Frequently Asked Questions
How does Calcific Tendonitis present and how do you diagnose it?
Degenerative calcification is often seen on scans of the rotator cuff and part of degenerative tendinopathy of the tendons. However 'calcific tendonitis' is a specific disease entity with a well described disease process.
Calcific tendonitis can present in different ways depending on the stage of the disease process, size and location of the calcific deposit. The common presentations are described below:
- Subacromial impingement - due to cuff dysfunction from the clacification and the space occupying calcific deposit in the supra/infraspinatus tendons.
- Persistant aching pain - due to the pressure effects of a large calcific deposit in the cuff.
- Acute severe onset of unremitting, disabling pain - due to chemical inflammation from leakage of the calcium crystals into the subacromial bursa or glenohumeral joint.
Clinical signs will vary depending on the presentation:
- Impingement signs (Neers, Hawkins, Copelands, empty can)
- Impingement & cuff pain (Jobes, empty can / full can, cuff weakness)
- Severe pain, joint tenderness and stiffness (similar to an acute painful frozen shoulder)
- Calcium may be seen on x-rays - ideally need 3 views - AP, Axillary & Outlet views
- Ultrasound scan - most useful, as allows 3 dimensional and dynamic assesment of the rotator cuff; also differentiates degenerative calcification from true calcific deposits.
My right shoulder constantly dislocates, hangs lower than my left one and aches almost constantly. It also makes a pop sound when I move it above and slightly behind my head. I also have a lump on my right AC joint, where it looks as if my right collar bone has moved forward and sticks out of the skin more than my left one. My right scapula also sticks out more at the back than the other one. The initial dislocation was from a fall and I relocated it myself, but now it's causing problems a month after the fall. I am young and active and want to go back to playing sport, but I'm concerned my shoulder will never be the same.
It sounds as if you have an unstable shoulder. Please read more here - https://www.shoulderdoc.co.uk/section/12. You may also have an AC Joint dislocation - https://www.shoulderdoc.co.uk/section/21. You need to see a shoulder specialist for investigations and treatment.
I have a question regarding tears i have sustained to both pectoral muscles. I originally tore my right pectoral in 2007 as a result of a motor bike accident and my left in 2011 whilst bench pressing. I sought medical intervention in both instances and received physiotherapy and followed a rehabilitation programme. After the first tear in 2007 I requested a surgical referral. I was informed by the surgeon that the process of repairing a torn pectoral is like trying to sow a chicken breast back together and that the outcome could be worse than the actual injury. I am unsure of what type or tears I have but believe it to be musculotendinous junction. The injury area in both is directly under my arm pit, If I tense the muscle it bulges out in the middle area of the pec and there is a indentation where it should attach to the shoulder. If I hold my arms out in a crucifix position the pectoral stops under my arm pit instead of joining to my arm. If that makes sense? I have managed to regain a decent level of strength in both my damaged pectorals, but I have struggled with various shoulder problem in both side and actively avoid exercises such as bench pressing. Sorry for the long winded explanation, but from my rough information do you believe that surgical repair is still an option open to me and if so what would I gain from the procedure?
Surgery is appropriate for pec major tendon injuries to reduce pain and restore strength in active people. The commonest injury is to tear the tendon off the bone. Surgical repair is generally successful in these cases. However, tears within the muscle are difficult to repair and the results are less favourable. Please see here for more info -https://www.shoulderdoc.co.uk/section/898.
I broke my clavical 20 years ago. It healed, but it has shortened - there is a lump sticking out where it knitted. As a result I have a shoulder that is 'squashed' in. I have restricted movement and severe pain at especially at night in bed. I am 68 but have always been fit and active ( an ex PE teacher). I play golf, but it is now sore over the last few holes. Is there anything that can be done to help?
This is very unlikely to be related to your clavicle fracture. If the clavicle unites then outcomes are usually very good. It would be extrememly unlikley for this to be causing a new onset pain that you describe. At 68 you are prone to all of the other shoulder pahologies; the most common being frozen shoulder or rotator cuff problems or even arthritis. You should see a specialist, get a diagnosis and then a plan can be made to help the pain.
What is the incidence of nerve damage in shoulder surgery?
nerve damage following most common shoulder procedures is extremely rare. permanaent nerve injury after a nerve block (interscalene block) is less than 0.1%. see: interscalene block
large complex open procedures, such as revision shoulder replacements or complex fracture or tumour surgery are more likely to have a risk of significant nerve damage, but again this is not common.
I have dislocated my shoulder for the first time. Should I have a surgical repair?
the main indication for a surgical repair after the first shoulder dislocation is an associated fracture.
if there is no fracture, then most shoulder dislocations will not require surgery. however, young, male athletes tend to be at a higher risk of further dilsocations and will usually be offered a surgical repair.
for more information see:
19 year old female football goalkeeper fractured mid-shaft clavicle 9 days ago abroad with a 'London Bridge' deformity. Is surgical fixationthe best option for longterm position and function?
indications for fixation (in my opinion - lf) include:
in an athlete i might go for fixation if i think there is a risk of delayed or non-union, as they would lose less time off their sport. it all depends on the time of season and the factors above.
the player would really need to see an orthopaedic surgeon with experience in managing clavicle fractures in athletes - the sooner the better.
What are 'Suture Anchors'?
suture anchors are very useful fixation devices for fixing tendons and ligaments to bone. they are made up of:
so the anchor inserts to the bone and the suture attaches to the tendon - thus fixing the tendon to the bone via the suture-anchor device
for more information click here
When is a Shoulder Replacement indicated for Arthritis of the Shoulder?
most people with arthritis of the shoulder can manage with pain-killers, exercise and physiotherapy.
a shoulder replacement is considered if you have the following:
1. severe pain which wakes you at night.
2. pain which prevents you doing your daily activities.
3. pain not controlled by pain-killers.
there are few contra-indications, if you have the above criteria. with modern techniques and implants, such as the copeland surface replacement, age is no longer a limiting factor.
for more information see patient information
Where can I find information on Anatomy of the Shoulder?
I recently fell on the point of my shoulder and have been told I sprained my AC Joint. What is the best treatment and when is surgery indicated?
when a joint is first sprained, conservative treatment is certainly the best. applying ice directly to the point of the shoulder is helpful to inhibit swelling and relieve pain. the arm can be supported with a sling which also relieves some of the weight from the shoulder. gentle motion of the arm can be allowed to prevent stiffness, and early physiotherapy is often of benefit.
occasionally an injection my speed recovery if the injury is slow to settle.
most ac joint injuries settle within 6 months, but a small proportion continue to give pain. this is usually because the small meniscus in the joint has been torn and not healed. at this stage surgery is an option - in the form of an arthroscopic ac joint excision.
Why does my shoulder joint pop, crack and click?
noises in the joints, such as popping, cracking or clicking, can be quite disturbing and cause concern. often, these noises are not indicative of any underlying problem. such noise often persists for years without any real problem developing. if there is no pain with cracks or clicks, you can assume it is being caused by the soft tissue in a joint. noises that are associated with pain may indicate damage to the surfaces of the joint. such cracks and clicks may be due to tears in labrum (see shoulder anatomy), which may snap over the other structures as the arm moves. if the labral tear is at the top of the shoulder it is called a slap lesion. sometimes the clicking may be due to the shoulder slipping in and out of joint. this is known as shoulder instability (subclinical).
I am going to have surgery on my shoulder. The doctor has offered me the choice between two different types of anesthesia: general and regional. What are the advantages and disadvantages of these?
regional anesthesia blocks sensation in a large area such as the entire shoulder or arm without putting the patient to sleep. the technique is called an interscalene block. with general anesthesia, the patient is not awake or aware during the operation.
during the first four hours after the operation, there is usually less pain with the regional anesthetic. this also means fewer pain medications.
please see the anaesthetic section under patient info for more details.
How many steroid injections can I have in my shoulder?
If you dislocate your shoulder how long do you need to refrain from work (office work). Can you make it worse if you remove the sling too early?
How do I avoid bad postoperative scars?
I have been told that I have loose bodies in my elbow. What are these?
Can one have an MRI scan where there is a prothesis in place, i.e. an MRI scan of cervical discs, neck refers, when there is a replacement shoulder? Or, an MRI scan of the hips when there is a hip replacement?
Loose metalwork and pacemakers are prone to move under the strong magnetic field of an MR scanner, but implants and prostheses that are fixed to bone will not.
I have had a shoulder replacement. Should I be taking antbiotic precautions before undergoing dental work?
I have a shoulder replacement and want to know if airport metal detectors will detect my shoulder replacement?
Whether a metal detector will detect your implant depends on the sensitivity settings on the detector. It is likely that a detector will pick up a steel or cobalt chrome implant.
Therefore it is advisable you get a letter or card from your surgeon confirming that you have a joint replacement.
One of our helpful readers has also wisely suggested the following:
1. Carry a letter from your doctor and/or consultant that you do indeed have a prosthesis, and where it is located
2. Be ready to *show* officials 'where' the scar is - so wear loose clothing
3. IF possible carry a small radiograph of the implanated prosthesis so that you can show this as well as the letter
4. Do be *prepared* for possible delays
5. Give yourself *Time* for these delays, especially if changing flights. Flight connections can be, and often are, hell, especially in Nth America. Allow for officious officialdom!
6. Remember, airport staff are only doing their job - be polite and patient!
I have been told that if I am going to require a shoulder stabilisation that I will not gain full range of movement to my shoulder afterwards. This news has concerned me as I am a dance teacher and need full mobility. Is this the case?
What is Winging of the Scapula and what causes it?
Winging of the scapula is a surprisingly common physical sign, but because it is often asymptomatic it receives little attention. However, symptoms of pain, weakness, or cosmetic deformity may demand attention.
Winging may be caused by injury or dysfunction of the muscles themselves or the nerves that supply the muscles.