Conditions

This section summaries information about the most common conditions I deal with in my clinic. If you have any question please get in touch with us on the numbers / emails provided or send us directly through the link on contact us section.

This is a degenerative condition. When the cartilage worn away,  it results in lose of its smooth surface and the bone surfaces will be grinding on each other. This will be presented as pain and stiffness (reduced range of movement) of the shoulder joint.

The most common cause is osteoarthritis. Other causes include inflammatory arthritis with Rheumatoid arthritis being the most common. Trauma (fractures) is another cause of arthritis (post traumatic arthritis)

Painful stiff shoulder is the classic complaint. This usually interferes with patients’ day to day activities. At later stage sleeping is usually interrupted by the pain. Noise and catching are also classic symptoms. Other causes of painful stiff shoulder has to be excluded by taking details medical history, thorough examination and scans as required. Plain Xray is the standard scan to diagnose shoulder arthritis. Other scans are usually needed to plan for management (CT / MRI).

Conservative treatment (non-surgical) is usually the first option. This is in a form of analgesia (pain management), anti-inflammatory and physiotherapy. Local injection can be suitable for selected cases only. If this fails to give the patient a satisfactory outcome, shoulder replacement surgery to be considered. There are different types of shoulder replacements for different types of shoulder arthritic conditions (hemi-arthroplasty “half shoulder replacement”, total shoulder replacement and reverse polarity total shoulder replacement). The choice depends on many factors including, patients age, type of arthritis, rotator cuff condition and bone stock. Post surgery physiotherapy rehabilitation protocol is the standard practice.

It is repeated dislocation or subluxation of the shoulder joint during active movement. Subluxation happens when the head of the humerus (the arm bone) moves more than it should do without coming out of the joint.

Trauma (injury) to the shoulder is the most common cause of shoulder instability. However, hyperlaxity of the ligaments and muscle pattern can cause instability without injury. Shoulder dislocates usually (95%) to the front (anterior). Dislocation usually causes tear of the labrum (the ring of soft tissue surrounding the glenoid). However, it can also cause tear to the rotator cuff and / or bone injury. Nerve injury can also happen following shoulder dislocation.

Shoulder instability usually presents it self as recurrent shoulder dislocation or persistence feeling that the shoulder is loose and keeps slipping out & in of the joint. Detailed medical history and thorough examination of the shoulder are mandatory. This will help to define which type of instability it is, so we can implement the suitable plane of management. X-ray is the initial scan required to assess the bone damage. However, CT scan gives more details if the bone defect is anticipated. MRI arthrogram (dye injected into the joint before the scan) is usually needed to asses the soft tissue damage. 

Different treatment regimes are available for different types on instability. The treatment plan also also depends on many factors including, age, cause of dislocations, number of episodes of dislocations, ligamentous laxity and the risk of further dislocations. The younger you are the higher the risk of further dislocations after the first episode. In contrary, the older you are the higher the risk of rotator cuff damage following the first dislocation. Physiotherapy, early range of movement  and activity modification is usually the first line of treatment for majority of cases.

Arthroscopic (key hole) anterior stabilisation is a standard operation. The operation involves reattachment of the torn labrum to its position in the glenoid and re-tensioning joint ligaments/capsule using synthetic anchors (usually 3 anchors). In certain conditions where there is significant bone defect we elect to do Latarjet procedure. This procedure involves cut and reattachment of the coracoid process to the front of the glenoid to provide shoulder stability.

Rotator cuff is a ring of 4 tendons surrounds the shoulder joint and inserted in upper end of the humerus (the ball of the ball and socket shoulder joint). They control the movements of the shoulder joint and contribute to its stability. Torn rotator cuff can be due to wear & tear or as a result of trauma/accident. Tear of one or more tendons of the rotator cuff can cause pain, limited movement and weakness of the shoulder movements.

Direct trauma to the shoulder such as a fall can cause acute (traumatic) tear of the rotator cuff). As we grow older, our tendons grow as well. Repeated minor trauma and degeneration of the tendons over year can cause chronic (degenerative) cuff tear.

Patients usually present with pain on the top / front / side of the shoulder. Pain increases on trial reaching above the shoulder level. Pain usually comes with weakness and stiffness on elevation of the arm. Impingement syndrome, frozen shoulder and ACJ arthritis can give similar symptoms and has to be excluded before we make torn rotator cuff as a diagnosis. So, detailed medical history and thorough examination of the shoulder are mandatory.  X ray is a standard tool to exclude other conditions as arthritis. This to be followed by the ultrasound scan which is one of the accurate scans to assess rotator cuff. MRI scan might also be required to assess the muscles and to plan for surgey.

There are different ways to tear rotator cuff tears including non-surgical and surgical treatment. It depends on many factors including, severity of symptoms, level of function, size & location of the tear and how did it happen (traumatic of degenerative tear). Non-surgical treatment is in a form of analgesia, physiotherapy rehabilitation and local injection. The aims of surgery is to reattach the torn rotator cuff tendon to the bone. This can be done either arthroscopic (keyhole) or mini open repair. Synthetic suture anchors are used to repair the torn tendon(s). This is typically done as a day case under general anaesthesia with a nerve block which keeps the arm numb for few hours after surgery. If the tear is massive and not suitable for direct repair, there are other options to be considered.

This is one of the most debilitating conditions of the shoulder. It is characterised by painful & stiff shoulder. This happen when the capsule of the joint become inflamed and thick instead of being thin and stretchy. No one knows the exact cause of frozen shoulder. However, there is usually association with other conditions like trauma and  diabetes mellitus.

Frozen shoulder has three phases. Each phase lasts for 6-12 months. With an overall process takes around 2 years, although usually longer. It started by painful shoulder (inflammatory phase), then less painful but stiff shoulder (frozen phase) and lastly the thawing phase when shoulder is not painful and starts to regain movement. Detailed medical history and thorough examination are mandatory to reach the rihgt diagnosis and to exclude other conditions like shoulder arthritis and impingement syndrome. Typically, range of movement is significantly reduced compared to the other (normal) side. X ray is important to exclude underlying arthritis.

Frozen shoulder is a self limiting condition. That means it s likely to improve and resolve by itself in a process takes usually 2 years or more. If you are managing well with the level of pain we advice you to do your usual exercise. Steroid injection can help during the inflammatory phase with less predicted results in the frozen phase where physiotherapy will be more effective. If your shoulder doesn’t  respond well to the non-operative measures, surgery can be an option.

This is an arthroscopic (keyhole) release of the joint capsule around the ball (glenoid). Surgery has been shown to be beneficial in early and late stages of frozen shoulder. It helps with pain and range of movement. Surgery always to be followed by physiotherapy. This is typically done as a day case under general anaesthesia possible with a nerve block added on which keeps the arm numb for few hours after surgery.

It is pain on the top of your shoulder which gets worse when you try to left your arm up above the level of your shoulder. Pain comes from the tendons and the bursa separating the tendon from the bone on top of our shoulder (acromion). If there is no enough space for the tendons between the humeral head and the acromion they usually get pinched, and subsequently inflamed. Possible causes of impingement syndrome include, inflammation of the tendons, calcific tendinitis, rotator cuff tear, shoulder instability, bony spur and ACJ arthritis.

Patients usually present with pain on the top / front / side of the shoulder. Pain increases on trial reaching above the shoulder level. Frozen shoulder, rotator cuff tear and ACJ arthritis can give similar symptoms. Detailed medical history and thorough examination are mandatory to reach the right diagnosis.  X ray is usually required to exclude other similar conditions as calcific tendinitis and shoulder arthritis. This to be followed by the ultrasound scan.

It is almost always conservative treatment (non-surgical). This is in a form of analgesia, anti-inflammatory and comprehensive physiotherapy protocol. Local cortisone injection can be very helpful. Majority of the patients respond well to the non-surgical treatment. Surgery can only be offered after failure to respond to a comprehensive physiotherapy protocol with one or two trials of local steroid injections. Surgery would be an arthroscopic (keyhole) subacromial decompression which involves shaving of few millimetres thickness of the undersurface of the acromion.  This is typically done as a day case under general anaesthesia possible with a nerve block added on which keeps the arm numb for few hours after surgery. The surgery will be followed by a physiotherapy rehabilitation program.

The lateral epicondyle is the bony lump on the outside of the elbow. Most of the muscles on the back side of the forearm are attached to the lateral epicondyle with a common tendon (common extensor origin).  Tennis elbow is a painful condition affects the common extensor tendon. In particular, it affects Extensor Carbi Radialis Brevis tendon (ECRB). The exact cause is not fully understood yet. However, it is likely to happen as a result of forearm muscle repeated overuse. This leads to tendon damage and degeneration.

Clear and detailed history followed by thorough examination will lead to the right diagnosis and exclusion of other conditions that might give a similar clinical picture. X ray and Ultrasound / MRI scan are usually required to confirm the diagnosis.

The standard treatments is non-surgical. This is in the form of rest, modification of activities, analgesia, anti-inflammatory and physiotherapy. It takes longer period of time until it resolves especially with patients who are not able to take adequate rest for a reasonable period of time.

Steroid injection has been in use for long time. However, recent evidence show high rate of recurrence and suboptimal long term results with steroid injections. Platelets Rich Plasma (PRP) injection have shown better oitcome compared to steroid injection on the longterm. Local injection has too be followed by physiotherapy. Surgery can be offered to patients who followed the non-surgical protocol for the advised period of time with no improvement. Surgery is typically done as a day case under general anaesthesia. The surgery will followed by a physiotherapy rehabilitation program.

The medial epicondyle is the bony lump on the inside of the elbow. Most of the muscles on the front of the forearm are attached to the medial epicondyle with a common tendon (common flexor origin).  Golfers elbow is a painful condition affects the common flexor origin. The exact cause is not fully understood yet. However, it his likely to happen as a result of forearm muscle repeated overuse. This leads to tendon damage and degeneration.

Clear and detailed medical history followed by thorough examination will lead to the right diagnosis and exclusion of other conditions that might give a similar clinical picture. X ray and Ultrasound / MRI scan are usually required to confirm the diagnosis.

The standard treatments is non-surgical. This is in the form of rest, modification of activities, analgesia, anti-inflammatory and physiotherapy. It takes longer period of time until it resolves especially with patients who are not able to take adequate rest for a reasonable period of time.

Steroid injection has been in use for long time. However, recent evidence show high rate of recurrence and suboptimal long term results with steroid injections. Platelets Rich Plasma (PRP) injection have shown better oitcome compared to steroid injection on the longterm. Local injection has too be followed by physiotherapy. Surgery can be offered to patients who followed the non-surgical protocol for the advised period of time with no improvement. Surgery is typically done as a day case under general anaesthesia. The surgery will followed by a physiotherapy rehabilitation program.

It is a compression of the median nerve in the wrist. Median nerve is one of the nerves supplies the hand. It passed through a tunnel in the wrist (the carpal tunnel). The floor of the tunnel is made of the wrist joint bones where the roof covered by a band of soft tissue. If the tunnel becomes tight the nerve gives symptoms of CTS. The classic symptoms are tingling and numbness of the hand & fingers. To a laters stage it can cause weakness and muscles wasting.

The cause is not known yet. However, it has association to some conditions like diabetes, thyroid disease, pregnancy and rheumatoid arthritis. Detailed medical history followed by thorough examination will lead to the right diagnosis. However, in some cases nerve test (nerve conduction study) is needed.

Non-surgical (conservative) treatment is usually the first line of treatment. This usually in a form of wrist splint (particularly night splint), anti-inflammatory and  physiotherapy. Local steroid injection can be used in selected cases. Surgery can be offered to patients with poor response to the conservative measures. This is typically under local anaesthesia as a day case. Surgery takes about 15-20 minutes.