Shoulder and Elbow

Conditions & Injuries

At Reading Shoulder & Elbow, Mr Malhas has a particular interest in sports injuries, trauma and degenerative disorders of the shoulder and elbow. Including:

  • Arthroscopic treatment of rotator cuff disorders, impingement and shoulder instability

  • Arthroscopic and open treatment of elbow tendonitis, instability and arthritis

  • Shoulder and elbow replacement surgery

  • Treatment of clavicle, shoulder and elbow fractures

Common Shoulder Problems:

 

  • Shoulder dislocation: This is when the shoulder is pushed out of its joint. It can either “pop” back on its own or may need to be manipulated back into joint in an A+E department. Although it can happen at any age, younger people and highly active people have a high risk of another dislocation.  Initially, a course of physiotherapy is advisable to rehabilitate the shoulder and then a review by a shoulder surgeon is required.  Any persisting symptoms of instability or another dislocation  may merit surgery.

 

  • Shoulder instability: This is similar to a dislocation but the shoulder never dislocates. Instead, the shoulder is on the verge of dislocation (called subluxation). Often there may not be any trauma involved. Patients complain of pain, clicking, loss of power and occasionally pins and needles. Although mainly found in sports-people, increasingly, we are identifying the problem in heavy gym users  and manual workers. Treatment often involves intensive physiotherapy and surgery (if symptoms persist despite physiotherapy).

  • Shoulder Impingement: Shoulder impingement is a condition that tends to affect 40-60 year old people.  It tends to give generalised shoulder pain made worse on trying to raise and arm above shoulder height. Most cases will settle with physiotherapy +/- a steroid injection. Only a few patients go on to require surgery. Other causes of shoulder problems should be excluded before treatment as many can mimic its symptoms (e.g. muscle tears and arthritis).

 

  • Clavicle joint or ACJ (acromio-clavicular joint):

 

  • Wear and tear in the ACJ is common. It is more common in keen sports people and in people with physical jobs. Many can be improved with physiotherapy and steroid injections. In cases that don’t improve a small operation to remove the diseased joint can be an option

  • ACJ dislocations are a common injury sustained during a fall on to the shoulder (e.g. rugby tackle, fall off a bike, road traffic accident). Mild sprains will settle in time but if there is a severe separation of the clavicle and the shoulder blade then an operation to repair the damage may be needed.

 

  • Rotator cuff tears:  The shoulder joint is a large ball balanced on a small cup (like a golf ball on a golf tee). It is not very stable. To hold the ball in place there is a thick “sock” or “cuff” of muscles that hold the ball in place while the big muscles (deltoid, pectoral, dorsal, biceps and triceps muscles) move the shoulder in space.  As the cuff muscles tear the joint starts to “wobble”. Initially there may just be pain but as the tear gets larger there is loss of movement and strength. Small tears can enlarge with time and large tears can be beyond repairing. Not all tears need to be repaired and physiotherapy is a good option. If there are significant symptoms or in younger patients then surgical treatment is advised.

 

  • Frozen Shoulder: A frozen shoulder (or adhesive capsulitis) is a condition where the shoulder becomes very painful and then stiffens up. Often there is no injury. It starts like a dull “toothache” and the lining of the joint stiffens and scars. The shoulder quickly looses its range of movement. Fortunately, it is eminently treatable with physiotherapy and steroid injections. A hydrodilation (or guided injection where the joint lining is stretched with a large volume of fluid) is an option for a quicker recovery. Finally, surgery can be offered if things are not improving with the interventions mentioned above.

  • Shoulder arthritis: Like any joint, the shoulder can wear out.  Simple measure such as physiotherapy and regular analgesia are a safe and effective way of managing the symptoms.  For those patients who find there symptoms unmanageable there are surgical options. A shoulder replacement is a good operation for pain relief and in cases of bad fracture of the shoulder. It can restore some range of movement but this is less predictable than pain relief. Newer and different types of shoulder replacement allow shoulder arthritis, with and without a cuff tear, to be effectively treated. 

    Shoulder website links:

Common Elbow Problems:

 

  • Tennis or Golfer’s elbow:  This is a common condition where muscle attachments at the elbow become inflamed. Many of the strong forearm muscles attach to the elbow so not only is the elbow sore but there can be pain on gripping or using the hand. Most will settle with time but physiotherapy or an injection (steroid, PRP or blood) is helpful. In resistant cases, surgery can be offered.

  • Cubital tunnel syndrome or ulna nerve compression.  This is a condition where one of the nerves is compressed or “pinched” at the elbow.  It can result in pins and needles affecting the ring and little fingers and patients often notice weakness or clumsiness of the affected hand.  Many people can get pins and needles in the hand when they sleep due to the position they sleep in. If it becomes common or affects you in the day then treatment can be helpful.  Splints and physiotherapy may be helpful but in moderate to severe case an operation may be needed. The operation is minor and involves releasing the nerve. 

 

  • Elbow trauma: Elbow injuries are common and while, fortunately, most settle without surgery, occasionally the elbow can continue to be stiff and sore.  Early recognition, treatment and mobilisation of the more severe injuries are important. In cases of persisting pain or stiffness after trauma, surgery may be useful to improve pain and range of movement (either key hole or open surgery).

 

  • Elbow Arthritis:  Elbows can wear out like any joint. Often people complain of a “stiff” elbow rather than a painful elbow.  Simple things like analgesia and physiotherapy are useful. If stiffness is a problem then an arthrolysis or a “tidying up” of the joint can help restore movement (either with key hole or open surgery). In cases of severe arthritis then an elbow replacement can be considered. Every arthritic elbow is different and specialist advice is important.

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