Clavicle Fractures

A recent study in Perth has shown significant functional impairment when clavicle fractures are allowed to heal with overlap, i.e. with the shoulder internally rotated.

Recommendation

Don't use a traditional sling when treating clavicle fractures - use a well fitted figure of eight brace.

 

Instability

We have got it wrong for 2000 years. Recent studies in Japan and Australia show that when the shoulder is internally rotated, the classic Bankart lesion worsens. The lesion reattaches to bone when the shoulder is externally rotated.

Arthroscopic techniques have advanced significantly and Bankart lesions are relatively easy to fix arthroscopically with minimal morbidity.

 

Recommendation

For a first time shoulder dislocation in a young patient, either treat with an external rotation brace for 3 weeks continuously or arthroscopic Bankart repair.

 

Frozen Shoulder

Idiopathic frozen shoulder is a not uncommon condition in 40 to 60 year olds, characterized by a thickened shoulder capsule and a loss of range of motion. The diagnosis is best made by testing the range of motion and is most obvious, I believe, when testing external rotation. Idiopathic frozen shoulder improves on its own, but it takes on average two and half years. We have obtained excellent results in terms of reduction pain and return to range of motion, using arthroscopic capsular release, followed by an aggressive range of motion program, supervised by a physiotherapist.

Recommendation

Idiopathic frozen shoulder can either be treated with benign neglect or an arthroscopic capsular release as a day case.

Rotator Cuff Tears

The rotator cuff is an important set of tendons that secures the humeral head into the glenoid. Once a full thickness rotator cuff tear has occurred, recent studies show it will get larger with time and become more difficult to repair.

Arthroscopic techniques have advanced significantly, allowing the rotator cuff to be repaired as a day case under local anaesthetic with minimal morbidity.

Recommendation

Full thickness rotator cuff tears should be repaired early. There is little to be gained from corticosteroid injections and/or symptomatic treatment.

 

Tennis Elbow

We are conducting a randomised clinical trial to compare traditional mini open surgery versus incision only for lateral epicondylitis not responding to non-operative Rx. If you have had symptoms for at least six months and interested in this minimally invasive trial, please call Dr Martin Kroslak on 0432 944 825 or my rooms on 9350 2088. There will be no charge for participating in this trial.