Upper Limb surgery
Shoulder pain is a common problem presented to general practitioners. The shoulder joint is prone to injury since it is very mobile. Frequent activity overhead and sudden trauma can cause damage to the tissues inside the shoulder. As well as pain, shoulder problems may present as weakness or restricted movement. The correct treatment depends on establishing the exact diagnosis. Often the diagnosis can be made on the history of symptoms, physical examination and radiological tests such as x-rays and MRI scan. Many causes of shoulder pain can be treated without surgery by steroid injection and/or physiotherapy. For more severe causes of shoulder pain such as subacromial impingement, frozen shoulder, rotator cuff tendon tear, shoulder instability/dislocation and osteoarthritis, surgery may be required.
See the video of shoulder surgery here
The elbow is a hinge joint that also allows rotation of the forearm. Problems with the elbow may present as pain, swelling, stiffness or a tingling sensation. Tennis elbow is inflammation of the tendons on the outer side at the elbow joint. Golfers elbow is similar inflammation on the inner side of the elbow joint. Both of these conditions can be painful for a long time and cause significant restrictions in activity. In the majority of cases, both these problems can be treated with a combination of elbow braces, physiotherapy and appropriate injection techniques. Very rarely (less than 5% of cases) is surgery required. An olecranon bursa is a swelling over the point of the elbow which can sometimes grow dramatically in size and excision may be requested. The ulnar nerve can be entrapped as it passes close to the elbow joint, and this can cause pain and tingling in the forearm and numbness in the little finger. The elbow like other joints can undergo osteoarthritic change and also be damaged by fracture or dislocation.
Tennis Elbow- See the video here
The human hand is a very complex structure with many components. The components such as nerves, tendons and joints can undergo wear and tear changes as well as being injured. The joints in the hand can undergo arthritic change and also be associated with small cystic swellings called ganglion. The tendons in the hand can develop painful swellings which may sometimes produce a triggering or locking phenomenon when the fingers move. Often such problems are treated with steroid injection. The median nerve which supplies sensation to the thumb, index and middle fingers can become entrapped as it passes through the wrist. This can produce pain at night and numbness in these digits, in a condition called carpal tunnel syndrome. This frequently requires an operation, which is very successful at curing the problem. Some people may develop a loss of extension especially of the little and ring fingers. This is a condition known as Dupuytrens` contracture. This contracture can be corrected with day case surgery.
See the video on carpal tunnel surgery here
The majority of shoulder surgery is performed as keyhole surgery (arthroscopy), which uses small incisions and causes less damage to other tissues in the shoulder. Consequently most procedures can be done as a day case, post-operative pain is decreased and return to work is accelerated.