How does your shoulder work?
Your shoulder has the largest range of motion in the human body.
It works like a ball-and-socket joint. The top of your arm fits into a shallow socket in your shoulder blade. As you move, your shoulder blade glides along your rib cage to help your arm move freely in different directions.
Smooth, pain-free movement requires your shoulder joint and shoulder blade to function well together. When they don’t, you feel it.
Rotator Cuff Tears.
What is the rotator cuff?
The rotator cuff is a group of four muscles around your shoulder. They form a cuff-like band that wraps around the top of your arm, helping to keep it centred in the socket. As you move, they work together to keep your shoulder stable and moving smoothly.
Rotator cuff tendons can tear.
This may happen from a sudden injury, such as a fall, or from repeated strain, like regularly working with your arm overhead. These tears can cause mild to severe shoulder pain and loss of movement.
What treatment works best?
You might expect a torn tendon to need surgery, but that’s not always the case with the rotator cuff. Most tears are small, meaning much of the cuff stays attached. Over time, pain often settles and movement can be improved by strengthening the part of the cuff that’s still attached.
Physiotherapy
As rotator cuff surgery requires prolonged rehabilitation and time away from usual activities and work, non-operative treatment is a good option for many patients.
Aphysiotherapist can guide you through non-surgical treatment. They’ll help reduce pain, restore movement, and rebuild strength in the muscles that support your shoulder and shoulder blade. If your pain persists or you’re still struggling to move, you might then consider surgery.
Surgery
Surgery involves repairing the torn rotator cuff tendon back to where it came from on the ball of the shoulder joint. This is achieved by placing small synthetic anchors into the bone where the tendon should attach. These anchors use stitches to tie the torn tendon to the bone where the anchor was placed. A bit like tying a sail’s rope onto a cleat that’s bolted into the deck of a sailboat.
Dr Bell uses arthroscopic (keyhole) techniques to perform rotator cuff repairs, resulting in most patients having scars that are barely noticeable.
Recovery from rotator cuff repair takes time.
Within the first 6 weeks.
The operated arm can’t be used for most activities including self-care, manipulating objects with the arm away from the body, and driving to allow the repaired tendon to bond to the bone it was repaired to.
After 6 weeks.
Following this initial healing phase, movement and strength is gradually restored under the guidance of your physio. This process can take up to 6 months. During which time, you’ll gradually get back to normal activities. Sport and heavier manual work will be the last activities to return.
Post-recovery.
Outcomes following rotator cuff repair surgery are generally more long-lasting than non-operative management. Less pain, with better strength and function are more likely, but the prolonged rehabilitation requirements are a deterrent for many patients.
But it’s important to remember, not all rotator cuff tears can be repaired.
If enough of the cuff tears away from the bone and left for too long, untreated, the tendon and its muscle will shrink and stiffen. If this happens, they can no longer be returned to the bone they tore from. If that does happen, there are alternatives we can explore.
Shoulder Instability.
How does your shoulder work?
Your shoulder socket is quite shallow, think of it like a golf ball sitting on a tee. This allows a wide range of movement, but it also means the joint needs support. Cartilage, ligaments, and tendons help deepen the socket and keep the ball in place, giving you stability and free movement.
When unstable, the ball can slip out of the socket in certain positions.
This is usually caused by a tear in the labrum (a ring of cartilage that lines the socket). Think of it like a broken golf tee. When it’s torn, the socket becomes too shallow to hold the ball in place, so it slips out more easily. In severe cases, the bone can also be damaged.
It can be painful and feel like your shoulder won’t move properly. You may find yourself trying to avoid movements that are hard to limit completely in daily life or certain sports.
What treatment works best?
For most patients, particularly younger people who want to keep playing sport, surgery is required to restore stability. Non-surgical options, like strengthening exercises, can still improve function for in-season athletes or those with lower demands.
You have a range of surgical options.
From keyhole (arthroscopic) surgery to repair the labrum, to bone grafting that rebuilds the damaged socket. I’ll recommend the best option based on a range of factors, including the damage to your joint, the condition of the surrounding tissues and your sporting and work goals.
Recovery from shoulder stabilisation surgery takes time.
Within the first 6 weeks.
The operated arm can’t be used for most activities including self-care, manipulating objects with the arm away from the body, and driving to allow the repaired or grafted tissue to bond to the bone it was placed against.
After 6 weeks.
Following this initial healing phase, movement and strength is gradually restored under the guidance of your physio. This process can take up to 6 months. During this time, you’ll gradually get back to normal activities. Sport and heavier manual work will be the last activities to return.
Shoulder Arthritis.
What is shoulder arthritis?
Where your arm meets your shoulder blade, the joint is covered in a smooth, slippery layer called articular cartilage. Arthritis is when this joint becomes inflamed. Over time, the cartilage wears away, leaving a rough surface and exposing the bone to more stress.
As cartilage wears away, the shoulder becomes painful and stiff.
At first, pain may occur with certain activities. Over time, it can become more constant. Movement also declines, making activities like sleep, reaching overhead, washing your hair, and even toileting more difficult.
Usually, it’s caused by genetics and ageing. Many people have more than one joint affected, as their cartilage isn’t durable enough to withstand a lifetime of use. It can also result from a large rotator cuff tear, leading to abnormal wear and, eventually, arthritis.
What treatment works best?
Researchers are exploring ways to restore articular cartilage, including stem cells and gene therapy. So far, none have worked in humans. Once cartilage has worn, it can’t be restored. Current treatments aim to minimise symptoms from worn cartilage and slow the progression of wear.
Non-operative treatment
In most cases, a range of non-operative treatments can help you control symptoms and improve function. Paracetamol and/or non-steroidal anti-inflammatories can provide good pain relief. A physiotherapist can prescribe and monitor range of motion stretching and strengthening exercises to help maintain (or even improve) your movement.
Adjusting your activities can also help, especially when arthritis remains mild. Avoiding aggravating activities, like throwing, freestyle swimming, or lifting loads away from your body, can keep symptoms manageable for years.
Surgery
You might consider surgery if non-operative measures fail to control your symptoms. For most patients, joint replacement is the most reliable option to relieve pain and improve function. This involves removing the worn-out bone ends, including the remaining cartilage and some underlying bone. An artificial joint made of metal and tough plastic (polyethylene) is then fixed to the bone surfaces where the joint used to be.
Two types of shoulder replacement are typically used.
Anatomic shoulder replacement
An anatomic shoulder replacement, where the ball is replaced with a metal ball and the socket with a plastic one. This requires intact rotator cuff tendons and a socket that isn’t too severely worn.
It provides good pain relief in 80-90% of patients, and most regain enough range of motion for daily living activities and light manual work.
Reverse shoulder replacement
A reverse shoulder replacement reverses the shoulder configuration. The rounded top of your arm bone usually fits into a cup-shaped socket. In a reverse replacement, these positions are swapped. The ball is fixed where the socket was, and the socket now sits at the top of your arm bone. This makes the shoulder more stable, removing the need for an intact rotator cuff.
This surgery generally provides good pain relief in 80-90% of patients, though with less movement and strength returning compared to an anatomic replacement. This level of function often won’t allow a return to manual work, but is well suited to daily living activities, light jobs around the house, and many recreational activities.
Precise bone cuts and implant placement are essential for a good outcome. So, before surgery, I will take a high-resolution CT scan of your shoulder and upload it to surgical planning software. He will then perform your surgery virtually, working out where to remove bone and which implants will work best for your unique shoulder.
This means, by the time you’re in theatre, I have already mapped out exactly how he will perform your surgery. This gives you the best possible chance of a great outcome.
Other shoulder conditions
Frozen Shoulder (Adhesive Capsulitis)
Calcific Tendonitis
Acromioclavicular (AC) Joint Injuries
Let’s get you moving like yourself again.
Whether you need a diagnosis, a second opinion, or a clear treatment plan, we’re here to help.
