Frequently Asked Questions

I have had pain with my partial thickness Rotator Cuff tears for some years, but injections give me some relief. Can I continue with this treatment?

Surgery for Rotator Cuff tears is reserved for patients with clinical issues such as pain or power loss. The best treatment for partial tears involve conservative approaches. These will be discussed during the consultation. A good physio is crucial in this process.

When conservative measures fail, surgical options may be explored. It is best to give the non-operative approaches some months for full effect.

I have had 2 injections and I am told that you can’t have more. What can I do?

The Steroids are anti-inflammatory drugs. Cortisone is a naturally occurring substance, so you can’t have a true "reaction". (although, it is possible to be allergic to the skin preparation)

The aim of the steroid is to cut down the inflammation in the shoulder. IT DOES NOT STOP PAIN, but it’s aim is to stop the inflammation causing the pain, therefore, it will take up to 5-7 days to work.

There is no specific rule as to how many you can have. Generally, I would not give more than 3 a year, not because I am worried about any issues with the drug, it is because if a patient requires constant injections, it would be worth thinking about other treatments.

Are there any serious side effects of injections?

Infection is the biggest concern. Some patients have a "steroid flare" – a transient reaction which is more painful than the needle. It only lasts a short while. Very small rises in blood sugars have been reported in diabetics, so this should be watched.

I am worried about the anchors in my body – can you tell me a little about them?

Arthroscopic Shoulder and Knee surgery involving reconstruction and repairs of tissues most often require bone anchors. Previously, metal and absorbable plastics were used. Although some shoulder surgeons and knee surgeons in Melbourne may still use these devices, I prefer PEEK. These are a special ( but expensive !!) plastic anchors which don’t have the problems seen with metal and it doesn’t absorb (and therefore stops bone reactions). They do not need to be removed. Rather, they stay in the bone forever. They do not "Set off alarms at airports". All insurance companies pay the full cost of these anchors.

Do I need to stay in hospital or can I go home the same day?

With most patients having arthroscopic ACL (Anterior Cruciate Ligament), Shoulder Reconstructions and Arthroscopic Rotator Cuff repairs, day surgery is offered. We will usually book an overnight bed in any case, but if the patient is comfortable, they can usually leave on the day of surgery. If the surgery is done late afternoon, we would suggest staying the night.

I have had an open rotator cuff repair by another surgeon but it has re-torn. Can you still do the rotator cuff repair key-hole (arthroscopically)

Yes, this will not interfere with the previous incisions. In my experience, access to the tears is better and the risk of "frozen shoulder" is less than re-opening the old scars. Arthroscopic rotator cuff repair surgery use the same devices (anchors) as open procedures, and instrumentation has improved over the years to allow excellent vision and the ability to fix other disease within the shoulder region.

What is the chance of converting to open surgery during the Arthroscopic (Key-Hole) Shoulder Surgery?

The chances are remote. Assuming the procedure is a standard arthroscopic rotator cuff repair, Anterior Cruciate Ligament repair or Shoulder arthroscopic Labral (stabilisation) my conversion rate from arthroscopic to open incision is 0% in the past 5 years.

Some procedures are done with standard incisions such as Bone transfers of the shoulder (Laterjet Procedure), but new techniques are being developed to allow these to be done arthroscopically.

I am 20 yo and need an ACL reconstruction – can you perform a LARS Synthetic Ligament Reconstruction.

My preferred graft for this procedure is natural tissue – hamstring or patella tendon. I do not perform this procedure for many reasons.

I keep dislocating my shoulder in the backwards direction after a rugby accident 3 years ago. Can this be fixed arthroscopically?

Yes. This is uncommon but usually associated with a labral tear given the mechanism of injury. Assuming there are no other factors such as bone loss, and a labral tear is present on scanning, an Arthroscopic Posterior Labral Repair (Reconstruction) is a simple procedure recommended for this problem

BUT... THE MRI SHOWS TEAR AT THE FRONT OF MY SHOULDER AS WELL...

All tears can be accessed and repaired at the same time. You might need one additional 6mm key hole incision. The rehab will remain unchanged.

Why doesn’t the insurance company cover the entire operation?

Insurance companies pay for most (if covered properly, all) of the hospital costs but not the doctors fees. Generally, there are 3 specialists involved in the surgery – the Surgeon, Anaethetist and assistant surgeon.

The surgical fees covered are a combination of the Medicare Rebate and the Insurance Company loading. Unfortunately, these have historically increased with the C.P.I. not "actual" costs.

For example, the Medicare Schedule Fee for fixing a broken clavicle with plate and screws is $221.80 (item: 47465 : 2013 MBS Fees). The insurance company may pay a small percentage more. (some, as low as 20%)

A haircut can cost you more, and given the extreme cost of overheads, it is not surprising that the patients may need to contribute to the fees.

All Health insurers will pay at different rates. Therefore, some patients will have out of pocket expenses higher than others.

When can I drive after Shoulder Surgery?

If any form of reconstruction or repair was required, I would usually recommend a sling for 6 weeks. In this period driving is prohibited due to safety issues.

You may still be able to write, type, draw, sleep, eat and shower but driving is not allowed.

Do I need to see a physiotherapist after Shoulder Surgery or Knee Surgery?

I would universally recommend a physio after ACL surgery, Shoulder Reconstructions and Rotator cuff Repairs.

For the first 2 weeks, I would suggest following the Shoulder Protocol, which you will be given after surgery. This can be done at home, without a physio. The Hospital physio will see you after the surgery and help explain the exercises.

At roughly the 2 week mark after surgery, I will inspect the wounds and remove the dressings, at this point an appointment for a physio will need to be made.

Which tendon would you use for a standard ACL Reconstruction?

This depends on many factors. I do not use synthetic ligaments, rather, either the hamstring or patella tendon. Each patient has slightly different needs and these will be addressed during the consultation.