Expert treatment for shoulder and elbow injuries and conditions

Acromioclavicular joint reconstruction surgery may be offered to you if you have damaged your ACJ (where your collarbone joins your shoulder blade) as the result of a fall or collision. ACJ injuries can vary in severity from a mild strain to a complete ligament tear. Where the damage is minor, non invasive techniques will be recommended, such as immobilisation and injections. If surgery is required, your consultant will stabilise the joint by using sections of your own ligament taken from the front of your shoulder. During convalescence your arm will need to be supported in a sling for about 4 weeks.

This is a keyhole procedure, usually undertaken with a local anaesthetic, to cut the tight capsular tissues surrounding the shoulder joint, allowing the shoulder to move more freely. Capsular release is generally used to treat a frozen shoulder that has not responded to other forms of treatment, including corticosteroid injections and joint distension or manipulation. Recovery time is generally six weeks to three months and the long term prognosis is  good, with most people reporting either zero or significantly reduced pain levels.

This procedure is usually performed on younger patients who have advanced arthritis of the shoulder but who are too young for joint replacement surgery. A small incision is made in the joint and a tiny camera known as an arthroscope is inserted. Surgical instruments are then used to remove loose cartilage and scar tissue surrounding the joint. Patients typically see pain levels reduce in a fortnight, with full function regained following six to twelve weeks of physiotherapy. This treatment has been shown to prevent the need for surgery for up to five years.

If treatments such as anti-inflammatories, physiotherapy and injections prove insufficient, this form of keyhole surgery can be performed to repair common problems with the elbow joint, such as tennis/golfers’ elbow and osteo or rheumatoid arthritis. Recovery is faster than traditional open surgery, although it will vary depending upon the severity of the condition. A personal rehabilitation plan, often involving physiotherapy, can help support the healing process.

ORIF is used to repair severe or compound bone fractures, often caused by a high-impact event such as a sports injury, serious fall or car accident, ORIF is a two-stage process. Firstly, open reduction involves the re-alignment of broken bones. This is followed by internal fixation, which is where the bones are held together using metal implants. If necessary, in some cases the surgeon may use external fixation (pins and metal screws in the bone above and below the fracture) to stabilise the bone while it heals. These project out of the skin and are attached to metal or carbon fibre bars. They are temporary and are removed once the bones have sufficiently healed. Recovery can take several months, depending on the extent of the fracture, and painkillers, anti-inflammatory medication and regular physiotherapy are required to restore strength and maximize range of movement.

The same procedure as above, but for the collarbone area. Again, it can take several months to return to normal daily activities after this type of surgery, and you may experience stiffness, discomfort, and weakness for some time afterwards. Most people make a good recovery, but your consultant will discuss the on-going impact your injury may have on work, family and everyday life.

The rotator cuff is the name given to the muscles and tendons that surround the shoulder. Its role is to keep the head of the upper arm bone (humerus) inside the shoulder socket (glenoid). There are several types of rotator cuff repair surgery, including open repair, mini open repair, all-arthroscopic repair and, in the most severe of cases, superior capsule reconstruction. Open repair involves a medium sized incision across the shoulder and is normally only undertaken to fix large or complex tears. The mini version uses a partial keyhole procedure to assess and treat damage to other structures within the joint, such as bony spurs. As the name suggests, an all-arthroscopic repair is 100% keyhole, employing a camera and instruments inserted into the shoulder to enable the surgeon to repair the damage via access to an external video screen. Finally, superior capsule reconstruction, another arthroscopic treatment, can be used to improve function and reduce pain where there is irreparable damage to the rotator cuff. Recovery time is dependent upon the severity of the problem and the specific surgical option employed, but can range from four to six weeks to the same number of months in certain cases.

Also called acromioplasty, shoulder decompression surgery is used to treat shoulder impingement, a common condition that causes weakness in your shoulder and pain when you raise your arm above your head. It is a keyhole process under general anaesthesia and is considered a final option to be pursued after other measures including activity modification, injections, and physiotherapy have been explored without success. As this is a day procedure, you can go home once the anaesthetic has worn off, but full recovery normally takes around four months.

Less common than a knee or hip replacement, shoulder replacement surgery is a safe and effective procedure for relieving acute shoulder pain associated with conditions such as osteoarthritis and severe rotator cuff injuries. It is also a good option for treating older patients who suffer from osteoporosis. Essentially the damaged parts of the shoulder are removed and replaced with artificial implants, often made of metal including titanium, cobalt chrome alloys and polyethylene. Ceramic shoulder replacements can also be used although this is a relatively new innovation. Surgery takes about two hours but a couple of days rest in hospital afterwards is required. Improved shoulder movement and a return to work is expected for most patients within six weeks. Studies indicate that the new shoulder joint will last in excess of 20 years in 80% of cases.

Shoulder stabilisation surgery is used to repair the damage caused from dislocating your shoulder or chronic shoulder instability caused by repeated dislocations. The procedure is arthroscopic in all cases to be as minimally invasive as possible, thus reducing recovery time and minimizing patient discomfort. The most common treatments are a Glenoid Labrum repair, a Bony Bankart repair and a SLAP Lesion repair. All surgical options are safe and effective and are designed to alleviate pain and restore lost shoulder function. Statistics show that 90% of patients have a good outcome and more than 85% can return to competitive activities.

Damage to the ulna nerve, which runs from your shoulder to your little finger and is responsible for causing the strange “funny bone” sensation when you hit your elbow, can result in permanent numbness or a loss of function in the muscles of the hand. Compression of this nerve may occur in the upper arm, elbow or forearm. Decompression surgery explores these three areas and removes any constrictions that are trapping the nerve. It is performed under local, regional or general anaesthetic and can be either an open or keyhole procedure. The arm needs to be kept elevated for 24-48 hours after surgery to prevent swelling, although you can normally go home the same day. Light activities can be undertaken within a few weeks and you should be able to return to work within the same period, dependent of course on the nature of your job.