Shoulder Problems

The most common cause of acromioclavicular joint arthritis is wear and tear through over use. For this reason it is most common in people who are aged 50 or older and in athletes who place a lot of stress on the joint.

Bicep Problems

The most common shoulder conditions affecting the biceps are injuries to the cartilage and tendons that attach the biceps muscle to the shoulder bones. These include SLAP lesions, tendonitis, and tendon rupture.

Calcific Tendonitis

Calcific tendonitis is a build-up of calcium deposits within one or more of the four tendons that meet at the top of the shoulder joint. Together these four tendons are known as the rotator cuff.

Frozen Shoulder

Frozen shoulder is a condition where the ball and socket joint of the shoulder appears to "freeze". This causes loss of motion with stiffness in all directions. Typically the shoulder joint is stiff and initially painful.

Shoulder Arthritis

Glenohumeral arthritis is also known as shoulder arthritis. It is a progressive type of arthritis that is normally caused by damage to the cartilage surfaces of the shoulder's glenohumeral (ball and socket) joint.

Shoulder Instability

This is when the ball of your shoulder slips in certain position or completely comes out of joint (dislocates). There are a number of types of instability and it can get worse with time.

Rotator Cuff Injuries

The rotator cuff is the group of four tendons that surround the shoulder joint and control its movement. The tendons can become inflamed, degenerate or tear and can lead to pain and weakness, particularly with sudden movements.

Snapping Scapula

Snapping scapula is a general term applied to a range of disorders that can result in a painful clicking or snapping sensation in the shoulder blade (scapula).

Subacromial Impingement

Subacromial impingement is a condition that causes pain in the shoulder and upper arm. It happens when the tendons of the shoulder joint are strained or injured.

Winging Scapula

Winging scapula is the description for a condition where the shoulder blade protrudes from your back, giving the impression of a wing. In most cases, only one shoulder blade is affected.

Open reduction internal fixation of Clavicle

ORIF Clavicle

On ward

Sling for up to 4-6/52 for pain relief. Can be removed for washing, dressing and exercise.

Day 1 on ward - Active assisted elevation 0-60° in forward lean standing (assisted pendular elevation). Teach elbow, wrist, hand and scapular setting exercises. Keep Shoulder in neutral plane for assisted elevation. Start elevation with short lever against gravity in standing. If pain allows can commence active assisted elevation thro scaption to 60 degrees only with weight of arm assisted in sit/standing. Can use ball roll on table.

Care NOT to let scapula move too early.

Teach sling care and washing.

Active External Rotation as pain allows.

N.B. AVOID axial loading for 3/12. NO long lever strengthening for 12/52.

2-6 weeks

Shoulder clinic review 6/52 (with X-ray on arrival) to discuss progression then 4-6/12 review with XR

Aim for controlled quality early motion to 90° by 4/52, pain limiting.

N.B. CARE not to impinge rotator cuff.

May progress beyond 90° after 5/52 if pain allows.

Early Isometric Rotator Cuff activation after 2/52 – GHJ in neutral i.e. post/ant deltoid then medial and lateral rotation – light resistance (30% MVC).

6-12 weeks

Progress after 6/52 to regain full ROM as pain and muscle control allows.

Clinic review with Mr Cole at approx 6/52.

No long lever strengthening for 10/52. Progress controlled rotator cuff and deltoid strengthening 6-12/52.

Ensure scapular dynamic control through full range of movement.

Return to work: Sedentary 4 weeks (as pain allows). Physical 3 months (as guided by surgeon).

Driving: 4-6 weeks (as pain and range allows) patient confirms safety to drive.

Sport: Non contact 3 months. Contact 6-9 months (as guided by surgeon).

Swimming: Gentle with modified stroke 6-8 weeks. Freestyle 12-16 weeks.

Andrew Cole6 November 2018

Open reduction internal fixation of Clavicle

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Southampton Shoulder Clinic

Southampton Shoulder Clinic

Mr Cole’s Shoulder Clinic