Shoulder Q&A: Mr Matthew Ricks

My name is Matthew Ricks. I am a Consultant Orthopaedic Surgeon. I sub specialise in the shoulder, elbow and hands, and have a particular interest in joint replacement, traumatic injuries to the shoulder and arthritis and keyhole surgery. Patients commonly ask me in clinic what's involved with a shoulder replacement and will I have pain after the shoulder replacement? So, a shoulder replacement is commonly performed for either arthritis of the main ball and socket joint or failure of the cuff. Now what happens is with the cuff is over years as you age or with a traumatic event, can develop tears within your cuff and over time if these tears become significant they can fail and the ball inside the socket can move north. This in turn can lead to a significant clunking and poor function to your shoulder. The cuff tears and cuff arthropathy make up half of my joint replacement causes and the other half is arthritis. So, these patients tend to suffer with a painful shoulder and a significantly decreased range of movement. So, we'll exhaust all conservative measures first of your shoulder, which can involve physiotherapy injections and if you fail to get back to a good level following that, then we always have the option of a joint replacement. A shoulder replacement is performed as a day case and we do a block. The block will hopefully leave you pain free for a period of time after. The painkiller pack is given to you and then you work with physiotherapy. Majority of patients around the three month mark are back to a good level of function with minimal pain. The aim is to try and take away your arthritic pain and get your function and life back following the shoulder replacement. Patients commonly present to clinic with traumatic cuff tears. These are usually following a fall or an injury to the shoulder and when you do come to clinic, we will do a thorough history, examination and then the appropriate imaging. Appropriate imaging is using the form of an MRI scan or ultrasound scan and what this is telling us is information about the cuff tear that you may have sustained. We are looking at certain elements of the tear to try and work out whether this is a degenerative tear that may have occurred over time or an acute traumatic tear. With the imaging, will be able to look to see whether it is repairable and the quality of the tendon and the tissues that may be behind it. Before surgery, we always tend to explore conservative measures first. This is commonly an injection, physiotherapy to work through your range of movement and strengthen up other muscles that may be able to compensate for the ones that you have torn. If we are unable to get you back to a good functional level with physio and conservative measures, then we always have the option of surgery. The majority of cuff tear surgery is performed through keyhole surgery. This is small stab incisions around the shoulders and using high-tech camera systems and instruments, we're able to reattach the cuff tears back on. If you do have a cuff tear that is repairable and is repaired through keyhole surgery, then there's a period of time of healing following this surgery. You'll be in a sling, you'll have painkiller support, and then you'll have follow-up with myself and with physiotherapy as well. This will allow you to work with your range of movement after you've healed to get you back to a good functional level.