Shoulder Pain

Treatments Offered

No Skills Required
No Skills Required
No Skills Required
No Skills Required

Shoulder Pain

Common Causes

  • Acromio Clavicular Joint Arthritis                 
  • Acromio Clavicular Joint Injury                 
  • Biceps Pathology 
  • Calcific Tendonitis     
  • Frozen Shoulder                  
  • Shoulder Arthritis              
  • Shoulder Instability                  
  • Shoulder Injuries        
  • SLAP Tear                 
  • Subacromial Impingement/Bursitis                
  • Stenoclavicular Joint Pain                    
  • Rotator Cuff Tear  
shoulder pain surgery

Acromioclavicular Joint Arthritis

This refers to degenerative disease involving the acromioclavicular (AC) joint

As we grow older, the cartilage lining of the bones in a joint slowly wears away. This thinning and loss of cartilage eventually leads to wear and tear of the bone itself and is called osteoarthritis. Changes appear in the bone including the development of bony projections or bony spurs. Similar to other joints, osteoarthritis of the AC joint presents with pain and swelling. 

Activities that results in excessive load through the joint, such as repeated overhead activities, heavy weightlifting and previous injuries can predispose to this condition.

Management of AC Joint Arthritis:

The following treatments are available

The initial treatment involves use of simple pain killers and anti-inflammatory tablets.

Physiotherapy: This is useful in initial stages, prevent stiffness and maintain the range of movement. 

AC Joint Injection: Steroid local anaesthetic injections are useful. This is done as an outpatient procedure in clinic. 

AC joint excision surgery: If pain persists despite the above measures, surgery is indicated. This involves removing the arthritic AC joint. This is done through keyhole (arthroscopic) surgery.

AC joint excision is carried out as a day surgery procedure under general anaesthetic and regional nerve block. Impingement of the shoulder often co exists and arthroscopic subacromial decompression (ASAD) is performed at the same time.

Recovery: You will wear a sling for comfort for a few days. Expect to return to light activities as tolerated within a week. Return to work will depend on the occupation and it will take a few weeks to perform heavy manual work. 

Acromioclavicular Joint Injury

This injury is called by falling directly on the shoulder. There are different grades to this injury based on the damage to the ligaments supporting the collar bone to the shoulder blade. Treatment will depend on the grade of injury and higher the grade, the greater the likelihood for surgical stabilisation.

AC Joint Stabilisation Surgery

Surgery involves reconstructing the reconstructing the ligaments connect the collar bone to the shoulder blade (coraco-clavicular ligament) using synthetic materials. AC joint stabilisation is carried out as a day surgery procedure under general anaesthetic and regional nerve block.

Recovery: You will wear a sling for three to four weeks. You will undergo physiotherapy until you regain full range of movement and strength. Expect to return to light activities in 4 weeks. Return to heavy manual work and sports will take three to four months.

Biceps Problems (LHB)

The biceps muscle has 2 heads- long and short. The tendon of the long head travels through a narrow groove and turns through an angle of 90 degrees near the shoulder joint. This places it at an increased risk for inflammation and leads to long head of biceps tendonitis. This is sometimes associated with rotator cuff problems such as impingement and tear. Long head of biceps can also rupture.

Long head of biceps tendonitis presents with pain in front of the shoulder, radiating down the arm.

Management of Biceps Tendonitis:

Ultrasound scan can be useful in detecting biceps tendonitis and associated rotator cuff tears.

Pain killers and anti-inflammatory medication- The initial treatment involves use of simple pain killers and anti-inflammatory tablets.

Physiotherapy: The exercises are useful in reducing strain on the tendon

Injection: Steroid local anaesthetic injections are useful. This is done as an outpatient procedure in clinic. 

LHB Surgery- If symptoms persist despite above measures, surgical options are

  1. Long head of biceps tenotomy (release of tendon from its attachments within shoulder) which will result in good pain relief but a “popeye” appearance of the biceps.
  2. Long head of biceps tenodesis (tendon is released and re attached to a different site using anchors).

The choice of surgery is based on the needs of the individual. 

Calcific Tendonitis

This condition is characterised by build-up of calcium deposits in the rotator cuff tendon, resulting in inflammation and pain. There is increased pressure due to reduced space between the rotator cuff and acromium (roof), leading to subacromial impingement, resulting in pain on lifting the arm over the head.

Management of calcific tendonitis and impingement:

Plain radiographs and Ultrasound scan can be useful.

Pain killers and anti-inflammatory medication- The initial treatment involves use of simple pain killers and anti-inflammatory tablets.

Physiotherapy- The exercises are useful in reducing strain on the tendon

Injection- Steroid local anaesthetic injections are useful. This is done as an outpatient procedure in clinic. 

Ultrasound guided barbotage- Under ultrasound guidance, the calcium deposit is injected and broken down. 

Surgery- Arthroscopic (Keyhole) removal of calcific deposits + sub acromial decompression (ASAD)

If symptoms persist despite above measures, surgical options involve measures that will remove the calcium and decompress the space between the tendon and acromium. 

Frozen Shoulder

In this condition, the lining or capsule of the shoulder joint loses it’s normal flexibility and becomes stiff, painful and inflamed. It can sometimes be triggered by a minor shoulder injury. The process of frozen shoulder occurs in 3 stages- a freezing phase, a frozen phase and a thawing phase and can settle on its own. This process can last 3 to 4 years. Treatment is required for symptomatic relief from the pain and stiffness.

Management of Frozen Shoulder:

Pain killers and anti-inflammatory medication- The initial treatment involves use of simple pain killers and anti-inflammatory tablets.

Physiotherapy- The exercises are useful in reducing stiffness and improving the range of motion of the shoulder.

Injection- Steroid local anaesthetic injections are useful. This is done as an outpatient procedure in clinic. 

Surgery- Arthroscopic (Keyhole) capsular release can be carried out if the above measures are not successful in alleviating symptoms.

Pectoralis Major Rupture

The Pectoralis major muscle injuries are increasingly seen in weightlifters, body builders and heavy manual workers. A common mechanism of injury is during bench press when a painful snap is felt in front of the shoulder. This is followed by bruising, swelling and bunching up of the muscle.

Management of Pectoralis Rupture:

MRI scan is needed if surgery is considered.

Although this injury can be managed non surgically surgical repair is carried out in individuals who need to return to strenuous shoulder activity, weight lifting and body building. 

Early repair is technically easier, and some studies have shown better outcomes with early repair.

Late repairs (chronic) are possible for chronic ruptures and this often needs reinforcing with allografts.

Rotator Cuff Tear

The rotator cuff is a group of muscles and tendons surrounding the shoulder joint. They maintain the shoulder joint in position. The rotator cuff is injured in people who perform repeated overhead activities involving the shoulder and it presents as a dull pain in the shoulder. It can cause difficulties when you lift your arm or try to reach behind your back or sleep in the involved side. Some people experience arm weakness.

Management of Rotator Cuff Tear:

X-rays. This can show associated arthritis or bone spurs

Ultrasound scan

Magnetic resonance imaging (MRI) sca Treatment

Pain killers and anti inflammatory medication- These relieve symptoms of pain but do not modify or improve this condition.

Physiotherapy- This is useful in reducing stiffness and improve range of motion.

Injection- Steroid local anaesthetic injections provide short term pain relief but does not improve the condition. This is done as an outpatient procedure in clinic for very small tears

Keyhole Surgery- Choice of surgery depends on the age of the patient, severity of the disease and presence of other associated shoulder problems

Rotator cuff repair- Arthroscopic (key hole) surgery or open surgery

Tendon transfer- When the tendon is too damaged for a successful repair, an adjacent tendon could be used as a replacement. 

Reverse shoulder replacement is used in neglected or chronic tears that have progressed to cuff tear arthropathy. 

Shoulder Arthritis

Arthritis refers to degenerative change in the joint, most commonly due to wear and tear. 

As we grow older, the cartilage lining of the bones in a joint slowly wears away. This thinning and loss of cartilage eventually leads to wear and tear of the bone itself and is called osteoarthritis. Other condition such as inflammatory disorders (like rheumatoid arthritis), trauma and increased high intensity use of the joint can also predispose to shoulder arthritis.

Patients are mainly troubled by pain and stiffness.

Management of Shoulder Arthritis:

Investigation: X rays and CT scan are useful in diagnosis and planning treatment

The following treatments are available:

Pain killers and anti-inflammatory medication- These relieve symptoms of pain but do not modify or improve this condition.

Physiotherapy- This is useful in reducing stiffness and improve range of motion.

Injection- Steroid local anaesthetic injections provide short term pain relief but dot improve the condition. This is done as an outpatient procedure in clinic.

Surgery– Choice of surgery depends on the age of the patient, severity of the disease and presence of other associated shoulder problems

Shoulder Replacement Surgery (Arthroplasty)

Shoulder joint replacement could involve replacing both sides of the joint (total shoulder replacement) or the humeral bone alone (hemi arthroplasty). Another option involves replacing the humeral surface alone (humeral head resurfacing).

Total shoulder replacement is again sub divided into anatomical replacement and reverse replacement based on the joint dynamics achieved after replacement. Your surgeon will discuss the option that is best suited for you. 

Revision shoulder replacement surgery is carried out in patients experiencing difficulties or failure with previous shoulder joint replacements.

Shoulder replacement surgery is carried out under general anaesthesia with regional nerve block. You will stay in hospital for 2-3 days after surgery. 

Recovery: You will wear a sling for comfort for 2-3 weeks.

Anatomical Shoulder Replacement

Reverse Shoulder Replacement

Shoulder & Clavicle Fractures

Shoulder fractures can result from a fall on the shoulder, road traffic accident, contact sports, Mountain biking injuries, skiing accidents etc.

Clavicle Fracture is the most common shoulder fracture and result of a fall onto the shoulder 

Proximal Humerus Fractures are fractures of the upper part of the arm are more common in older (over 65 years of age) people.

Scapula Fractures: Fractures of this bone rarely occur. They usually result from high-energy trauma such as motor vehicle accidents or a far fall.

complex shoulder fracture
reverse shoulder replacement
shoulder fracture dislocation

Management of Shoulder & Clavicle fractures:

Most of these injuries are managed nonsurgically in a sling for comfort followed by physiotherapy rehabilitation

Clavicle & Shoulder fracture fixation Surgery – Displaced fractures may require surgical fixation

Shoulder Hemiarthroplasty for fractures which are not ameneable for fixationScapula Fracture fixation is occasionally required for severe injuries

Shoulder Dislocation

The shoulder joint is a ball and socket joint which is stabilised by the labrum and the capsule which condenses into superior, middle and inferior glenohumeral ligaments. Stretch or tear of the labrum and / or the ligaments causes an unstable joint resulting in subluxation or dislocation. Subluxation is instability with abnormal movement, but the ball remains within the socket. In dislocation, the ball moves out of the socket. 

In shoulder instability, the joint subluxes or dislocates repeatedly during active movement

Dislocation could be anterior (most common), inferior or posterior. Please refer to sites of labral tear described above, that result in different types of shoulder dislocations based on the site of dislocation.

Various causes for dislocations:

Traumatic dislocation: Shoulder injury that occurs with sufficient force to pull the shoulder out of joint. It usually needs reduction in A&E and the arm will be put in a sling following the reduction. This is be followed with physiotherapy. In injuries with greater force, labral tears result in a unstable shoulder and further dislocation. This is an indication for surgery, which will depend on the site and nature of tear.

Management shoulder Instability:

Radiological imaging – X rays, CT scan or MRI scan

Anterior stabilisation surgery: Arthroscopic (keyhole) stabilisation carried for repairing anterior tears or Bankart lesion.

LABRAL TEAR
LABRAL TEAR
LABRAL REPAIR PREPERATION
LABRAL REPAIR

Labral Tears

Labrum is a fibrous structure that lines the rim of the socket of the shoulder joint. The shoulder joint is a ball and socket joint with the shoulder blade, glenoid, forming a shallow socket and the humerus head forming the ball. The socket (glenoid) is shallow in comparison to the ball and the labrum lines the rim of the socket, increasing the concavity and the stability of the joint and also provides a suction cup effect. 

Labral tears are seen in shoulder dislocation and can result in shoulder instability. The site of the tear is described by depicting the glenoid as a clock face. A tear in the front of the shoulder (anterior) is described a 3 ‘0’ clock tear, lower margin(inferior) as a 6 ‘0’ clock tear, one on the back(posterior) as a 9 ‘0’ clock tear and one on the top(superior) as a 12 ‘0’ clock tear.

An anterior tear occurring between 3 and 6 ‘0’clock is also called a Bankart tear while a superior tear occurring 11 and 1 ‘0’clock is a SLAP tear. A posterior tear between 6 and 11 ‘0’ clock is called a reverse Bankart tear. A combination of all of the above results in a 270 degree tear.

Chronic tears of the labrum can result in joint fluid seeping out to form paralabral cysts which can compress on adjacent nerve and cause symptoms.

SLAP Tear

A tear at the top of the labrum

SLAP repair– Surgical repair of superior labral tear

Hill Sach’s lesion: Is a dent in the ball of the shoulder

Latarjet procedure: This is done for recurrent shoulder dislocations when soft tissue (Bankart) stabilisation is not possible due to poor quality labral tissues or there is significant bone loss either in the humeral head or the glenoid

Arthroscopic Shoulder Stabilisation

is carried out under general anaesthetic and regional nerve block. It is usually done as a day case procedure although latarjet procedure involves overnight stay. 

You will require a polysling for 4-6 weeks following surgery. Please refer to physiotherapy rehabilitation protocol for further details. Return to work will depend on your occupation and size of tear. Please discuss with surgeon.

2. Atraumatic dislocation: The shoulder joint dislocation occurs with minimal force and often, the shoulder pops back or corrects itself. It is seen in people with lax joints. Treatment involves physiotherapy to restore balance to the muscles and the joint. Surgery is rarely indicated if physiotherapy is unsuccessful.

3. Positional dislocation: Some people can dislocate the shoulder with no trauma and in some cases, do this as a party trick. It is painless and can be put back without difficulty. This is mainly due to the lax muscles around the joint. Physiotherapy is useful. Surgery is reserved for rare cases.

Sternoclavicular (SCJ) Joint Problems

Sternoclavicular joint is the joint between the breastbone and the collar bone. Instability and arthritis are the most common problems encountered.

Dislocations of the SCJ are rare and may result from direct injury as an acute occurrence or in the more persistent case of atraumatic structural instability or non-structural abnormal muscle patterning. 

Management of SCJ problems:

Most cases of instability and arthritis are managed nonsurgically by activity modification, pain killers and physiotherapy.

Persistent pain and instability not responsive to above measures can be managed surgically. SCJ excision for arthritis and surgical stabilization using synthetic grafts for instability has shown promising results in the functional outcome studies that I have been involved in. 

Subacromial Impingement

This refers to reduced space between the humeral head(ball) and acromium (roof) resulting in pain during overhead activities. The group of muscles around the shoulder that raise and lower the arm are known as rotator cuff. The space between the rotator cuff and the roof of the shoulder joint (acromium) is occupied by a fluid filled sac called subacromial bursa. This sac ensures smooth gliding movements of the rotator cuff. Number of conditions can affect this smooth gliding, resulting in impingement. They include Rotator cuff tears and strains, calcific tendonitis, overuse tendinopathy, labral tears, shoulder, instability, bony spur and abnormal muscle patterns.

Management of Subacromial Impingement:

The following treatments are available

Pain killers and anti-inflammatory medication- The initial treatment involves use of simple pain killers and anti-inflammatory tablets.

Physiotherapy- This is useful in strengthening the rotator cuff, improving posture. 

Injection- Steroid local anaesthetic injections are useful. It helps reduce inflammation and pain and improves movement. This is done as an outpatient procedure in clinic. 

Surgery: Surgery is not commonly required. The aim of surgery is to increase the space between the rotator cuff tendon and the acromium, relieving inflammation and pain. Arthroscopic(keyhole) sub acromial decompression (ASAD) is carried out as a day surgery procedure under general anaesthetic and regional nerve block.

Recovery: You will wear a sling for comfort for a few days. Expect to return to light activities as tolerated within a week. Return to work will depend on the occupation and it will take a few weeks to perform heavy manual work.

Complex Shoulder Conditions and Treatment Offered

Revision Shoulder Replacement

Bone Allograft Reconstruction of the Glenoid

Complex Shoulder Reconstructive Surgery

Treatment of Fracture Sequelae

Biceps and Pectoralis Major Reconstruction Using Allograft

Scapulothoracic Fusion

error: Content is protected !!