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Frequently Asked Questions

What is acromioplasty? How will it help my shoulder?

With acromioplasty, surgeons shave part of the acromion bone on the point of the shoulder. A ligament over the top of the shoulder is cut, and injured tissues are removed. This procedure is sometimes done to treat pinched tissues in the shoulder (called shoulder impingement). It is also used to treat tears in the rotator cuff. Acromioplasty can be done using an arthroscope. This slender instrument has a camera on the end that allows surgeons to work without making big incisions in the skin. Athroscopic acromioplasty is a less invasive procedure than open shoulder repairs, which require large incisions. For shoulder impingement and minor rotator cuff tears, acromioplasty has good results. Five years later, most patients have pain relief. They also have normal strength and motion in the shoulder. For rotator cuff tears, acromioplasty works best on minor tears and those on the undersurface of the tendon. Talk with your doctor about how this procedure may help in your case.

I had a rotator cuff repair a year ago. The doctor used four metal anchors to hold the torn tendon in place. I am planning to fly overseas next month. Will the metal anchors set off the security system?

Not likely. Most metals used in orthopedic surgery are made of titanium. This is an alloy or mixture of two or more metals that dissolve in each other when heated to a high temperature. As far as the security system goes, these alloys are no different than the amalgam in dental fillings. They do not trigger the security system. Most doctors will give their patients a letter or prescription with the necessary medical information. This can be shown if there are any questions during the security checks.

I have a partial rotator cuff tear. My doctor is ordering a type of surgery called acromioplasty (ASD) to "decompress" the tendons in the shoulder area. Will this take away the pain in my shoulder? And can I expect the results to last?

If the tear affects less than half of the rotator cuff tendon (grade 1 or 2 tear), you'll probably have good results. Ninety percent of patients with minor tears show immediate improvement from this procedure. And the results seem to last. In a recent study, most patients continued to be pain free when rechecked up to five years after surgery. Patients showed good shoulder strength and motion and were able to do all their activities. Patients followed for up to 10 years didn't show any worsening in the shoulder area.

I am going to have surgery on my shoulder. The doctor has offered me the choice between two different types of anesthesia: general and regional. What are the advantages and disadvantages of these?

regional anesthesia blocks sensation in a large area such as the entire shoulder or arm without putting the patient to sleep. the technique is called an interscalene block. with general anesthesia, the patient is not awake or aware during the operation.

during the first four hours after the operation, there is usually less pain with the regional anesthetic. this also means fewer pain medications.

please see the anaesthetic section under patient info for more details.

Why does my shoulder joint pop, crack and click?

noises in the joints, such as popping, cracking or clicking, can be quite disturbing and cause concern. often, these noises are not indicative of any underlying problem. such noise often persists for years without any real problem developing. if there is no pain with cracks or clicks, you can assume it is being caused by the soft tissue in a joint. noises that are associated with pain may indicate damage to the surfaces of the joint. such cracks and clicks may be due to tears in labrum (see shoulder anatomy), which may snap over the other structures as the arm moves. if the labral tear is at the top of the shoulder it is called a slap lesion. sometimes the clicking may be due to the shoulder slipping in and out of joint. this is known as shoulder instability (subclinical).

I recently fell on the point of my shoulder and have been told I sprained my AC Joint. What is the best treatment and when is surgery indicated?

when a joint is first sprained, conservative treatment is certainly the best. applying ice directly to the point of the shoulder is helpful to inhibit swelling and relieve pain. the arm can be supported with a sling which also relieves some of the weight from the shoulder. gentle motion of the arm can be allowed to prevent stiffness, and early physiotherapy is often of benefit.
occasionally an injection my speed recovery if the injury is slow to settle.

most ac joint injuries settle within 6 months, but a small proportion continue to give pain. this is usually because the small meniscus in the joint has been torn and not healed. at this stage surgery is an option - in the form of an arthroscopic ac joint excision.

also see the latest research on ac joint here 

Where can I find information on Anatomy of the Shoulder?

When is a Shoulder Replacement indicated for Arthritis of the Shoulder?

most people with arthritis of the shoulder can manage with pain-killers, exercise and physiotherapy.
a shoulder replacement is considered if you have the following:
1. severe pain which wakes you at night.
2. pain which prevents you doing your daily activities.
3. pain not controlled by pain-killers.

there are few contra-indications, if you have the above criteria. with modern techniques and implants, such as the copeland surface replacement, age is no longer a limiting factor.

for more information see patient information 

What are 'Suture Anchors'?

suture anchors are very useful fixation devices for fixing tendons and ligaments to bone. they are made up of:
  • the anchor - which is inserted into the bone. this may be a screw mechanism or an interference fit (like a rawlbolt used in diy). they may be made of metal or biodegradable material (which dissolves inthe body over time).
  • the eyelet - is a hole or a loop in the anchor to through which the suture passes. this links the anchor to the suture.
  • the suture - is attached to the anchor by through the eyelet of the anchor. it also may be a non-absorbable material or a biodegradable material

  • so the anchor inserts to the bone and the suture attaches to the tendon - thus fixing the tendon to the bone via the suture-anchor device

    for more information click here
     

    What is Winging of the Scapula and what causes it?

    The scapula (shoulder blade) is the largest bone of the shoulder complex and has the greatest number of muscles attached to it. These muscles both stabilise the arm to the body and move the arm around in space. All these muscles act at the same time at times and oppose each other at other times, but work together like a well trained team to allow the arm to move in space. If any of these muscles are not working in the right way at the right time this leads to a break in the rhythmic motion of the scapula. This is known as a scapula 'dysrythmia'. This leads to 'winging' of the scapula.

    Winging of the scapula is a surprisingly common physical sign, but because it is often asymptomatic it receives little attention. However, symptoms of pain, weakness, or cosmetic deformity may demand attention.

    Winging may be caused by injury or dysfunction of the muscles themselves or the nerves that supply the muscles.


    Causes:
  • 1. Loss of serratus anterior muscle function
  • 2. Loss of trapezius muscle function
  • 3. Weakness of all the scapula stabilisers
  • 4. Loss of the scapular suspensory mechanism
  • 5. Winging secondary to instability
  • 6. Winging secondary to pain
  • 6. Brachial Plexus injury
  • 19 year old female football goalkeeper fractured mid-shaft clavicle 9 days ago abroad with a 'London Bridge' deformity. Is surgical fixation the best option for longterm position and function?

    indications for fixation (in my opinion - lf) include:
  • significant shortening & displacement
  • high energy fracture
  • skin tenting
  • neurovascular problems
  • open fracture
  • in an athlete i might go for fixation if i think there is a risk of delayed or non-union, as they would lose less time off their sport. it all depends on the time of season and the factors above.

    the player would really need to see an orthopaedic surgeon with experience in managing clavicle fractures in athletes - the sooner the better.


    also see:
  • news & research on clavicle
  • I have been told that if I am going to require a shoulder stabilisation that I will not gain full range of movement to my shoulder afterwards. This news has concerned me as I am a dance teacher and need full mobility. Is this the case?

    Stabilisation surgery for recurrent dislocations of the shoulder involves repair of the Bankart lesion (the torn labrum lining the front of the joint), as well as 'shifting' the capsule of the joint. The capsular shift is done by suturing the capsule over itself (like stitching the hem of a skirt to shorten it). Therefore, the capsule is made shorter and tighter than it was prior to the surgery. Sometimes this is ovetightened and results in some degree of post-operative stiffness. Usually this is not too tight to prevent normal activities and only noticed by overhead athletes. Also, the shoulder is immobilised in a sling for 3-6 weeks after surgery and this may also result in some degree of stiffness. Modern arthroscopic (keyhole) techniques, surgical awareness and good rehabilitation has resulted in much less post-operative stiffness. Recent studies have reported less than 5 degrees loss of motion compared to pre-operatively. You should discuss this with your surgeon prior to surgery.

    I have a shoulder replacement and want to know if airport metal detectors will detect my shoulder replacement?

    Shoulder replacements tend to be made out of stainless steel, cobalt chrome or titanium. All have some ferrous in them which could be detected by airport metal detectors. Steel has more ferrous than cobalt chrome, which has more than titanium.

    Whether a metal detector will detect your implant depends on the sensitivity settings on the detector. It is likely that a detector will pick up a steel or cobalt chrome implant.

    Therefore it is advisable you get a letter or card from your surgeon confirming that you have a joint replacement.

    One of our helpful readers has also wisely suggested the following:


    1. Carry a letter from your doctor and/or consultant that you do indeed have a prosthesis, and where it is located

    2. Be ready to *show* officials 'where' the scar is - so wear loose clothing

    3. IF possible carry a small radiograph of the implanated prosthesis so that you can show this as well as the letter

    4. Do be *prepared* for possible delays

    5. Give yourself *Time* for these delays, especially if changing flights. Flight connections can be, and often are, hell, especially in Nth America. Allow for officious officialdom!

    6. Remember, airport staff are only doing their job - be polite and patient!

    I have dislocated my shoulder for the first time. Should I have a surgical repair?

    the main indication for a surgical repair after the first shoulder dislocation is an associated fracture.

    if there is no fracture, then most shoulder dislocations will not require surgery. however, young, male athletes tend to be at a higher risk of further dilsocations and will usually be offered a surgical repair.

    for more information see:


    first time dilsocators

    surgical versus non-surgical treatment for acute anterior shoulder dislocation - cochrane review

    What is the incidence of nerve damage in shoulder surgery?

    nerve damage following most common shoulder procedures is extremely rare. permanaent nerve injury after a nerve block (interscalene block) is less than 0.1%. see: interscalene block

    large complex open procedures, such as revision shoulder replacements or complex fracture or tumour surgery are more likely to have a risk of significant nerve damage, but again this is not common.  

    I have had a shoulder replacement. Should I be taking antbiotic precautions before undergoing dental work?

    It is not common practice to counsel patients about antibiotics for dental procedures following total joint replacement, as there is no good evidence that it is required. Most surgeons follow the American Academy guidelines

    Can one have an MRI scan where there is a prothesis in place, i.e. an MRI scan of cervical discs, neck refers, when there is a replacement shoulder? Or, an MRI scan of the hips when there is a hip replacement?

    It is possible to have an MR scan with a shoulder replacement (or other well-fixed bone implants). However, image quality will be poor if scanning the area near the prosthesis.

    Loose metalwork and pacemakers are prone to move under the strong magnetic field of an MR scanner, but implants and prostheses that are fixed to bone will not.

    I have been told that I have loose bodies in my elbow. What are these?

    Loose bodies are often bits of cartilage that have become loose with wear and tear of the joint. They float around in the joint and gradually grow in size. They typically cause locking, clicking and sticking of the joint. This is usually painful. The loose bodies require surgical removal, which can be done by keyhole surgery (arthroscopy)

    How do I avoid bad postoperative scars?

    Scars around the shoulder can be a cause of concern, particularly for ladies wearing thin strap tops and swimwear. Generally surgical wounds are made in the natural skin lines, known as Langer's lines, so scars should heal very well. It normally does take up to one year for a scar to disappear, but this can be improved with Silicon Gel application. For more information see the Patient Information section

    If you dislocate your shoulder how long do you need to refrain from work (office work). Can you make it worse if you remove the sling too early?

    You should always discuss this with your clinician. Generally, most patients should wear a sling for comfort for about two weeks after a shoulder dislocation and start physiotherapy in this time. This is better than prolonged sling useage. However, some doctors prefer their patients to wear external rotation slings for about 4-6 weeks. During the time of sling use you should refrain from driving and overhead activities. Light desk work should be fine. You will not cause any additional damage by removing the sling early for simple dislocations, but you should always discuss this with your clinician.

    How many steroid injections can I have in my shoulder?

    There is no rule about the number of cortisone injections a person can have, but there are some concerns with repeated cortisone injections to one area of the body: The cortisone injections are not helping If one or two cortisone injections into one region do not help a problem for a sustained period of time, then it is unlikely that more cortisone injections will be of any benefit. Repeated cortisone injections are not healthy for tissues Small amounts of cortisone in the body are probably reasonable, but repeated injections can cause damage to tissues over time. Sometimes this is of little concern. For example, if a patient has severe knee arthritis, and a cortisone injection every 6 months helps significantly, then the number of injections probably does not matter too much. On the other hand, if a patient has shoulder tendonitis, but an otherwise healthy shoulder, the number of injections should probably be limited to prevent further damage to these tendons. So what is the bottom line? There is no hard and fast rule that says how many cortisone injections can be given over time. However, cortisone injections can have side effects, and repeated use of cortisone injections should be done with caution. Patients should understand that there are reasons not to use cortisone injections, even if they may help some symptoms. Because of this, most orthopedic surgeons will limit the number of cortisone injections they will offer to a patient.
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