Orthopaedic Nurse Specialists Training With Arthrex

At Shoulder Elbow Orthopaedic Group, we understand the honour and responsibility bestowed on us when patients trust us with their health. Our orthopaedic multi-disciplinary team is committed to a shared purpose to ensure the best care for our patients. 

Arthrex Orthopaedic Nurses Specialists Training, Orthopaedic Training, Shoulder Elbow Orthopaedic Group, Orthopaedic Clinic Singapore

Hence it is not only crucial for our orthopaedic surgeons to be equipped with updated surgical skills and knowledge. However, it is also important that the Shoulder Elbow Orthopaedic Group’s orthopaedic nurse specialists receive training to update and improve their skills and knowledge. 

On 23 Feb 2022, we closed all Shoulder Elbow Orthopaedic Clinic branches so our nurses, accompanied by our orthopaedic specialists, could attend a hands-on skills training workshop. 

Arthrex Nurses Specialists Orthopaedic Training, Orthopaedic Training, Shoulder Elbow Orthopaedic Group, Orthopaedic Clinic Singapore

Thank you, Arthrex, for helping our nurses learn invaluable skills that will aid our aim always to provide better care for our patients.

Easy Exercises for Tennis Elbow Rehabilitation

Tennis elbow is a form of tendonosis that affects the lateral elbow tendons. It is also commonly referred to as lateral epicondylitis. When the thick fibrous tissue linking up the muscles and joints in the elbow deteriorates, it results in tennis elbow. Tendonosis is not to be confused with tendonitis. Tendonosis is much more serious and is not an inflammation like tendonitis. It is the actual degradation of the tendons.

It is caused by the overuse of an injured elbow. As the name suggests, racket sportsmen suffer from this injury at a much higher ratio than anyone else. The repetitive action of racket swings causes this slow degradation of the tendon over time. The ailment is also found increasingly in professional rock climbers as they perform similar movements where strain is focused on their elbows. 

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The imbalance and weakness of the different muscles around the elbow are what causes the initial problem. After an injury, the tendons do not get enough time to heal appropriately and continued use results in the development of tendonosis as described above.

Common symptoms of Tennis elbow are persistent elbow pain, a burning sensation on the outside of the elbow and weak grip strength.

What Can I do if I am Suffering From Tennis Elbow?

Once diagnosed, you should pay more attention to your elbow and the sports you engage in. You should seek to rehabilitate your tennis elbow through several different means, which are described below:

  1. Take Breaks

You should make sure to give your elbow enough rest and take regular breaks in between tasks that engage your elbow. Try to only perform strenuous actions for no more than 15-30 minutes before taking a break.

  1. Use Tape or Braces

Tape and braces help support and stabilise your weak muscles and joints, providing a more even distribution of the workload. This reduces strain on the tendon and reduces further degradation.

  1. Eat the Right Food

Food rich in collagen, vitamin C, and zinc all can help repair your tendons. Supplements are good as well, but you should consult your healthcare professional to see if these are suitable options for you.

  1. Exercise

There is no better form of rehabilitation of your tennis elbow than exercise. Physical therapy in the form of strength training and stretching is a sure-fire way to improve your elbow health and reduce elbow pain.

When Should I See a Doctor for Tennis Elbow?

You should see a doctor if your pain intensifies and does not seem to go away no matter what you do. Some key signs to see a doctor are:

  1. Discolouration of your elbow
  2. Moving your elbow becomes excruciatingly painful
  3. Your elbow feels warmer to touch than the rest of your body

What Are Some Easy Exercises for Patients Suffering From Tennis Elbow?

Here are some easy exercises that you can do at home post-treatment to regain active range of motion in your elbow.

In severe cases which fail non-operative management, our doctors may consider doing scans to assess the injury and degree of tear of the common extensor tendon origin, and may discuss the options of repairing the damaged tendon.

Easy Exercises for Rotator Cuff Pain

The rotator cuff, which is often improperly referred to as the rotator ‘cup’, is the section of your shoulder where four different muscles and tendons come together and connect to the upper arm bone or humerus.

These four separate muscles are the Supraspinatus, Infraspinatus, Teres Minor and Subscapularis. These muscles come together to form a fanned-out cone-like shape, which can be likened to a flared shirt sleeve.

Each of these muscles has a slightly different function, and they work together to achieve various ranges of motion. This includes stabilising the head of the humerus in the shoulder joint, abducting or elevating the shoulder joint out to the side, externally rotating the shoulder joint and depressing the head of the humerus.

Essentially, all of the muscles work together to constantly ensure that the humerus remains fixed securely in the shoulder joint throughout the shoulder’s wide range of motion.

What Is a Rotator Cuff Injury?

Rotator cuff injury can occur when any one of the muscles that make up the rotator cuff get damaged. You will know immediately when you have injured your rotator cuff as you are very likely to experience pain or weakness when lifting your arms. However, in some rare instances, people who have a rotator cuff injury have no knowledge of it. Damage to the rotator cuff can be in the form of a rotator cuff tear, rotator cuff tendonitis, shoulder impingement, shoulder bursitis, shoulder labrum tear or shoulder separation.

The most common rotator cuff injuries are in the form of tears and impingements. Impingement happens when one of the rotator cuff muscles becomes inflamed, and the swelling then squeezes the space between the arm and the bone, causing pain. On the other hand, a tear is a more severe type of injury whereby the tendon or muscle gets torn.

These injuries can occur through a single traumatic event such as a fall or during sports or slow, progressive degeneration of the muscles over months or years. It can also happen if a mild injury is not given the proper time to heal.

What Can I do After Injuring My Rotator Cuff?

Following the injury of your rotator cuff, you should apply ice to reduce the pain and swelling. The ice will reduce inflammation and help with the pain. The cold stops cellular atrophy and reduces the formation of scar tissue. The icing should also be followed by ample rest during the initial phase immediately post-injury to prevent further exacerbation of the injury. Light exercises should follow this to regain full range of motion.

When Should I See a Doctor for a Rotator Cuff Injury?

You should see a doctor if your pain and swelling do not improve after the first day or so and you have difficulty raising or sleeping on your arm. This could be indicative that your injury is a tear and not just a sprain or impingement.

A tear that cannot be healed through the use of ice and exercise left untreated could become a permanent problem for you. Very sharp pains upon movement of your shoulder are tell-tale signs of a tear in your rotator cuff, and this should warrant you going to see a doctor as surgery may be required.

What Are Some Easy Exercises for Rotator Cuff Pain?

If your pain starts to fade or you’ve already seen the doctor, and they’ve told you that there’s no tear. You can start these exercises to nurse your rotator cuff back to full health.

We’ve included this video to show you some easy rotator cuff exercises that can be done anywhere and any time.

Alternatively, we’ve listed the steps for some other easy rotator cuff exercises if you’ve suffered from a rotator cuff injury.

Doorway Stretch 

  • Stand with your feet together.
  • Bend your elbows and extend your arms out to your side as if you were about to embrace someone.
  • Place one foot forward, lean into the doorway arches with both hands on the frame, and then grip the sides tightly. Continue leaning into the door and keep your grip tight on the frame.
  • Lean forward until you feel the stretch across your chest.
  • Hold this stretch for 5 deep breaths and repeat this 8 times.
  • Do 3 sets of this at least 3 times a week.

Sleeper Stretch

  • Lie down on your side and place your affected shoulder under your body. With your arm bent and out in front of you, and your fist facing straight up to the ceiling. You may use a pillow should you need to.
  • Use your other arm to hold the affected arm towards the ground. Stop this pressing motion as soon as you feel a stretch in the back of your affected shoulder.
  • Hold this position for 30 seconds, then relax your arm for 30 seconds and repeat this 8 times.
  • Do 3 sets of this at least 3 times a week.

Internal Rotation

  • Lie down on your side, place your affected shoulder slightly out, so it is not exactly under your body, and tuck your elbow into your ribs. You may use a pillow should you need to.
  • Hold your injured arm against your side keeping your elbow bent at a 90° angle. You may carry a lightweight in your arm, but you do not need to.
  • Make sure your elbow is fixed into your ribs, slowly rotate your arm at the shoulder, and raise your arm up and into your body.
  • Slowly lower the weight to the initial position and repeat this 8 times.
  • Do 3 sets of this at least 3 times a week.

Bent-Over Horizontal Abduction

  • Lie down on your belly on a raised platform such as a table or bed with enough space between the platform and the floor so that you can hang the entirety of your injured arm over the side of it.
  • Keep your arm hanging straight down and slowly raise it till it is parallel with the edge of the table and your body.
  • Slowly lower it back to the initial hanging position and repeat the arm raises 8 times.
  • Do 3 sets of this at least 3 times a week.

Reverse Fly

  • Stand with your feet shoulder-width apart and keep your knees slightly bent.
  • Make sure your back is straight but bend forward slightly.
  • You may choose to carry a light weight in each hand (but you do not need to) and extend your arms and raise them away from your body. This should resemble a flapping motion.
  • Do not lock your elbows. Squeeze your shoulder blades together with each rep and make sure not to raise your arms back past your shoulders and repeat this 8 times.
  • Do 3 sets of this at least 3 times a week.

How Can I Condition My Shoulder After a Rotator Cuff Injury?

Rotator cuff injuries affect a large number of people every year and most commonly athletes or active hobbyists. Thus, conditioning the shoulder after the damage is extremely important. Shoulder conditioning is another term for physiotherapy and exercise. 

The better the conditioning program following the injury, the faster you can expect the injury to heal and be ready for full use once again.

 

What Is a Rotator Cuff Injury?

Rotator cuff injury occurs when any of the numerous muscles and tendons that make up the rotator cuff are injured. These are the muscles and tendons of the shoulder that connect to the upper arm bone of the humerus. 

The four separate muscles that make up the rotator cuff are the Supraspinatus, Infraspinatus, Teres Minor and Subscapularis. These muscles come together and form the shape of a ‘cuff’.

 

These muscles all have slightly different uses, and they work together to provide the shoulder with different ranges and directions of motion. Almost all of the movements you can imagine when you feel your shoulders move are controlled by the rotator cuff. 

Primarily they hold together the humerus and the shoulder joint in its position throughout all the different ranges of motion that you use your shoulder to make.

What Is Shoulder Conditioning After a Rotator Cuff Injury?

Shoulder conditioning after a rotator cuff injury is the act of nursing and treating the shoulder through exercises and physiotherapy to reduce further damage and quicken the recovery time of the rotator cuff so that normal use of the rotator cuff can resume. 

These exercises intend to gradually rebuild the strength in the muscles and tendons of the rotator cuff, slowly increasing the strength of the muscles, speeding up the healing process. 

 

Shoulder conditioning after a rotator cuff injury is not an overnight process. A full recovery of the rotator cuff takes time and consistent effort. 

Sticking to a regular conditioning plan after your rotator cuff injury is the surest way to get your shoulder back to full health in the shortest time. It should be followed religiously by anyone who has recently injured their rotator cuff.

 

How Can I Condition My Shoulder After a Rotator Cuff Injury?

You can condition your shoulder after a rotator cuff injury by following these simple conditioning exercises described below. Remember to drink lots of water, eat well and take vitamins that improve your body’s natural healing ability, such as Vitamin C.

Watch this video for some easy rotator cuff exercises that you can do at home or at the office:

Alternatively, we’ve listed out the steps for various other exercises to help condition your shoulder after a rotator cuff injury.

External Rotation with Arm Abducted 90°

You will need an elastic stretch band of a comfortable resistance for this exercise. Depending on how bad your rotator cuff injury is, you can get a few of various resistances and test out which ones feel better for you. Start with the lowest resistance and then move up. 

  1. Make a 3-foot-long loop with your elastic stretch band and tie the ends together. Attach the loop to a fixed object such as a large table leg. You’ll want the object you are connecting it to to be immobile and not shift or move at all. Doorknobs may also be suitable, but you will need to make sure that the door is closed and that you are pulling in the opposite direction required for the door to swing open.
  2. Stand straight facing the object the band is tied to, hold the band and bend your elbow at 90° and raise to your shoulder level. This would mean that your elbow will be at your shoulder level with your arm facing outward in front of you.
  3. Now, while keeping your shoulder and elbow level with each other, pull back on the band until your hand is up to the same level as your head. Slowly return your hand to the starting position after this.
  4. Do 3 sets of 8 repetitions each time and do this 3 times per week as the exercise becomes easier to perform progress to 3 sets of 12 repetitions.

 

Internal Rotation

As with the previous exercise, you will need an elastic stretch band of comfortable resistance. Test which one feels best and then move up if necessary. 

  1. Make a 3-foot-long loop with your elastic stretch band and tie the ends together. Attach the loop to a fixed object such as a large table leg. You’ll want the object you are connecting it to to be immobile and not shift or move at all.
  2. Stand straight and parallel to the object that you tied the band to. This means that the object will be on your side with the elastic stretch band pulled away and your arm bent 90° as if you were holding a mug at your waist. The arm you are using should be the one closest to the object tied to the band.
  3. Now, while keeping your elbow close to your waist, bend your arm inwards and towards your body while keeping it straight. Slowly return your arm to the starting position after this.
  4. Do 3 sets of 8 repetitions each time and do this 3 times per week as the exercise becomes easier to perform progress to 3 sets of 12 repetitions.

 

External Rotation

As with the previous exercise, you will need an elastic stretch band of comfortable resistance. Test which one feels best and then move up, if necessary. 

  1. Make a 3-foot-long loop with your elastic stretch band and tie the ends together. Attach the loop to a fixed object such as a large table leg. You’ll want the object you are connecting it to to be immobile and not shift or move at all.
  2. This exercise is very similar to the previous movement, with the first difference being that the arm you will be using will be the arm that is furthest away from the object tied to the band.
  3. The second difference is that instead of moving your arm inwards towards your body, you move it outwards away from your body and to your side. Make sure to squeeze your shoulder blades together when moving your arm away from your body. Slowly return your arm to the starting position after this.
  4. Do 3 sets of 8 repetitions each time and do this 3 times per week as the exercise becomes easier to perform progress to 3 sets of 12 repetitions.

 

When Should I See a Doctor for a Rotator Cuff Injury?

You should see a doctor for your rotator cuff injury if your injury does not improve after the first few days or so and if you experience great difficulty raising or sleeping on your arm. This could mean that your rotator cuff is torn, and shoulder conditioning may not improve your situation.

Frozen Shoulder in Athletes

Frozen Shoulder in Athletes

An all-too-common malaise that is faced by many athletes is the pain of a frozen shoulder. This injury is often experienced following excessive use of the arm and shoulder during workouts and/or during competition or may even simply arise suddenly with little indication as to how the injury occurred.

 

What Is Frozen Shoulder?

Frozen shoulder is the gradual development of stiffness and pain in and around the shoulder joint area. This stiffness and pain are caused by the inflammation of the joint capsule of the shoulder. 

Frozen shoulder pain is often felt when rotating the shoulder joint or moving one’s arm away from the body. This pain causes limited reaching of the arms above the head or to the side. 

The initial stiffness and pain of a frozen shoulder often lead to the patient reducing shoulder movement, which in turn causes contraction of the joint capsule and decreased elasticity. As the joint capsule shrinks, it diminishes the protective lubricating fluid (synovial fluid) that is present between the upper arm bone (the humerus) and the joint capsule.

As the condition progresses, this joint capsule thickens, becomes inflamed and eventually inelastic. This results in the formation of thick bands of scar tissue forming between the joint capsule and the head of the humerus. 

These bands of scar tissue are referred to as adhesions and are the reason for the medical term for frozen shoulder – Adhesive Capsulitis (AC). 

 

Who Is at Risk of Developing Frozen Shoulder?

Frozen shoulder is predominantly felt by women (4 times more often) between the ages of 40 – 70. People with vascular diseases, diabetes, cancer, and Parkinson’s Disease are also at higher risk. 

It’s important to note here that people with diabetes are at a significantly higher risk compared to the other diseases. This is thought to be because diabetics have an increased formation of collagen due to having a high blood sugar level. This excess collagen goes on to form more numerous and thicker adhesions that are responsible for frozen shoulder.

Individuals who have bad posture or are immobile for long periods due to fractures, broken bones or other sports-related injuries are also at greater risk of developing frozen shoulder.

However, this does not mean that young people, including male athletes, are not at risk. It has been documented that athletes whose workout regime focuses on excessive pectoral (chest) and deltoid (shoulder) training can sometimes increase the risk of frozen shoulder. It is recommended to include periods of stretching before and after exercising to prevent damage to these muscles and the development of a frozen shoulder.

Athletes who are most at risk of frozen shoulder are those who use these muscles the most. Athletes playing games or participating in activities such as tennis, ping-pong, badminton, squash, rock climbing, golf, baseball, volleyball, and swimming will find themselves at the greatest risk. Essentially, any activity that requires intense use of the upper body.

 

Can You Stop Frozen Shoulder From Progressing?

There are three different phases of frozen shoulder; the freezing phase, frozen phase, and thawing phase. It is possible to accelerate the transition from each phase, shorten the time spent in each, and even stop frozen shoulder from progressing if treated quickly and adequately.

 

  • The Freezing Phase (Stage One)
    This is the primary stage whereby the shoulder begins to stiffen up or freeze, and pain is experienced upon movement of the arms and shoulder. Pain will continue to worsen during this phase as the shoulder gets more and more stiff. This phase can last anywhere between 2 to 9 months on average.
  • The Frozen Phase (Stage Two)
    This is the intermediate stage when pain begins to teeter off, but stiffness continues to increase, and those suffering will find their range of movement reduced tremendously. This phase can last anywhere between 4 to 12 months on average.
  • The Thawing Phase (Stage Three)
    This is the final stage and is the beginning of the healing process. Range of movement will improve, and there will be almost no pain at all. This phase can last anywhere between 12 to 42 months on average.
    A small percentage of people may not fully regain the complete range of movement of their shoulder even at the end of this phase.

 

What Treatments Are There for Frozen Shoulder?

There are various forms of treatments available to help stop frozen shoulder from progressing or relieve it more quickly. These treatments are in the form of oral medication, injections, home remedies and physiotherapy.

Doctors will typically prescribe anti-inflammatories, muscle relaxants, and pain killers in the form of tablets to be taken orally to help alleviate symptoms in an attempt to move through the freezing and frozen phases more quickly. 

Besides oral medication, one increasingly popular treatment is cortisone injections. Cortisone is an anti-inflammatory medication that reduces swelling and scarring. It has been found that this form of treatment is best administered during the early stages of the condition. 

Nerve Blocks are also another injection style treatment to relieve frozen shoulder. With these injections, a small injection of local anaesthetic above the spine of the scapula is made, and an infiltration of a long-acting local anaesthetic around the suprascapular nerve is given. 

The long-lasting anaesthetic is usually given in combination with cortisone to reduce the sensitivity of the nerve, thereby reducing pain. This is normally done only when other treatments have failed to provide relief. 

One home remedy that can help with the pain is applying an ice pack to the affected area for 10 -15 minutes several times a day. The cold from the ice pack slows the flow of blood, causing vasoconstriction, which relieves pain. 

The removal of the ice pack then causes vasodilation which is when the blood rushes back into the veins. The blood brings along essential chemicals to the injury site that help speed up the healing process.

Most athletes should be very familiar with physiotherapy as sports injuries are part and parcel of the job. Physiotherapy is almost always recommended together with any other treatments and ultimately will be what helps revitalise the joint capsule’s elasticity and regain the shoulder’s full range of motion. 

The journey to full recovery may be long and arduous, but it is the most effective form of treatment known for this ailment.  

 

What Happens if Frozen Shoulder Is Not Treated?

A frozen shoulder may go away on its own if left untreated, but it may also increase the risk of a permanent loss of a full range of motion after the thawing stage. It could also lead to other ailments developing, such as tendonitis and neck pain – which often may only be resolved with surgery. 

Capsular Release is a minimally invasive surgery whereby the tight capsular tissues surrounding the shoulder joint are cut and then cauterised. The surgery is performed under local or general anaesthetic. 

Recovery time varies, but one can expect to fully recover from 6 weeks to 3 months after the surgery. Doctors will generally recommend not exerting or using the shoulder to carry things or reach above the head for a minimum of 2 weeks.

 

What Movement or Activities Aggravate Frozen Shoulder?

Contrary to what most might think, keeping your shoulder immobile will worsen your condition. This will increase the number of adhesions that form and extend the period by which your shoulder will hurt and be stiff. 

This also does not mean that you should expose the shoulder to pulling, jerky or jarring movements, as these kinds of motions can put extra stress on your tendons and lead to the development of tendonitis. 

The secret here is to find a balance.

 

What Are Some Exercises for Frozen Shoulder?

There are several different types of arm and shoulder exercises that can help increase your mobility and heal your frozen shoulder more quickly. 

These exercises range from various kinds of stretching movements that make use of the arms, shoulders, and elbows. As mentioned, physiotherapy is the best-known form of treatment for getting your shoulder unfrozen and back into shape in the fastest time possible. 

 

What Is the Link Between Cycling and Shoulder Pain?

As an avid and passionate cyclist, Dr Desmond Ong understands  and some of the commonly seen and experienced injuries and pain points of the sport. Dr Desmond explains why some people experience pain when they first begin cycling, and when it would be best to seek medical advice. 

  1. Tell Us a Little Bit About Your Experience With Cycling As a Sport.

I currently ride a rim brake Pinarello Dogma F12 with Dura-ace Di2 and Scope R3c carbon wheels.

I have been riding seriously since 2006 and, over the years, have gotten to know groups such as Cycleworx, Smile Asia, FOTR, New Moon Khcycle.

Dr Desmond Ong, Bowtie Doctor, Shoulder Pain, Cycling,  Shoulder Elbow Orthopaedic Group

My life-long love for sports, the fellowship among cyclists, and the need to push my body to understand its limits drives my passion for road riding.

The discipline of training for better performance on the bike is similar to that needed to excel as a surgeon. Dealing with the physical demands of training and the injuries encountered along the way also helps me understand the difficulties my patients go through dealing with their own ailments and injuries and how best to help them overcome these challenges and achieve their goals.

  1. Can Cycling Cause Shoulder Pain? Is Biking Bad For Shoulders?

Cycling is a sport that engages the whole body. It is, therefore, an excellent sport for building up our core muscle strength and endurance. Therefore, cycling is not necessarily bad for shoulders. However, cycling puts the shoulder at risk of injury and pain because of the load on the upper limbs.

Firstly, a typical riding position would place 40% of a rider’s weight on his upper limbs. This is fairly considerable and may be unique to cycling. Secondly, the body may be placed in the same position for hours, depending on the ride’s duration. 

Therefore like all exercises, excessive stress in terms of frequency, duration and intensity will put the shoulder at risk of injury from overuse or repetitive strain. At the same time, falls and accidents can cause traumatic injury to the shoulder and other parts of a cyclist’s body.

  1. How Do I Stop My Shoulder Pain When Cycling?

Most of us remember cycling as trips taken in our childhood or youth to East Coast or other parks when done on a rental bike. This sense of nostalgia and recognition of cycling’s health benefits have prompted many to pursue the sport in later life. 

The Covid-19 pandemic has seen a global surge in bicycle sales and cycling participation. However, the physical fitness needed to meet more serious cycling demands is often lacking in most sedentary workers. 

Therefore, it is essential when starting out to ride with friends who are of a similar level of experience. This will aid in accommodating a beginner’s needs. At any time during a ride, cyclists should not persist if the shoulders hurt.

Pain is an indication that the load on the shoulder is too excessive. Either due to sub-optimum endurance or strength. Stopping the ride will relieve the burden on the shoulders, allowing the shoulders to get some much-needed rest. Likewise, persisting on may lead to significant injury. 

  1. How to Avoid Shoulder Pain for Cyclists? How to Prevent Sore Shoulders Whilst Cycling?

When starting out, it is important to buy a bicycle from a reputable shop as the initial outlay for a bicycle can be considerable. The shop should be able to fit a buyer with an appropriately sized bike. Additionally, they can make the various adjustments on the different components, e.g stem, handlebar, crank, seat post and saddle. Alternatively, approach a qualified bicycle fitter for a fitting session. 

The multitude of adjustments will ensure that the cyclist’s position on the bicycle is optimum to avoid issues like shoulder pain. A beginner’s position will also be very different from that of an experienced rider. Meaning the shop should adjust the position as one’s experience, and fitness improves. 

As a rule, the beginner’s position may be more upright, and less stretched out so that the load on the shoulders is less. Then as the rider’s experience and fitness improve, the position can be adjusted to a more aerodynamic one desired by the rider.

  1. What Are 3 Common Shoulder Injuries Seen in Cyclists?

Some common shoulder injuries that are associated with cycling include: 

Shoulder Pain, Shoulder Injuries, Clavicle Fracture, Shoulder Elbow Orthopaedic Group

Image of a right clavicle fracture

  • Clavicle Fractures
  • Acromioclavicular Joint Dislocations 
  • Rotator Cuff Tears
  1. When Should I Seek Help From an Orthopaedic Surgeon for My Shoulder Pain?

Cyclists should seek help immediately if they were involved in any crashes or accidents. Some injuries may not be apparent and will only be diagnosed after an investigation by an orthopaedic surgeon. 

Leaving such injuries undiagnosed puts cyclists at risk of worsening the injuries or sustaining further damages. Secondly, any pain persisting more than 2-3 days or affecting simple activities of daily living should be evaluated by an orthopaedic surgeon.

Cochin International Orthopaedic Summit 2021(CIOS 2021)— “Complications in Orthopaedics”

Date and Time: Oct 14 2021, 18.40 – 19.40

Dr Ruben Manohara has been invited to speak at Cochin International Orthopaedic Summit 2021. Where he will be part of the session – “Upper Limb Complication – Shoulder”. Dr Ruben Manohara will be giving two talks. They are:

  1. My Worst Case Around the Shoulder
  2. How to Avoid Complications in Clavicle Fracture Fixation

He is honoured to be part of the CIOS 2021 faculty and happy to contribute to the international orthopaedic community.

CIOS 2021 will feature an innovative combination of engaging interactions with international experts, cutting-edge surgical demonstrations, and instructional symposia that will offer live Q&A with premier faculty and renowned regional hosts about Complications in Orthopaedics from various branches of Orthopaedics. 

Fellow doctors can register for the Orthopaedic Summit via this link https://ciosonline.com/

 

Cochin International Orthopaedic Summit 2021, CIOS 2021, Dr Ruben Manohara, Shoulder Elbow Orthopaedic

Treatment Options For Massive Rotator Cuff Tears | PhysioActive Talk

Date and Time: April 30 2021, 12:30pm – 2:00pm
Guest Speaker: Dr Desmond Ong, Consultant Orthopaedic/Shoulder Surgeon at Shoulder Elbow Orthopaedic Clinic

Dr Desmond Ong joined our partners at PhysioActive to discuss rotator cuff tears and how they are a common cause of shoulder pain.

Rotator cuff tears become more common with age and can rob many of their ability to do the things they enjoy and their independence in their golden years. Dr Desmond touched on how non-surgical treatment options can improve one’s pain.

Learn how to better care for patients suffering from rotator cuff tears and the various treatment options available and how each option brings its own set of benefits. For more information on rotator cuff tears and the respective treatment options go to https://sportsinortho.com/.

Dr Desmond Ong, Shoulder Elbow Orthopaedic, PhysioActive, Massive Rotator Cuff Tears, Treatment Options, Insight and Evidence

Dr Desmond Ong, Shoulder Elbow Orthopaedic, PhysioActive, Massive Rotator Cuff Tears, Treatment Options

Dr Desmond Ong, Shoulder Elbow Orthopaedic, PhysioActive, Joint Preserving Options, Classic Transfers

Key Hole Surgery

Often when the topic of surgery comes up during the discussion with my patients, the question of how big will my scar be or how many stitches will there be comes up. The pleasant surprise will then commonly be that with current technology, many sports related joint injuries can be treated via small key holes now.

 

New Technology?

Truth is “Minimally Invasive (MIS)”, “Keyhole”, “Bandaid”, “Scope” surgery is not exactly that state of the art nowadays as it has been around for almost a century now and can safely be considered to be the mainstay treatment for most sports injuries.

 

Arthroscopic surgery has been reported since the 1910s but the technology and application greatly took off after the invention of fibre-optic cable when images can be projected into a television monitor. This saves us from having to struggle peering through a small peephole lens. This plus high definition lenses and monitors has made doing such procedures much clearer, easier and thus safer. Afterall, a surgeon should only operate on what he/she can see clearly.

 

So what exactly is KeyHole surgery.

KeyHole or Arthroscopic surgery is a type of orthopedic surgery that utilizes an instrument called an arthroscope which essentially is a lens connected via fibre-optic cable to a monitor. It is so called keyhole or minimally invasive as it can be performed requiring only small incisions, usually around around ¾ of a centimeter. These incisions are called portals. The word arthroscope is from the Greek words meaning “to look at joints.” The arthroscope is made up of a lens and a light source, and is connected to a video camera. The surgeon can view the inside of the joint directly through the arthroscope, or an image may be displayed on a monitor. This image gives the surgeon a clear view of the tissue inside the joint. The surgeon can then use other tiny instruments specially designed for arthroscopic surgery to perform necessary procedures. Arthroscopic surgery can be used as a diagnostic tool, or for therapeutic procedures ranging from easing the pain of arthritis patients to mending torn ligaments. This range from shoulder stabilization, rotator cuff repair, capsular release for frozen shoulder, acromioclavicular joint reconstruction (dislocation of the outermost part of the collar bone which many cyclist suffer from after a fall), tennis elbow release, knee meniscus debridement (clean up)/ repair, ligamentous (anterior and posterior cruciate) reconstruction, hip labral debridement repair. This is on top of the diagnostic arthroscopies we do for the joints and debridement of these joints.

 

Why KeyHole?

 

First I must quantify that although this technique is and can be used for many sports related injuries when all non operative options have been exhausted, it is not for every patient and every condition. In certain situations, trying to struggle through 4 to 5 small holes each around ¾ cm may cause more damage then just doing a simple mini-open procedure with a 3-4cm incision,

Nevertheless, extended exposure of joints during open surgery prolongs recovery and increases pain and risk of complications, such as infection and stiffness. Minimally invasive surgeries, in general, result in less pain and swelling after surgery than open techniques. As a result, arthroscopically treated patients tend to heal faster and begin rehabilitation earlier and, subsequently, return to normal activity and work sooner.

Technically, using a lens also allow surgeons to see certain parts of the joint that would otherwise be inaccessible through a limited mini-open incision as the lens can get into awkward corners of the joint easier.

Arthrocopic surgery has made some previously very long and arduous ones a lot more controlled and straightforward. This allow us to provide our patients a more predictable outcome in terms of results.

In some surgeries, arthroscopic techniques have become mainstays over open procedures like shoulder stabilization surgery, rotator cuff repair, acromioclavicular joint reconstructions, knee meniscus and ligamentous reconstruction. This is to an extend that the open surgery is only reserved for complex or revision (repeat) surgeries.

Another benefit of arthroscopy is that a lot of these procedures can be performed in an day surgery setting which can often reduce cost.

 

So what’s the down side?

As of all surgical procedures, there are risks. Like in all joint surgeries, risks include bleeding into the knee joint, damage to the cartilage, meniscus/labrum, or ligaments in the joint, blood clot in the leg (deep venous thrombosis), injury to a blood vessel or nerve, compartment syndrome when the fluid we use to pump into the joint to work (yes we work in an underwater environment) leaks into the calf area of the leg, infection in the joint and joint stiffness. Unique to arthroscopy, equipment failure accounted for a significant part of the complications. Arthroscopy is a technical procedure requiring a wide range of equipment (camera and monitor, surgical equipment, pump, tourniquet, etc.) that can malfunction or break during a procedure.

Conclusion

Arthroscopy, one of the greatest advances in orthopedic surgery in the 20th century, has been around for a almost a century. It offers a minimally invasive alternative to standard open surgical techniques, which often require extended incisions for adequate joint exposure to the extent that it has become the mainstay for many conditions. Decreased complications, pain, shorter recovery, and the resulting cost savings are proven advantages. Without a doubt, the advances of arthroscopic surgery will allow us to return our patients back to their peak performance a lot faster and with a lot less pain and fuss. With improvements in fibre-optics, lens and monitor technology, it will also allow surgeons to see clearer and as a result do better work for our patients, producing better results and allowing our patients not to have to live with their pain.