20% of individuals in their 50s may have rotator cuff tears. By the time individuals reach their 80s, the prevalence of rotator cuff tears may be over 50%.

ROTATOR CUFF TEARS

Rotator cuff tears are often the result of wear and tear on the shoulder joint, commonly associated with aging, overuse, or repetitive overhead activities. The rotator cuff is a group of four muscles and their tendons that surround the shoulder joint, providing stability and facilitating a wide range of motion. When these tendons become damaged or weakened, tears can occur. Trauma, such as a fall or sudden impact, may also contribute to rotator cuff injuries. The natural history of rotator cuff tears involves a progression of damage, starting with microtears that can eventually lead to partial or full-thickness tears.

Symptoms of a rotator cuff tear can be debilitating, and often include pain, especially during overhead movements or when lifting objects, weakness in the affected arm, and a decreased range of motion. Individuals may also experience discomfort while sleeping on the affected side. Early diagnosis and appropriate management, which may involve physical therapy, anti-inflammatory medications, and in some cases, surgical intervention, are crucial for effective treatment and prevention of further complications.

For some severe, chronic tears, repair may not be a feasible option. In that instance, Jason has training in tendon transfer procedures which can be performed to relieve pain and restore function in your shoulder joint.

Many patients with severe tears are told to simply wait until their symptoms are bad enough to have a shoulder replacement. I didn’t want to settle for that, so I did advanced training in tendon transfer techniques to solve this problem. - Dr Jason Hockings

Lower Trapezius transfer is Jason’s preferred technique and offers many benefits for patients with irreparable rotator cuff tears and has good to excellent results. It involves weaving the lower trapezius into a tendon spacer and inserting it into the humeral head. This acts as a humeral head depressor to recruit the deltoid more effectively and facilitate more optimum deltoid function as well as providing a motor for external rotation and abduction.

Jason will assess your rotator cuff pathology during your consultation and determine what surgical treatment is needed and if arthroscopic rotator cuff repair is appropriate. Arthroscopic rotator cuff repair and open rotator cuff repair are two surgical approaches used to address rotator cuff tears. Arthroscopic repair involves the use of a small camera (arthroscope) and specialized instruments inserted through tiny incisions, while open repair requires a larger incision to directly access the affected area. Here are some benefits of arthroscopic rotator cuff repair compared to open rotator cuff repair:

Minimally Invasive: Arthroscopic surgery is less invasive than open surgery, resulting in smaller incisions. This often leads to less tissue damage, reduced pain, and a quicker recovery time.

Faster Recovery: Patients undergoing arthroscopic rotator cuff repair typically experience a faster recovery compared to those undergoing open surgery. The smaller incisions and reduced trauma to surrounding tissues contribute to quicker healing and rehabilitation.

Reduced Postoperative Pain: Arthroscopic procedures generally result in less postoperative pain compared to open surgery. This can contribute to improved patient comfort and a smoother recovery process.

Improved Visualization: The arthroscope provides a detailed, magnified view of the inside of the joint, allowing surgeons to visualize the torn rotator cuff and surrounding structures more clearly. This enhanced visibility can lead to more precise repair and better outcomes.

Lower Infection Risk: The smaller incisions in arthroscopic surgery reduce the risk of infection compared to the larger incision required in open surgery.

Preservation of Normal Tissues: Arthroscopic techniques allow for better preservation of normal, healthy tissues surrounding the shoulder joint. This can lead to improved long-term function and reduced risk of complications.

RECOVERY

The recovery after rotator cuff repair can vary depending on several factors, including the size and severity of the tear, the surgical technique used, the patient’s overall health, and adherence to postoperative rehabilitation protocols. However, here is a general timeline for the typical recovery process after rotator cuff repair:

Immediate Postoperative Period (Days 1-7)

The patient may experience pain, swelling, and discomfort in the shoulder region.

Pain management is typically addressed through prescribed medications.

The arm may be immobilized in a sling to protect the repair and promote healing.

Early gentle motion exercises may be initiated under the guidance of a physical therapist.

Weeks 2-6

The initial focus is on controlling pain and inflammation.

Passive range of motion exercises may be introduced to prevent stiffness.

The patient continues to wear the sling when not engaging in exercises or daily activities.

Physical therapy sessions may become more frequent, emphasizing controlled movements.

Weeks 6-12

Active range of motion exercises are typically initiated.

Strengthening exercises for the surrounding shoulder muscles begin gradually.

The sling may be discontinued as the patient gains more control over the arm.

Physical therapy continues to progress with a focus on improving strength and flexibility.

Months 3-6

Strengthening exercises become more intensive.

Functional activities and sport-specific exercises may be introduced.

The patient gradually returns to normal daily activities but avoids heavy lifting and overhead movements.

Continued physical therapy aims to optimize strength, endurance, and overall shoulder function.

Months 6-12

The emphasis is on achieving full strength and function.

Gradual return to sports or activities that involve overhead motion may be permitted.

The patient is closely monitored for any signs of pain or discomfort during more challenging activities.

It’s important to note that individual recovery experiences can vary, and the timeline mentioned above is a general guide. Some patients may progress more quickly, while others may require a more extended rehabilitation period. Additionally, compliance with the prescribed rehabilitation program, including physical therapy exercises and activity restrictions, is crucial for a successful recovery after rotator cuff repair.

SHOULDER INSTABILITY/DISLOCATION

Shoulder instability refers to a condition in which the structures that hold the shoulder joint in place become compromised, leading to excessive movement or dislocation of the joint. The causes of shoulder instability can be multifaceted, encompassing traumatic injuries, repetitive overhead activities, or inherent structural abnormalities. Traumatic dislocations, often resulting from sports injuries or accidents, can damage the ligaments and structures supporting the shoulder, contributing to instability. Over time, repetitive stress or overuse can lead to gradual stretching of these ligaments, increasing the risk of instability. The natural history of shoulder instability involves a continuum, from mild instability episodes to recurrent dislocations, potentially causing structural damage and functional impairment.

Treatment strategies vary based on the severity of instability but may include conservative measures such as physical therapy to strengthen the surrounding muscles and improve joint stability. For more severe cases or recurrent dislocations, surgical intervention may be necessary to repair or tighten the damaged ligaments and restore shoulder stability. The choice of treatment is individualized, considering the patient's specific circumstances and functional goals. Early diagnosis and appropriate management are crucial in preventing further damage and optimizing outcomes for individuals with shoulder instability. For highly unstable shoulders, more powerful surgical procedures (Latarjet procedure) are performed to transplant extra bone around the shoulder joint as a physical barrier to dislocation.

Jason will evaluate your shoulder instability during your consultation to determine the most appropriate treatment option for you.

RECOVERY

The recovery following shoulder stabilization surgery can vary based on the specific surgical procedure performed, the extent of tissue damage, and individual factors such as overall health and adherence to rehabilitation protocols. However, here is a general timeline for the typical recovery after shoulder stabilization surgery:

Immediate Postoperative Period (Days 1-7)

The patient typically wears a sling to support and protect the shoulder.

Pain management is initiated with prescribed medications.

Initial postoperative exercises may focus on gentle range of motion to prevent stiffness.

Weeks 1-6

The focus is on controlling pain and inflammation.

Passive range of motion exercises may be introduced, and the patient may begin using the arm for light activities of daily living.

Physical therapy sessions start to prevent muscle atrophy and improve range of motion.

Weeks 6-12

Active range of motion exercises become more intensive.

Strengthening exercises for the shoulder muscles are gradually introduced.

The patient may start to wean off the sling as comfort and stability allow.

Continued physical therapy focuses on restoring strength and function.

Months 3-6

Strengthening exercises intensify, targeting specific muscles involved in shoulder stability.

Functional activities and sport-specific exercises may be introduced gradually.

The patient may start a gradual return to more demanding activities, avoiding high-risk motions.

Months 6-12

The focus is on achieving full strength and functional restoration.

The patient may gradually resume normal activities, including sports participation, under the guidance of the surgeon and physical therapist.

It’s crucial for individuals to follow the prescribed rehabilitation program diligently, including attending physical therapy sessions and adhering to activity restrictions outlined by the surgeon. The timeline and specific milestones can vary, and the surgeon will provide guidance tailored to the individual’s progress and specific surgical procedure.

Full recovery after shoulder stabilization surgery may take several months, and patients should communicate any concerns or difficulties with their healthcare team. Returning to activities too quickly can increase the risk of re-injury, so a gradual and systematic approach to rehabilitation is essential for optimal outcomes.

Nearly 1 in 3 people over the age of 60 have shoulder arthritis to some degree. Patients perceive the impact of shoulder arthritis to be comparable with chronic medical conditions such as heart failure, diabetes and heart attack.

SHOULDER ARTHRITIS

Shoulder arthritis is a condition characterized by the inflammation and degeneration of the shoulder joint, leading to pain and decreased mobility. The primary causes of shoulder arthritis include age-related wear and tear (osteoarthritis) and inflammatory joint diseases such as rheumatoid arthritis. It can also be caused by long-standing, untreated, or irreparable rotator cuff tears. As the cartilage that cushions the joint surface deteriorates, friction increases, resulting in pain, stiffness, and reduced range of motion. The natural history of shoulder arthritis involves a gradual progression of symptoms, starting with intermittent discomfort and progressing to persistent pain, joint stiffness, and functional limitations. Symptoms often include aching pain in the shoulder, especially with movement, as well as difficulty reaching overhead or behind the back.

Treatment approaches for shoulder arthritis aim to alleviate pain and improve function. Conservative measures include pain medications, physical therapy, and corticosteroid injections. In more advanced cases, surgical options such as shoulder joint replacement may be considered to replace the damaged joint surfaces and restore mobility. The choice of treatment depends on the severity of symptoms, the extent of joint damage, and the individual's overall health.

Shoulder replacement surgery, also known as shoulder arthroplasty, reliably yields positive outcomes, providing relief from pain and improving overall shoulder function. This surgical procedure is commonly performed to address conditions such as osteoarthritis, rheumatoid arthritis, or cuff tear arthropathy. The benefits of shoulder replacement surgery include the alleviation of chronic pain associated with the degenerated joint, enhanced range of motion, and improved quality of life.

RECOVERY

The recovery following shoulder replacement surgery, is a gradual process that varies from person to person. The specific type of shoulder replacement surgery (total shoulder replacement or reverse total shoulder replacement), the underlying condition being treated, and individual factors all contribute to the recovery timeline. Here is a general overview of the recovery stages:

Immediate Postoperative Period (Days 1-7)

Patients typically spend the initial days in the hospital for monitoring and pain management.

The arm is often placed in a sling to support and protect the shoulder.

Weeks 1-6

Physical therapy begins with gentle passive range of motion exercises.

Pain management is crucial during this period, and prescribed medications may be used.

Patients gradually start to use the arm for light activities of daily living.

Weeks 6-12

Active range of motion exercises become more intensive.

Strengthening exercises for the shoulder muscles are introduced.

The use of the sling may be reduced as comfort and stability allow.

Months 3-6

Strengthening exercises intensify, targeting specific muscles involved in shoulder stability.

Functional activities and sport-specific exercises may be introduced gradually.

The patient may start a gradual return to more demanding activities, avoiding high-risk motions.

Months 6-12

The focus is on achieving full strength and functional restoration.

The patient may gradually resume normal activities, including sports participation, under the guidance of the surgeon and physical therapist.

It’s important to note that individual recovery experiences can vary, and the timeline mentioned above is a general guide. Full recovery after shoulder replacement surgery may take several months, and patients should follow the prescribed rehabilitation program diligently. Returning to activities too quickly can increase the risk of complications or re-injury, so a gradual and systematic approach to rehabilitation is essential for optimal outcomes. 

TENDON PATHOLOGY

Tennis elbow and golfer's elbow are both forms of tendinopathy that affect the elbow, though they involve different tendons and occur on opposite sides. Tennis elbow, or lateral epicondylitis, is characterized by inflammation or degeneration of the tendons on the outer side of the elbow, typically caused by repetitive wrist and forearm movements. In contrast, golfer's elbow, or medial epicondylitis, affects the tendons on the inner side of the elbow and is often associated with repeated gripping and flexing of the wrist. The natural history of these conditions involves a gradual onset of pain, tenderness, and weakness around the affected elbow. Symptoms may radiate into the forearm or wrist. Treatment for tennis and golfer's elbow generally begins with conservative measures such as rest, ice, anti-inflammatory medications, and physiotherapy to strengthen and stretch the affected muscles and tendons. Bracing or splinting may also be recommended. In more persistent cases, corticosteroid injections or, rarely, surgical intervention may be considered. Early diagnosis and appropriate management are key to achieving a successful outcome and preventing chronic disability.

During your consultation, Dr Hockings will assess your condition and formulate the optimum management plan which may or may not involve surgery for your painful elbow.

ACROMIOCLAVICULAR JOINT INJURIES & STABILISATION

Acromioclavicular joint stabilization surgery is a procedure performed to address instability and dislocation of the acromioclavicular joint (AC joint), which connects the clavicle (collarbone) to the scapula (shoulder blade). This surgery aims to restore stability and proper alignment to the joint, typically after traumatic injury or repetitive strain. During the procedure, the surgeon may use various techniques, such as reconstructing ligaments or using implants, to secure the joint and promote healing. By stabilizing the AC joint, this surgery helps alleviate pain, improve shoulder function, and prevent further damage, enabling patients to regain strength and mobility in the shoulder region. Rehabilitation and post-operative care are crucial for optimal recovery and long-term success of the surgery.

Jason prefers to perform arthroscopic assisted ACJ stabilisation techniques. Arthroscopic-assisted acromioclavicular joint stabilization surgery offers several advantages over traditional open surgery. Firstly, arthroscopic techniques involve smaller incisions, resulting in reduced tissue damage, less post-operative pain, and faster recovery times. Additionally, arthroscopy allows for better visualization of the joint structures, enabling more precise surgical maneuvers and potentially reducing the risk of complications. The minimally invasive nature of arthroscopic surgery also typically leads to shorter hospital stays and quicker return to daily activities and sports. Moreover, arthroscopic procedures often result in improved cosmetic outcomes, with smaller scars compared to open surgery. Overall, arthroscopic-assisted AC joint stabilization offers patients a less invasive, more efficient, and potentially safer approach to treating AC joint instability.

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