Treatments
Hands & Wrists
At LondonOrtho we provide comprehensive specialist advise, investigation and treatment for all musculoskeletal conditions including sports injuries, fractures, osteoarthritis and rheumatoid arthritis.
At LondonOrtho we provide comprehensive specialist advise, investigation and treatment for all musculoskeletal conditions including sports injuries, fractures, osteoarthritis and rheumatoid arthritis.
CONTACT US
Jackie Barrow
contact@londonortho.co.uk
01494 873252
01494 873252
Purpose
To decompresss the impingement of the rotator cuff against the coraco-acromial arch ( acromium process, spur, coraco-acromial ligment) and thickened/inflamed bursa.
Indication
Patients with shoulder pan from impingement. Patients may also have an associated acromioclavicular joint degeneration requiring excision. Patients may also have an associated rotator cuff tear, which may or may not, require separate repair.
Skin Incisions
Sagittal: this gives the best cosmetic result
Procedure
The deltoid is detached from the antero-lateral aspect of the acromium and split distally to a maximum of 3 cm. The under surface of this region of the acromium is then removed( a Neer type acromioplasty). A limited or full excision of the bursal sac is caried out, depending on the severity of the condition. The deltoid is carefully repaired ( including sutures through the bone)
Possible Associated Procedures
Arthroscopy of the gleno-humeral joint
Excision of the acromioclavicular joint
Repair of rotator cuff tear
Possible Associated Complications
Infection
Detachment of the repaired deltoid
Nerve injury, e.g suprascapular nerve
Shoulder stiffness
Purpose
To decompress the impingement of the rotator cuff against the coraco acromial arch ( acromium process, spur, coraco- acromial ligament) and thickened /inflamed bursa.
Indications
Patients with shoulder pain from impingement in which the rotator cuff is intact or where there is a tear not suitable forrepair. Rarely, it may be necessary to convert to an open procedure.
Skin Incisions
Posterior- arthroscope
Lateral- arthroscopic instruments and arthroscope
Anterior- used for gleno-humeral joint assessment and as an outflow portal; or should acromioclavicular joint require excision/or chlectomy.
Procedure
Removal of the antero-lateral ,inferior aspect of the acromiu and the acromial attachment of the coracoacromial ligament with arthroscopic power tools and radiofrequency instruments.
Possible Associated Procedures
Arthroscopic assessment of the gleno-humeral joint
Acromioclavicular joint excision
Rotator cuff repair
Biceps stabilisation, or tenodesisMain Possible Complications
Nerve Injury
Failure to completely decompress
After your operation
A sling is applied in theatre and worn for 48 hours. The post operative swelling usually resolves in 24 hours.
The sutures cn be removed after 2 weeks and the physiotherapist will check the range of movement.
4 Weeks post op
Your surgeon will asses the range of passive and active range of movement. If there is no progression in the range of motion from the two week assessment then a referral will be made for increased physiotherapy; an MUA may be considered (or a capsular release) at a later stage.
Neurological function will be assessed.
12 Weeks post op
Assess active and passive range of movement
Assess rotator cuff function
Assess scapulothoracic function
Examine for concurrent pathology
6 Months Post op
Assess active and passive range of motion
Discharge with continuation of physiotherapy or review in 3 monthsprascapular nerve
Shoulder stiffness
Purpose
To relieve pain and improve rotator cuff function
Indications
Patients with pain or difficulty elevating the arm against gravity or lifting ,from repairable rotator cuff tears, either degenerate or tears resulting from an injury e.g sudden, heavy lifting.
Skin Incisions
Sagittal, superior/lateral aspect of the shoulder. This is designed to give the best cosmetic results.
Approach
The deltoid is divided between its fibers and detached from the front of the acromium to provide access to the torn rotator cuff. An acromioplasty is usually also required(link). This increases the sub acromial space and reduces the possibility of impingement and recurrent tear.
Procedure
The rotator cuff tear is located (most commonly in the supraspinatus tendon). The tendon is carefully released of all adhesions and bought back to its original position. It is then repaired, without tension directly to the bone utilizing small anchors secured within the bone. The bone surface has to be carefully prepared.
Possible Associated Procedures
Arthroscopy
Excision of the acromioclavicular joint
Sub Acromial Decompression
Manipulation Under Anaesthetic
Main Possible Complications
Infection
After the operation
0-2 weeks
An abduction brace (either 15 or 30 degrees ) is applied in theatre.
Avoid all active movements
Seen by physiotherapist to be shown how to safely remove and re-apply brace and to perform passive, controlled shoulder movements.
2 Weeks Post Op
Wound and sutures are reviewed by the hospital or practice nurse.
Pain levels discussed to keep under control
Physiotherapist assesses active and passive range of motion
4 Weeks Post Op
Surgeon reviews deltoid and rotator cuff function, pain levels, active and passive range of motion and neurological function.
Physiotherapist progresses to active assisted exercises.
6 Weeks Post Op
Physiotherapy session to progress to full active exercise and discard brace.
12 Weeks Post Op
Surgeon assesses active and passive range of motion, anterior deltoid function and rotator cuff function.
6 Months Post Op
Final Review
Assess active and passive range of motion
Discharge with continuation of physiotherapy or review in a further 3 months
Continue home strengthening exercise programme and plan return to chosen sports/manual work/heavy lifting.
