Shoulder Surgery

The shoulder is the most mobile joint in the human body, and is vital for positioning of the hands to provide function. Therefore issues with the shoulder can cause significant disability.

James treats a wide array of degenerative and traumatic problems of the shoulder. The most common of these are:

• Arthritis

• Rotator Cuff Tears

• Shoulder Instability / Dislocation of the shoulder

Arthritis

Osteoarthritis is the most common form of arthritis. This is when the smooth cartilage which lines the ends of the bones wears out. This creates a stiff and painful joint. The symptoms of this can range from a minor annoyance to severely debilitating.

Initial management of osteoarthritic joints involves activity modification, physiotherapy, and simple pain medication and anti-inflammatories.

When non-operative management fails, surgery can be considered.

The mainstay of surgical management of advanced shoulder osteoarthritis is a total shoulder arthroplasty (replacement). In this procedure, the arthritic joint surfaces are replaced with prosthetic parts. This removes the major pain causing pathology in the arthritic shoulder.

Depending on the pattern of arthritis and other pathology present (such as rotator cuff tears), the replacement can be either an Anatomic Total Shoulder Arthroplasty (aTSA) or a Reverse Total Shoulder Arthroplasty (rTSA). The most appropriate treatment for each patient will be discussed on a case-by-case basis.

Rotator Cuff Tears

Rotator cuff tears are common, and do not always cause pain or functional problems. When they are symptomatic, they can cause significant problems.

Rotator cuff tears can be either acute or degenerative.

Acute tears are more often seen in younger patients following trauma to the shoulder, and usually require prompt surgical attention.

Degenerative tears are more common, and are usually seen in patients in their 50s or older. These are usually due to ‘wear and tear’ over the years, but can be precipitated by injury.

Degenerative tears should usually undergo a period of non-operative management with physiotherapy and pain relief. Injections to the shoulder can also be helpful. Failing this, rotator cuff repair surgery can be offered.

Rotator cuff repair is generally performed via arthroscopic (keyhole) surgery, however, some tears require a ‘mini-open’ approach. The torn tendon is reattached to bone using surgical anchors.

Some cuff tears are too large or too chronic to enable repair. There are a number of other options in this setting, which can be individualised to each patient’s situation.

Shoulder Instability

The significant mobility of the shoulder makes it the most commonly dislocated joint in the human body.

Some people experience recurrent dislocation of their shoulder, which can interfere with sporting and recreational pursuits, and more severe cases can interfere with daily activities.

Initial non-operative treatment of shoulder instability focusses on strength and coordination of the shoulder musculature.

Surgical treatment of shoulder instability is tailored to each individual patient. This can be either open or arthroscopic (keyhole) surgery, and can either involve repair of the glenoid labrum or a coracoid transfer (Latarjet) procedure.

The most appropriate surgery for each patient is determined by examination and advanced imaging techniques.