Treatments

We offer a wide range of arthroscopic (key Hole) and open surgeries for management of Shoulder, Elbow & upper limb related problems.

The most common reason for shoulder replacement is arthritis. This can be osteoarthritis (wear & tear), rheumatoid arthritis. Bad shoulder injuries (fractures) can also be treated with shoulder replacement.

The main aim of the operation is to reduce your shoulder pain. Hopefully with less pain movement will improve. This depends on how stiff your joint was before the operation.

• Hemi-arthroplasty (half shoulder replacement):

  The head of the humerus is replaced by metal/ceramic head attached to a standard or a short stem.

• Anatomical total shoulder Replacement:
  The head of the humerus is replaced by metal/ceramic head attached to a standard or a short stem. In addition, the glenoid (socket) to be replaced by a new plastic socket.

• Reversed total shoulder replacement:
  It is designed for arthritis shoulders with deficient rotator cuff. The ball & socket are switched. So, a plastic socket and teh stem are attached to the arm and a metal ball is attached to the socket.

You will be contacted by the hospital team to arrange for your pre-assessment appointment. This can take place either by telephone consultation of face to face according to your medical condition and the type of your operation.

• You should not eat or drink for 6 hours before the operation. In pre-assessment appointment you will be told when to stop eating and drinking.

• You will be admitted to the hospital.

• You will see me before the operation. So, you will have a chance to ask any question related to the operation.

• You will also see the anaesthetist who will explain to you type of anaesthesia you will get.

• The operation will be done under general anaesthesia (you will be asleep). You might also be given nerve block by the anaesthetist before the operation to numb your arm during and for few hours after the operation.

• Your arm that is being operated on will be marked with a marker pen.

The operation involves replacement of the arthritis head of the humerus and the socket (glenoid) with metal or ceramic head and plastic socket.

• You will wake up in the recovery room where you will be nursed by the team until your are ready to go back to the ward.

• When you wake up your arm will be in a sling.

• In the ward, in addition to the routine nursing care you will also be seen by the physiotherapy team to start the rehabilitation protocol.

• The following day you will get shoulder x ray.

• The average hospital stay is 2-3 days.

• First 6 weeks:

• • Arm sling for 6 weeks.

  • Take the sling off for the recommended exercise.

  • No supporting body weight with operated arm for 3 months.

  • Active finger, wrist elbow and scapular movements to start from day one.

  • Pendulum shoulder exercise to start as early as possible.

• 6-12 weeks:

• • Wean yourself of the sling.

  • Active assisted then active shoulder movement.

  • You can return to driving after 8-10 weeks when you regain reasonable active movement and when you feel safe & confident to do so.

• 12 weeks onwards:

• • Active shoulder movement.

  • Range of movement.

  • Return to swimming (Breast stroke).

  • Full recovery can take up to 12 months.

• Your wound to be checked and clips/stitches to be removed by your district nurse/GP at 2 weeks.

• Out patient clinic appointment with me at 6 weeks.

Regain shoulder stability & reducing the risk of dislocation.

You will be contacted by the hospital team to arrange for your pre-assessment appointment. This can take place either by telephone consultation of face to face according to your medical condition and the type of your operation.

• You should not eat or drink for 6 hours before the operation. In pre-assessment appointment you will be told when to stop eating and drinking.

• You will be admitted to the hospital.

• You will see me before the operation. So, you will have a chance to ask any question related to the operation.

• You will also see the anaesthetist who will explain to you type of anaesthesia you will get.

• The operation will be done under general anaesthesia (you will be asleep). You might also be given nerve block by the anaesthetist before the operation to numb your arm during and for few hours after the operation.

• Your arm that is being operated on will be marked with a marker pen.

• This is a day case surgery.

• The operation takes about 1 hour.

• It is an arthroscopic (Keyhole) surgey.

• Each arthroscopy portals is 5-10 mm wide. Two portals are usually needed to perform this operation.

• The operation involves reattachment of the torn labrum to its position in the glenoid and re-tensioning joint ligaments/capsule as required.

• In most of the cases we use 3 anchors for teh repair.

• During the operation the surgeon may identify further damage in your shoulder. This well be dealt with as required.

• You will wake up in the recovery room where you will be nursed by the team until your are ready to go back to the ward.

• When you wake up your arm will be in a sling.

• In the ward, in addition to the routine nursing care you will also be seen by the physiotherapy team to start the rehabilitation protocol.

• You will be discharges from the hospital on the same day.

• First 6 weeks:

  • Wear the arm sling day and night for 6 weeks.

  • Take the sling off for the recommended exercise.

  • No supporting body weight with operated arm for 3 months.

  • Active finger, wrist elbow and scapular movements to start from day 1.

  • Pendulum shoulder exercise to start as early as possible and for 6 weeks.

  • Passive and active assisted forward flexion up to 90° and external rotation to neutral starting after week 3.

  • Avoid external rotation in neutral greater than 30˚.

  • Avoid external rotation in abduction.

  • You can do your disk job as early as you can tolerate.

• 6-12 weeks:

  • Discard sling.

  • Active assisted then active shoulder movement.

  • You can return to driving after 8 weeks when you regain reasonable active movement and when you feel safe & confident to do so.

• 12 weeks onwards:

  • Strengthening exercises.

  • Range of movement.

  • Return to swimming at 12 weeks (breast stroke)

  • Contact sports at 6 months

  • Full recovery can take up to 12 months.

• Your wound to be checked by your district nurse/GP at 2 weeks.

• Out patient clinic appointment with me at 6 weeks.

To improve shoulder function (movement and strength) and to reduce shouder pain.

You will be contacted by the hospital team to arrange your pre-assessment appointment. This can take place either by telephone consultation of face to face according to your medical condition and the type of your operation.

• You should not eat or drink for 6 hours before the operation. In pre-assessment appointment you will be told when to stop eating and drinking.

• You will be admitted to the hospital.

• You will see me before the operation. So, you will have a chance to ask any question related to the operation.

• You will also see the anaesthetist who will explain to you type of anaesthesia you will get.

• The operation will be done under general anaesthesia (you will be asleep). You might also be given nerve block by the anaesthetist before the operation to numb your arm during and for few hours after the operation.

• Your arm that is being operated on will be marked with a marker pen.

• This is a day case surgery.

• The operation takes about 1 hour.

• The operation can be done arthroscopic (Keyhole) or mini open surgery (small incision).

• Each arthroscopy portals are usually 5-10 mm wide. Two to three portals are usually needed to perform this operation.

• The aim of the operation is to reattach the tendon(s) to its bone on the top of the humeral head.

• The repair of the shoulder tendons is done using synthetic anchors.

• Number of anchors varies according to many factors including size and shape of the tear.

• During the operation the surgeon may identify further damage in your shoulder. This well be dealt with as required.

• If the tear is too large for the repair be achieved, alternative options can be available as partial repair.

• You will wake up in the recovery room where you will be nursed by the team until your are ready to go back to the ward.

• When you wake up your arm will be in a sling.

• In the ward, in addition to the routine nursing care you will also be seen by the physiotherapy team to start the rehabilitation protocol.

• You will be discharges from the hospital on the same day.

• First 6 weeks:

• • Wear the sling day and night for 3-6 weeks.

  • You might be instructed to use the sling only during the night after 3 weeks.

  • No supporting body weight with operated arm for 3 months

  • Active finger, wrist elbow and scapular movements to start from day 1.

  • Pendulum shoulder exercise to start as early as possible and for 6 weeks.

  • You can do your disk job as early as you can tolerate.

• 6-12 weeks:

• • Active assisted then active shoulder movement.

  • You can return to driving after 8 weeks when you regain reasonable active movement and when you feel safe & confident to do so.

• 12 weeks onwards:

• • Strengthening exercises.

  • Range of movement.

  • Return to swimming at 16 weeks

  • Contact sports at 6 months

  • Full recovery can take up to 12 months. Pain, particularly at night, can persist until then.

• Your wound to be checked by your district nurse/GP at 2 weeks.

• Out patient clinic appointment with me at 6 weeks.

To improve shoulder movement and to reduce pain

You will be contacted by the hospital team to arrange your pre-assessment appointment. This can take place either by telephone consultation of face to face according to your medical condition and the type of your operation.

• • You should not eat or drink for 6 hours before the operation. In pre-assessment appointment you will be told when to stop eating and drinking.

  • You will be admitted to the hospital.

  • You will see me before the operation. So, you will have a chance to ask any question related to the operation.

  • You will also see the anaesthetist who will explain to you type of anaesthesia you will get.

  • The operation will be done under general anaesthesia (you will be asleep). You might also be given nerve block by the anaesthetist before the operation to numb your arm during and for few hours after the operation.

  • Your arm that is being operated on will be marked with a marker pen.

• This is a day case surgery.

• Arthroscopic (Keyhole) capsular release of the shoulder. This involves circumferential capsular release of the joint capsule.

• Each arthroscopy portals are usually 5 mm wide. Two portals are usually needed to perform this operation.

• The operation takes about 1 hour.

• You will wake up in the recovery room where you will be nursed by the team until your are ready to go back to the ward.

• When you wake up your arm will be in a sling.

• You wear this sling only for your comfort.

• In the ward, in addition to the routine nursing care you will also be seen by the physiotherapy team to start the rehabilitation protocol.

• You will be discharges from the hospital on the same day.

• You will be encourage to remove the sling as soon as you can and start early range of movement.

• First 2 weeks:

• • Wear the sling only for comfort.

  • Discard it as early as you can and start early shoulder movement.

  • Finger, wrist elbow and scapular movements to start from day one.

  • Pendulum shoulder exercise to start as early as possible.

  • Passive, active assisted and active movements are allowed as tolerated.

  • You can do your disk job as early as you can tolerate.

  • You can return to driving when you regain reasonable active movement, safe and confident to do so.

• 2-6 weeks:

• • Active shoulder movements.

  • Light manual work at 4 weeks.

• 6 weeks onwards:

• • Return to heavy manual work as tolerated.

  • You can return to all your activities including contact sports and swimming.

• Your wound to be checked by your district nurse/GP at 2 weeks.

• Out patient clinic appointment with me at 3 months.

• Reduce pain.

• Improve shoulder movement.

You will be contacted by the hospital team to arrange for your pre-assessment appointment. This can take place either by telephone consultation of face to face according to your medical condition and the type of your operation.

• You should not eat or drink for 6 hours before the operation. In pre-assessment appointment you will be told when to stop eating and drinking.

• You will be admitted to the hospital.

• You will see me before the operation. So, you will have a chance to ask any question related to the operation.

• You will also see the anaesthetist who will explain to you type of anaesthesia you will get.

• The operation will be done under general anaesthesia (you will be asleep). You might also be given nerve block by the anaesthetist before the operation to numb your arm during and for few hours after the operation.

• Your arm that is being operated on will be marked with a marker pen.

• This is a day case surgery.

• Arthroscopic (Keyhole) surgey. Each arthroscopy portals are usually 5 mm wide. Two to three portals are usually needed to perform this operation.

• The operation involves trimming of few millimetres of the end of the clavicle. This is sometimes also involves trimming of few millimetres of the under surface of the acromion. This will give more space for the tendons.

• The operation takes about 30-45 minutes.

• You will wake up in the recovery room where you will be nursed by the team until your are ready to go back to the ward.

• When you wake up your arm will be in a sling.

• You wear this sling only for your comfort.

• You will be encourage to remove the sling as soon as you can and start early range of movement.

• In the ward, in addition to the routine nursing care you will also be seen by the physiotherapy team to start the rehabilitation protocol.

• You will be discharges from the hospital on the same day.

• First 2 weeks:

• • Wear the sling only for comfort.

  • Discard it as early as you can and start early shoulder movement.

  • Finger, wrist elbow and scapular movements to start from day one.

  • Pendulum shoulder exercise to start as early as possible.

  • Passive, active assisted and active movements are allowed as tolerated.

  • You can do your disk job as early as you can tolerate.

  • You can return to driving when you regain reasonable active movement, safe and confident to do so.

• 2-6 weeks:

• • Active shoulder movements.

  • Light manual work at 4 weeks.

• 6 weeks onwards:

• • Return to heavy manual work as tolerated.

  • You can return to all your activities including contact sports and swimming.

• Your wound to be checked by your district nurse/GP at 2 weeks.

• Out patient clinic appointment with me at 3 months.

To avoid deterioration of the ulnar nerve related weakness and reduced sensation. Symptoms might improved, although this is not granted. Symptoms improvements depends on many factors ( ex: duration of your symptoms, age & other medical conditions like diabetes).

You will be contacted by the hospital team to arrange your pre-assessment appointment. This can take place either by telephone consultation of face to face according to your medical condition and the type of your operation.

• You should not eat or drink for 6 hours before the operation. In pre-assessment appointment you will be told when to stop eating and drinking.

• You will be admitted to the hospital.

• Your arm that is being operated on will be marked with a marker pen.

• You will see me before the operation. So, you will have a chance to ask any question related to the operation.

• You will also see the anaesthetist who will explain to you type of anaesthesia you will get.

• The operation will be done under general anaesthesia (you will be asleep). You will also be given local anaesthesia at the end of the operation to help with the post operative pain. This can also be done under regional anaesthesia where you will be awake but your are will be numbed.

• This is a day case surgery.

• The operation takes about 30 minutes.

• Through an incision we make over the inside of the elbow, I release thickened tissue compressing the nerve. If the nerve is irritated because the ulnar never is unstable, I might move the nerve to a new position where it is stable and not irritated (nerve transposition).

• You will wake up in the recovery room where you will be nursed by the team until your are ready to go back to the ward.

• When you wake up your arm will be in bulky bandage that you will be advice to remove it in 2-3 days and start early elbow movement.

• In the ward, in addition to the routine nursing care you will also be seen by the physiotherapy team to start the rehabilitation protocol.

• You will be discharges from the hospital on the same day.

• Your wound to be checked by your district nurse/GP at 2 weeks.

• Out patient clinic appointment with me at 3 months.

• To avoid deterioration of the carpal tunnel syndrome symptoms (nerve-related weakness, reduced sensation, tingling, numbness and muscle wasting).

• Some symptoms might improved, although this is not granted.

• Symptoms improvement depends on many factors (ex: duration of your symptoms, age & other medical conditions like diabetes).

You will be contacted by the hospital team to arrange your pre-assessment appointment. This can take place either by telephone consultation of face to face according to your medical condition and the type of your operation.

• This operation will be performed under local anaesthetics. So, you will be awake during the operation.

• You will be admitted to the hospital.

• Your arm that is being operated on will be marked with a marker pen.

• You will see me before the operation. So, you will have a chance to ask any question related to the operation.

• You have to remove any rings and/or brackets in the arm that is being operated.

• This is a day case surgery.

• The operation takes about 20 minutes.

• An incision is made over the palmer aspect of the wrist. I release thickened tissue compressing the nerve while the nerve is being protected

• I’ll cover the wound with light dressing covered by bulky bandage.

• You are advised to remove the bulky bandage in 2-3 days but to keep the sticky dressing for 2 weeks.

• You will be discharges from the hospital on the same day.

• Your wound to be checked by your district nurse/GP at 2 weeks.

• Out patient clinic appointment with me at 3 months.

• You can bring your clinic appointment forward if required.