Treatments

The rotator cuff muscles are a group of four muscles that pass from the shoulder blade (scapula) and attach to the top of the ball joint (humerus). These muscles are responsible for rotation and elevation of the arm.FROZEN SHOULDER Rotator cuff tears are very common, especially as we all get older. They frequently cause pain over the upper arm that is made worse by overhead activities, reaching behind your back and lifting. They often ache at night and people find that they are unable to lie on the injured shoulder. They also cause weakness. Rotator cuff tears most frequently occur with general wear and tear, and most people usually don’t remember injuring their shoulder. These “degenerative tears”, if not associated with arm weakness, may be successfully treated without surgery. This involves avoiding overhead activities, regular simple pain relief and gentle physiotherapy. Anti-inflammatory steroid injections can be very helpful in these situations to help manage pain and discomfort. When symptoms fail to improve despite these measures, surgical repair of the tear is indicated. The less common group of rotator cuff tears occur following an injury, and are called “traumatic tears”. People usually remember the exact incident, and often have significant weakness after the injury. Early surgical repair is often indicated.

The shoulder is a shallow ball and socket joint. This allows fantastic range of movement, but also makes it an inherently unstable joint. The socket is made deeper by a rim of fibrocartilage (labrum). Additional stability is provided by thickenings of the joint capsule (ligaments) and the rotator cuff muscles. Shoulder stability relies upon these ligaments remaining intact and the muscles being strong.A shoulder dislocation occurs when the ball (humerus) comes out of the socket (glenoid). This may be partial (subluxation) or full (dislocation). After the first episode, it is likely that the labrum and ligaments will be torn, putting the shoulder at high risk of recurrent episodes of instability. This is especially true for patients under the age of 30 years.Recurrent shoulder instability following a traumatic shoulder dislocation can be effectively treated by repairing the torn labrum and ligaments. This is most commonly done using keyhole (arthroscopic) surgery and, when using modern techniques, is associated with a high rate of success. The labrum is reattached to the edge of the socket and the ligaments are tightened. This is done using suture anchors inserted into the edge of the socket (glenoid).Recovery following surgery usually involves staying one night in hospital, and being in a sling for 6 weeks. Most people can drive a car after 6 to 8 weeks. Rehabilitation guidelines to share with your physiotherapist are provided following the surgery. Return sport is usually possible at 6 months.

The knee joint is a frequent source of problems requiring the attention of an orthopaedic surgeon. The joint is primarily formed by the two large bones of the lower limb, the femur (thigh bone) and the tibia (shin bone). The patella (kneecap) articulates with the femur at the front of the knee. The fibula joins with the tibia on the lateral (outside) side of the knee. Together, the femur, tibia and patella make three compartments (medial, lateral and patellofemoral). Each of the bones has a bearing surface of articular or hyaline cartilage. In addition there is a meniscus in each of the medial and lateral compartments. The menisci are like cushions or spacers and are made of fibrocartilage. They often simply referred to as the cartilages. The direction of movement of the bones is controlled by the ligaments and the muscles make the joint move. The major ligaments are the anterior and posterior cruciate ligaments and the medial and lateral collateral ligaments. In addition, the collateral ligaments have important associated ligaments towards the back of the knee. The major muscle groups are the quadriceps at the front of the thigh and the hamstring muscles at the back. Muscles attach to bones via tendons. The main tendons around the knee are the quadriceps and patellar tendons which attach to the top and bottom of the patella respectively. The iliotibial band is like a tendon on the lateral side of the knee.