FAQs

What does recovery involve?

Postoperative
After surgery, you will stay in the recovery room for 1 to 2 hours before being transferred to the ward. You will be discharged the following morning, after making sure that your pain is well controlled, you are eating and drinking and are able to toilet. You will need someone to drive you home and stay with you for at least the first night.

More information about recovery after shoulder operation can be found here

At Home
How quickly your shoulder recovers after surgery depends on what exactly was done and can vary quite significantly from person to person. Most patients have some pain and discomfort for at least the first week or two. If you have had more extensive surgery, the discomfort may last several weeks before subsiding.

Ice will help relieve pain and swelling. If appropriate, you will be prescribed a combination of short and long acting analgesics. These include Oxycontin or Targin, Naprosyn Slow Release (SR) and Paracetamol (Panadol). On occasion, you may be given Lyrica or Tramadol.

If a repair has been performed, you will need a sling or special immobiliser to protect your shoulder. I will discuss with you how long to use the sling.

Rehabilitation
Rehabilitation is an important part of getting maximum benefit out of surgery and returning to your usual activities. A physiotherapy based program will help you regain your shoulder motion and eventually strength. I will advise on a plan based on the surgical procedure that was performed.

Any surgical or invasive procedure carries risks. Before proceeding, you should seek a second opinion from an appropriately qualified health practitioner.

What is a Frozen Shoulder?

The shoulder joint is the most mobile joint in the body. Its capsule (the tissue that surrounds the shoulder joint) has special properties that allows for this to happen. In a frozen shoulder (adhesive capsulitis), the capsule becomes tight, inflamed and scarred. This can result in severe pain and restriction of motion, which potentially can last two years.

The condition can be difficult to diagnose, especially in its early stages. Sometimes, the pain and stiffness is incorrectly attributed to a small partial tear of the rotator cuff. An accurate diagnosis early on can help with setting realistic expectations, avoiding unnecessary injections or surgery and hopefully speeding up recovery.

Any surgical or invasive procedure carries risks. Before proceeding, you should seek a second opinion from an appropriately qualified health practitioner.

What types of operations do you do for dislocating shoulders?

By far, the commonest operation that I perform for a dislocating shoulder is an arthroscopic stabilisation of the shoulder joint (key hole surgery). For the correct indication, this operation has a very high likelihood of stabilising the shoulder, with very few complications.

Arthroscopic surgery is not appropriate for every dislocating shoulder. Depending on your age, overall flexibility, sporting needs, associated injuries to the bone, etc. it may be more appropriate to consider open surgery.

The commonest bone block operation that I perform is a Bristow-Latarjet bone graft.

Please watch the animation for more information about what a Bristow-Latarjet procedure involves.

My shoulder has dislocated a couple of times. Do I have any alternatives, in order to avoid surgery?

Surgery to stabilise a dislocating shoulder is very much an individual’s choice. Alternatives to surgery include:

  • Modifying your activities to reduce the risk of another dislocation
  • Physiotherapy to re-educate your shoulder muscles
  • Taping (during sports) to avoid ‘at-risk’ arm positions

Any surgical or invasive procedure carries risks. Before proceeding, you should seek a second opinion from an appropriately qualified health practitioner.

Do I need surgery after my shoulder dislocation(s)?

Shoulder and Elbow Specialist
An assessment needs to be done of the likelihood of your shoulder “popping out” again.
Important factors to consider include:

  • Your age at the time of first dislocation
  • Your work and sporting requirements
  • The flexibility of your uninjured ligaments
  • Examination of your injured shoulder
  • Associated injuries to the shoulder such as bone loss (i.e. bony Bankart or Hill Sachs lesion), nerve damage, tear of the rotator cuffs, etc.

With this information, your surgeon will be able to give you an estimate of the likelihood of your shoulder continuing to dislocate.

Any surgical or invasive procedure carries risks. Before proceeding, you should seek a second opinion from an appropriately qualified health practitioner.

Is there a downside to not having surgery for my torn rotator cuff?

There is one potential downside to not having a torn rotator cuff tendon repaired. Over time a number of small partial-thickness rotator cuff tears progress to become large full-thickness tears. Some of these larger tears become painful. If you choose not to have your tear repaired, there is a possibility for the tear to become irreparable.

Despite this, I still feel that rotator cuff surgery should be done to alleviate pain in the shoulder.

Any surgical or invasive procedure carries risks. Before proceeding, you should seek a second opinion from an appropriately qualified health practitioner.

Why do some patients lose movement following a rotator cuff tendon repair?

Post operative stiffness is a possible complication following rotator cuff tendon repair. This can result in loss of movement and increasing pain in the shoulder. The commonest reason for this is because the attempted repair results in an unbalance shoulder. Hence the healing potential of rotator cuff tendon needs to be carefully assessed prior to surgery.

Any surgical or invasive procedure carries risks. Before proceeding, you should seek a second opinion from an appropriately qualified health practitioner.

Why does recovery from rotator cuff surgery take such a long time?

The aim of a rotator cuff surgery is to re-attach the tendon back onto bone. The tendon then needs time to heal back onto bone. Once the tendon heals to bone and the joint is mobile, the muscle needs to be re-strengthened. Early physiotherapy with incremented increase in rehabilitation is critical to allow for tendon healing and minimise stiffness.

Any surgical or invasive procedure carries risks. Before proceeding, you should seek a second opinion from an appropriately qualified health practitioner.

When would you consider offering surgery to repair a torn rotator cuff?

A number of factors need to be considered:

  • the amount of pain caused by the torn tendon
  • your age and level of activity
  • the condition of the torn tendon and muscle

The amount of pain a torn tendon causes, and the response you have had to the various non-surgical means of treatment is by far the most important factor in determining whether surgery is required. It is often pain at night disturbing sleep on a regular basis that seems to make people consider surgery.

Age of the patient at time of surgery seems to be one of the most important in determining whether a repaired tendon will heal or not.

For patients under the age of 50 – 55 years
Few patients under the age of 50 – 55 will have a torn rotator cuff, and this will almost always be traumatic in nature. Surgery in these patients needs to be considered early.

For patients between the ages of 55 and 70 years
Using modern arthroscopic (key-hole surgery) techniques, most torn rotator cuffs are repairable. The arthroscope allows for better visualisation and mobilisation of the tear pattern, how to best repair it, better access to put in anchors and sutures for the repair, double-row technique to provide secure fixation of the tendon back onto bone; all without interfering with the deltoid muscle.

But just because a tear is repairable, that does not mean that it should be repaired. Not all repaired tendons will HEAL back to bone again.

The tear should not be considered in isolation. A careful assessment of the likelihood of healing needs to be made. Pre-existing medical conditions need to be taken into account. A thorough shoulder exam will determine whether it is appropriate to consider repair of the torn tendon. Additional imaging can be very valuable in determining the likelihood of functionality following a rotator cuff repair.

After the age of 70 years
In most patients over the age of 70 years, the rotator cuff muscle and tendon will often have pre-existing changes within it. Often a tear becomes painful with little further injury. Although most tears may still be repairable, unfortunately they may not heal once repaired. For this group of patients other arthroscopic (key-hole surgery) techniques may be more appropriate. Alternative treatment may result in quicker recovery time, and better outcomes.

Any surgical or invasive procedure carries risks. Before proceeding, you should seek a second opinion from an appropriately qualified health practitioner.

Do I need to have surgery for my torn rotator cuff?

Most tears in patients under the age of 50-55 are traumatic in nature and require an early assessment by an Orthopaedic Surgeon.

Otherwise, it is extremely important to try a period of physiotherapy, pain-killers (including anti-inflammatory medications), modifying your activities and on occasion, steroid injections, to see if the pain from the torn tendon can be settled. Although a torn tendon does not heal itself, the pain from it can certainly be managed.

Any surgical or invasive procedure carries risks. Before proceeding, you should seek a second opinion from an appropriately qualified health practitioner.