FAQs II

An orthopaedic surgeon is a medical practitioner who has completed postgraduate specialist training in the diagnosis, treatment, rehabilitation and prevention of injuries and diseases of the musculoskeletal system (bones and joints, muscles, ligaments, tendons and cartilage).

Most orthopaedic surgeons in Australia specialise within the specialty itself, in other words you will find there are shoulder and elbow orthopaedic surgeons as well as foot and ankle orthopaedic surgeons, knee orthopaedic surgeons, hand and wrist orthopaedic surgeons and so on.

Some orthopaedic surgeons also have a parallel specialty (following additional training) in sports medicine, trauma or paediatrics.

Some of the most common orthopaedic injuries are sprains and strains, fractures, and dislocations.

Injuries can occur when playing indoor or outdoor sports or while exercising.

Sports injuries can result from accidents, inadequate training, improper use of protective devices, or insufficient stretching or warm-up.

Outside of the emergency context, the answer depends on several factors.

Age, lifestyle, general physical and emotional health, expectations for what their shoulder or elbow “should” be like and how restricting the problem has become all play a role.

Many people “put up with” shoulder or elbow problems until one day decide they’ve “had enough.” The pain becomes unmanageable, sleep is disturbed too often, function compromised, work, sport or leisure activities affected or all of the above.

In our experience, people seem to persist with a symptomatic shoulder actively doing things to help manage their problems (or not) for about 4 to 12 months before seeking an opinion. What one person can put up with may prove too much for another so there are always exceptions. We’ve had patients who report having problems for 10, 20, even 50 years before seeking an opinion. Others present quite soon after injury, such as when they return from holiday. For while their injury was manageable on holiday, it now bothers them significantly or impedes their ability to return to work, school or other normal activities.

While injuries and problems vary at different times because a variety of factors, some of the more common shoulder problems presenting to our surgeons include:

• tears of the rotator cuff, biceps tendon or SLAP;
• shoulder impingement, frozen shoulder, shoulder instability;
• fractures of the scapula or clavicle;
• shoulder separation;
• and arthritis of the shoulder.

As mentioned before, people either present with an acute problem that has just suddenly developed from a fall or other trauma or with a chronic problem that they have been “putting up with” for some time.

While injuries and problems vary at different times for a variety of factors, some of the more common elbow problems presenting to our orthopaedic surgeons include:

• lateral epicondylitis aka “tennis elbow”, medial epicondylitis aka “golfer’s elbow”;
• elbow dislocation;
• fractures of the distal humerus or radial head;
• ulnar nerve entrapment;
• biceps tendon repair and
• osteoarthritis of the elbow.

Yes, often people report that they can’t remember a specific injury, especially if they’ve been experiencing symptoms for a while. They just know that they “have a problem” with their shoulder or elbow.

The private practices of Dr Cass, Dr Young and Prof Sonnabend are collectively known as “Sydney Shoulder Specialists” and more information regarding same can be found at www.sydneyshoulder.com.au.

Surgery for rotator cuff problems usually involves one or more of the following procedures: debridement, subacromial decompression and rotator cuff repair.

Debridement involves clearing out damaged tissue from the shoulder joint. Subacromial decompression involves shaving bone or removing spurs that are beneath the tip of the shoulder blade to create more room between the shoulder blade and the upper arm bone so that the rotator cuff tendon can glide smoothly without being pinched.

If the rotator cuff tendon is torn, it is repaired by being sewn together and reattached to the top of the upper arm bone.

Joint replacement surgery is a type of operation performed to replace an arthritic or otherwise damaged joint with a new, artificial joint called “prosthesis”.

Many joints can be replaced including shoulders and elbows although the knee and hip are most perhaps the more commonly replaced joints.

No, joint replacements dramatically improve the quality of life of people of all ages who are living with serious and disabling joint pain and dysfunction.

Shoulder and elbow replacement surgeries can be safely done on people of almost any age, from 12 up (e.g. patients with juvenile rheumatoid arthritis or very serious injuries) to adults in their 90s if the patient’s overall health is stable.

Shoulder and elbow replacements have been performed in Australia for almost 40 years, and the quality, selection and types of prostheses are better than ever. Through several decades of orthopaedic research both here and overseas, surgeons now know how to tailor implant selection and procedures to a patient’s age, health status and activity level. They also know how to care for patients with joint replacements for the rest of their lives including any additional or revision surgeries should all or part of the implant wear out or loosen.

On average, artificial joints have a lifespan of 10 to 20 years.

If you are in your 40s or 50s when you have joint replacement surgery and very active, you may need to have another joint replacement surgery later in life.

This is an important question to discuss with your surgeon.

What activities can be resumed, and when it is safe to do so will depend on the procedure your surgeon uses, and your recovery.

Generally, high impact activities should be avoided, or resumed very carefully with specific guidance from your surgeon, based on your individual health and surgery. High impact activities, such as tennis can put too much wear and strain on joint replacements, whereas low impact activities, such as swimming, generally do not affect the wear of joint replacements.

Your surgeon’s goal is to help your joint replacement last as long as possible. This is why it is important to follow their advice on which activities are ‘safe’ to do and when.

Yes. Restoring your full range of motion, strength and flexibility following surgery takes time.

Post-operative physical therapy programs are designed to maximize your recovery after surgery.

In most instances healing should occur within 6 weeks but it all depends on whether the acromioclavicular or glenohumeral joint is dislocated, the amount of associated injury and if surgery is required.

Yes, it is important to have your joint x-rayed and examined by your orthopaedic surgeon.

There are many different types of fractures and fracture surgeries, some of which can occasionally lead to arthritis or other problems, such as irritation around the implant used to repair your fracture. By having new x-rays, another examination of your shoulder or elbow, and learning about your current symptoms, the surgeon can determine what is causing your pain and work with you to resolve this.

The concern about not letting you drive for a few weeks after surgery is related to making sure that your physical reaction time returns to normal, and that you are not driving while relying on narcotics for pain relief – which can make you drowsier than normal.

According to research, it generally takes about 6-8 weeks for your physical reaction time to return to normal after major surgery.

On average, patients can return to driving around 6 weeks after surgery. However, because each person is different in how they recover from surgery, it is important to discuss this with your surgeon.

This depends on the type of surgery you had, and type of work you do (sedentary/desk job, versus physically demanding active work).

Often patients who have shoulder or elbow replacement surgery will return to work somewhere between 4-6 weeks after surgery, depending on the physical demands of their job.

It is common to return to work part-time or light duties at 4-6 weeks then work back to full duties between 6-12 weeks.

This is an individual situation that is important to fully discuss with your surgeon.

Diagnosing an injury or disease usually begins with collecting a thorough medical history, undergoing a physical examination, and having an X-ray, MRI, or CT scan.

Using an arthroscope assists surgeons to finalise a more accurate diagnosis than can be gained from imaging and “open” surgery. An arthroscope is a tube-like instrument with fibre optics.

Some complications of not undergoing an orthopaedic surgery for your condition include pain, loss of joint motion, joint weakness, numbness and an early onset of arthritis.

Here is an interesting article from Australian Doctor which was published in March 2015.

Sometimes, after consultation with an orthopaedic surgeon patients are advised that your condition can be treated with non-surgical options. This generally refers to a combination of medications, rest, exercise, physiotherapy and time.