Provides a more stable fixation of the biceps tendon, which can be beneficial in cases of biceps tendon pathology.
Reduced Risk of Muscle Deformity: Avoids the "Popeye" deformity, which can be a cosmetic concern with tenotomy.

Cons:

Complexity: More complex than tenotomy, requiring precise surgical technique and potentially longer operation times.
Cost: Higher cost due to the need for more specialized equipment and techniques.
Recovery: May involve a longer recovery period and more postoperative pain compared to tenotomy.

Shoulder

Fellowship at Sydney Shoulder Research Institute in Shoulder surgery.

Subpectoral Biceps Tenodesis

Understanding the Difference Between: Total Shoulder Replacement and Reverse Shoulder Replacement

Total Shoulder Replacement:

Reverse Shoulder Replacement:

Deciding Between the Two

Understanding the Difference Between: Total Shoulder Replacement and Reverse Shoulder Replacement

Total Shoulder Replacement:

Reverse Shoulder Replacement:

Deciding Between the Two

Understanding the Difference Between: Arthroscopic Subacromial Decompression and Distal Clavicle Excision

Arthroscopic Subacromial Decompression:

Distal Clavicle Excision:

Pros and Cons of Biceps Tenotomy vs. Biceps Tenodesis

Biceps Tenotomy:

Biceps Tenodesis:

Understanding the Difference Between:
Total Shoulder Replacement and Reverse Shoulder Replacement

Understanding the Difference Between:
Total Shoulder Replacement and Reverse Shoulder Replacement

Understanding the Difference Between:
Arthroscopic Subacromial Decompression and Distal Clavicle Excision

Pros and Cons of
Biceps Tenotomy vs. Biceps Tenodesis