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  • Applications for the shoulder fellowship starting in 2017 is now open.
    Please apply by visiting the Unit and sending your CV to Jan Barker
    Visits to the Reading shoulder unit are welcome - Please liaise with Jan Barker [Read more]
  • RSU is advertising for shoulder fellowship to start in July 2017
    a post-CCT shoulder fellowship for One year. please send CV to Mrs Jan Barker and arrange a visit to meet Prof Levy and Mr Sforza. [Read more]
  • Coming up courses:
    we invite you to join us:

    1. Reading Shoulder Arthroplasty Instructional course,  3-4 november 2017. Poznan, Poland.
      With UK and International faculty

      Limited places - Register early
  • New, New, New: Innovative Design Orthopaedics -
    IDO Isometer Shoulder Muscle Strength Gauge. [Read more]
  • Verso Stemless TSA with a new company Innovative Design Orthopaedics (IDO)
  • Shoulder study day for Physiotherapists
    Will be available soon.
    Please register your interest by e-mail to: course@readingshoulderunit.com [Read more]
  • For GPs - New!!! NHS Choose & Book
    The Unit at Berkshire Independent Hospital is open for NHS patients through Choose & Book (Extended Choice Network).
    Book online
    or contact the secretaries. [Read more]
  • Groundbreaking research from the Reading Shoulder Unit by Prof. Ofer Levy and his team regarding Propionibacterium Acnes and shoulder arthritis. 
    Propionibacterium acnes: an underestimated etiology in the pathogenesis of osteoarthritis?

    This is a very important article in that it suggests the presence of propionibacterium in previously unoperated shoulders with arthritis and furthermore that 'aseptic' failures of shoulder arthroplasty may, in fact, be related to indolent infections with this slow growing organism.
    Read comments by Dr Frederick A. Matsen III, M.D.
    [Read more]
  • New Survey on usage of shoulder replacement prostheses.
    Take the survey [Read more]
  • Listen to the BBC Radio4 programme - a day in the operating theatre at the Reading Shoulder Unit at the Royal Berkshire Hospital - Case Notes with Dr Mark Porter on Regional anaesthesia for shoulder surgery [Read more]
  • The least complications with the Verso shoulder compared with other reverse shoulder systems
    From the Royal National Orthopaedic Hospital, Birmingham, UK

    Bone Joint J 2013 vol. 95-B no. SUPP 27 25

    COMPLICATION RATES FROM THREE
    COMMONLY USED REVERSE POLARITY TOTAL
    SHOULDER REPLACEMENTS: A MINIMUM TWOYEAR
    FOLLOW-UP OF 64 CASES
    S. Robati, M.K. Shahid, J. Allport, A. Ray and G. Sforza 
  • Art at the Reading Shoulder and Elbow Centre
    Original fine art prints all dealing with human body in different situations by four artists are exhibited in the Reading Shoulder and Elbow centre 

    The prints on display are available to buy, with the artist contributing a donation to research. For more information please contact the secretaries in the unit.

    [Read more]
  • The Verso stemless rTSA is approved in Australia & New Zealand by the TGA.
    Its use is launched soon in Australia & New Zealand. 

  • Excellent clinical results over more than 11 years with the Verso rTSA.
    Very high patient satisfaction and return to full activities including sports. [Read more]
Biceps Disorders / SLAP Tears

Introduction


The shoulder is a ball and socket joint. The socket of the shoulder is like a flat saucer, while the ball is a hemisphere. This arrangement of a shallow socket and a hemishperical ball allows for a large range of movement, but makes the joint prone to instability. To increase the stability of the joint without compromising the movement, the socket is deepened by the attachment of a cartilagenous ring along its circumference called the 'Labrum'. Along the upper part of this ring, the tendon of the biceps attaches to the labrum (Fig 1).


What is a SLAP lesion?


A SLAP lesion occurs when the upper labrum (superior labrum) is torn at or near it's attachment with the biceps. The tear occurs on either side of the 12 o'clock position on a clock face and hence the name Superior Labrum Anterior and Posterior (SLAP) Tear.

            
Fig 1 : Diagramatic representation of the labrum       Fig 2: SLAP Lesion at arthroscopy and a SLAP lesion

    

How does it occur?


A SLAP tear usually occurs with heavy forceful lifting, acute forceful traction movement of the arm (Like in water skiing), repeated overhead activity (tennis, throwing) or a fall on the outstretched hand.


How is it Diagnosed?


The diagnosis is made from the history and findings at examination. The patient can present with pain or mechanical symptoms in the joint. If associated with an anterior labral tear, they may present with a history of shoulder instability or dislocations.In addition, special tests such as an MR-Arthrogram help in confirming the diagnosis. However, in the abscence of findings on examination or MR, a diagnostic arthroscopy may sometimes be performed.


How is it treated?


If symptomatic, the tear can be treated surgically using 'key hole' surgical technique. The procedure is done as a day surgical procedure. Using special bone anchors ( screws) and sutures, the torn labrum is attached back to its normal position. Sometimes, the tear may be irreparable. In such cases, it is smoothed down (debrided) to a stable surface.


General Advice


You will usually be in hospital either for a day or overnight. A doctor/physiotherapist will see you prior to discharge and you will be taught exercises to do and given further advice to guide you through your recovery. You will be given a sling. This is provided for upto 6 weeks. You should avoid forced straightening of the elbow or heavy lifting for atleast 6 weeks. You can expect to be back at work between 8-10 weeks depending on your job. Your symptoms should be approximately 80% better after three months but may take 6 months to totally settle. 


Complications


As with all surgery there is a risk of some complications. These are rare, but you should be aware of them before your operation.

They include:
  • Complications relating to the anaesthetic.
  • Infection.
  • Failure to achieve successful result.
  • A need to redo the surgery.
  • Injury to the nerves or blood vessels around the shoulder.
  • fracture
  • Prolonged stiffness and or pain.

If you require further information please discuss with the doctors either in clinic or on admission.


What to expect about the operation and rehabilitation


Pain:
A supplementary local anaesthetic or nerve block is used during the operation which means that immediately after the operation the shoulder and arm may feel numb. This may last a few hours. After this the shoulder may well be sore and you will be given painkillers to help this whilst in hospital. These can be continued after you are discharged home. Ice packs may also help reduce pain. Wrap frozen peas or crushed ice in a damp, cold cloth and place on the shoulder for up to 15 minutes.

Wearing a Sling:
You will return from theatre wearing a sling.  This is required for upto 6 weeks, to allow the repair to heal. You should avoid forced straightening of the elbow or heavy lifting for atleast 6 weeks.

The Wound:
This is a keyhole operation usually done through two or three 5mm puncture wounds. There will be no stitches only small sticking plaster strips over the wounds. These should be kept dry until healed. This usually takes 5 to 7 days.

Driving:
You may begin driving 6 weeks after your operation.

Returning to work:
This will depend on your occupation. If you are in a sedentary job you may return as soon as you feel able following removal of the sling (usually after 6 weeks). If your job involves heavy lifting or using your arm above shoulder height you may require a longer period of absence (12-16 weeks).

Leisure activities:
You should avoid sustained, repetitive overhead activities or activities involving forced elbow extension  for three months.  Golf can begin at 12 weeks. For guidance on DIY and racquet sports you should speak with your physiotherapist.
Contact or risky sports should be avoided for 6 months post operatively.

Follow up Appointment:
You will be made a follow up appointment at the Shoulder Unit for around three weeks after your surgery. At this stage you will be reviewed by the specialist physiotherapist or Consultant  who will check your progress, make sure you are moving your arm, and give you further exercises as appropriate.

Exercises:
After leaving hospital you should exercise the arm frequently throughout the day. The arm may feel sore whilst you are doing the exercises but there should be no intense or lasting pain. Aim for four exercise sessions per day. The physiotherapist will advise you regarding the exercises prior to discharge.

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