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Q & A / View or ask Dr Joe de Beer a question

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Question

I'm a 29yr old woman with constant pain in my right shoulder blade. I've seen various practitioners which include physios, biokineticists, body stress release, osteopath, yoga, pilates and X-rays. My most recent X-rays were done at constantiaberg hospital under the name Sarah Jane Mills about a year ago. The results have included: weak core muscles, hyper flexibility, bad posture, slight muscular scholiosis which adds pressure to the painful area. My history includes a cracked tailbone aged 12 which went untreated and resulted in lower spinal degradation. All treatments help either my shoulder or my lower back pain. My mother is about to go for surgery for a frozen shoulder which she has suffered from as far back as I can remember. 

My question is to assess the specific state of my shoulder and spinal situation to determine a long term treatment solution to avoid surgery until no other option is available. 

I am a seamstress, right handed, so I need full functionality. Please advise.

Answer

The most likely cause would be a neurological problem like Thoracic Outlet Syndrome. 

Regards,

Dr Joe de Beer

Question

Hi Dr de Beer,

 

I am 41 year male and have been have been suffering from a pinched nerve in my neck that is causing pins & needles feeling in my left arm and shoulder. I have tried treating it with cataflam with not much sucess. Are neck injuries like this something you look at?

Thanks

Michael

 

 

Answer

Sorry, I am a shoulder specialist so you need to go to a neurosurgeon for your pinched nerve in the neck

Regards,

dr Joe de Beer

Question

How much does it cost for a coristone injection? For a frozen shoulder (rotator cuff) ? And do I need a referral from my doctor?

Answer

No referral needed but you can chat to my staff about costs. (021 9111017)

If you are on medical aid we will do it at medical aid tariffs

Regards,

 

Dr Joe de Beer

Question

Dokter is daar niks wat ek kan doen om dit te verbeter nie. Dit is regtig baie seer. Ek bly in Pongola dit is redelik baie ver vanaf dokter af? Enge raad sal ek waardeur asb.

Groete 

Lewiesa

Answer

Beste Lewiesa,

Ek sal voorstel dat jy ons dr wat die Torakale Uitgangsindrome vir ons behandel se sekretaresse skakel en 'n naam kry van iemand in jou omgewing: ons man is dr Dave Harris : 021 9006411

Question

Dokter ek het verskriklik seer by my linker blad die pyn raak net erger dit is vanaf my blad na my linker kant van my nek en my linker arm. My linker arm raak lam. My vingers swel party keer. Ek wil nie net dokter toe gaan en dan se sy dit is 'n spier wat vas druk nie. Ek het al spier verslappings pille gedrink en voltaren maar niks verminder die pyn nie. Asb as dokter miskien vir my raad asb het ek sal dit baie waardeur? 

Answer

Dit klink beslis of jy aan Torakale Uitgangssindroom ly - kyk na my website en sien "Thoracic Outlet Syndrome"

As jy wil he ons moet jou sien kan jy skakel by 021 9111017 of info@shoulerinstitute

Groete,

Dr Joe de Beer

Question

Good day dr. I am 21 years old. I had a posterior dislocation in my left shoulder, because of rugby. I have recieved 3 operations to repair it. I believe they were bankarts. Not one of them was a success. Is a bone block the next step? And what is the success rate of a bone block operation?

Answer

Dear Tian,

Yes indeed, a posterior bone block is your only option and we have had very good success with that procedure in many cases. If you want to contact us about helping you the numbers are: 021 9111017 or directly on my mail at jodebeer@icloud.com

Regards,

Dr Joe de Beer

Question

Dokter ek het 'n stywe-seer gevoel in my kakebeen. Wat kan dit wees. Ek is 54 jaar oud.

Answer

Graag wil ek jou net inlig dat ek 'n skouer spesialis is - jy moet 'n tandarts sien

Question

Dr. Ek is 76 jaar oud het 'n dubbel rotatorkraag opersaie gehad. het vanf 1 week na operasie weeklikse fiso begin. Die operasie was op 14 Sep. 2015 gedoen (dus +/- 3 maande gelede). Nie meer pyn in skouer, net in bo-arm. Doen reeks oefeninge 2 x per dag, meestal strek oefeninginge met rek weerstand. Ek gaan nog steeds met die oefeninge voort het nou die fiso besoeke gestaak. Wil graag weer begin gholfspeel is daar 'n risiko aan verbonde, kan die penne waarmee die hegting gedoen was loskom agv. die gholf. My arm is nog nie strek soos dit voor die operasie was nie. ek sal u kommentaar en raad waardeer.

Groete Dina 

Answer

Beste Dina,

Het ons jou operasie gedoen? Die terukeer na sport soos golf sal bepaal word deur die sjirurg wat jou opereer het en die gensesing van die rotatorkraag objektief ge evalueer het

Groete,

Joe de Beer

Question

Dr Joe . What can be done about Marginal osteophytes that causes muscles to become inflamed around joint.Can the Osteophytes be surgically removed.Thx Chris

Answer

Osteophytes seen on an XR of the shoulder joint usually indicate that there is osteoarthritis of the joint. The osteophytes are a result of the pathology and not a cause of the problem. Best would be to see a shoulder specialist to discuss the best way forward

Regards,

Dr Joe de Beer

Question

Good Day,

 

I have been experiencing surfers shoulder for about 5 weeks now. I havebeen going to physio as well as bio and have not done any surfing in the 5 weeks since pain onset.  Do you think cortisone injections could help reduce the inflamation as I do not really want to have surgery if it is not nessesery.

 

Thank you so much

Answer

The best is to see a shoulder specialistto examine you, take XRays and ultrasound to make a diagnosis and then the proper treatment can be suggested - hopefully only an injection 

Regards,

Dr Joe de Beer

Question

Dear Sr

I live in Mauritius.

I have been given a quote for the following operation (copied from quote)

 

Surgery/Diagnosis : ARTHRO ACROMIOPLASTY+ REGULARISATION 1/4 EXTERNE Class of Surgery  6 + 4/2 Doctor's Name : CLAVICULE + BURSECTOMIE/// BY DR PH.SOUBRANE Surgery Time 2 hours

Apparently I have bone spur which has caused a small tear on the interior of a tendon/ muscle. I have had an MRI scan.

I would like to know what sort of fees you would charge for the procedure as the hospital cost here in Mauritius appears extortionate. I reaize that only a rough idea may be given.

Many thanks

Caryl Rey

Answer

Dear Caryl,

I believe my staff have been arraniging the procedure for you ? If any problems let me know

Joe de Beer

Question

I am interested in the Interpositional Graft for "shoulder Osteoarthritis". Is the only location to have the surgery done in South Africa? Or is it possible to have it done in the U.S. I first looked into the procedure in 2010. Have any Advances or developments been made?

Thanks you, Chris McGarvie

Answer

Dear Chris,

Yes indded good progress has been made and you may consult with dr Steve Burkhart who has a very good experience with the procedure. The two of us have done work togethere on it. He is in San Antonio, Texas and the man to go to

Joe de Beer

Question

I had 5 weeks ago a shoulder operation, everything was fine. Went to the fisio as instructed, untill last week when i injured my shoulder in a almost car accident. My fisiotheripist said my bisepmusscle teared from where it was re-attached. Is another operation neccessary or can one leave it be?

Answer

The biceps tendon can be left as it will not lead to much problems. You did not perhaps have the surgery with us, because if so we will of course look at it with pleasure

Dr Joe de Beer

Question

DEAR DR DE BEER,

I HAVE A TEAR IN MY SUPRSPINATUS MUSCLE OF MY LEFT SHOULDER. I READ THAT THE RECOVERY FROM REPAIRING THE TEAR IS VERY LONG AND PAINFUL. IS THIS TRUE?

Answer

It is not always that long a recovery but in some instances, depending on the size of the tear and the repair metnod it may take longer. What is important is that if it is definitely a tear it will not heal without surgery and the long term outcome is then not good

Regards, 

Joe de Beer

Question

Please asisst if possible my son is now 21 years old .since he was about 6 years of age he had a knob at the bottom of his foot in the hollow area. and it got painfull when he walked . now he has on his back just under his sholder blade . He has the worst pain after he wakes up because he might have turned and slept on it . I have an idea that it might me a musse that rolled up but I have no idea . 

Answer

There is a condition called osteochondroma of the bones which could also cause a growth deep to the shoulder blade. He should have an X-ray and CT scan to show it up and then one could consider how to manage it . If you  are in our area we will be happy to look at it : 021 9111017

Question

my left blade feels as if wants to tear off, my shoulder, elbow and arm pains and my fingers feel numb

 

Answer

Without examining you it sounds like a Thoracic Outlet Syndrome that you are suffering from but the exact diagnosis will be confirmed by clinical examination

Question

How bad was my injury for me to now have eight anchors holding my rotator cuff in place?

Answer

You are anonymous with your question but essentially the bigger the tear, the more anchors need to be used. If, in addition, the biceps tendon needed to be tenodesed, anchors could also be required for that .Eight anhors sound like a large number indeed

Regards,

Joe de Beer

Question

I have been experiencing quite intense pain in my right shoulder, where I recently (30 July) had a needle aspiration for a large calcification.  About a week after the procedure, I fell over one of my dogs while out on a walk with them, and since then have had this pain which is affecting my sleep as well as my ability to do things like yoga etc.  I recall breaking the fall with the right hand, so suspect that I may have damaged something in the shoulder which was still "fresh" from the needling.  I simply cannot take the time out for surgey (had the left shoulder operated on last year in April and was in a sling for 6 weeks) and am wondering if there are alternatives that I could try?

Thank you in advance,

Megan

Answer

you should be examined and an ultrasound done to determing the exact cause of the pain: if it is simply the calcium that is continuing its absorption a cortisone injection might help your pain. On the other hand, if you tore the rotator cuff it is a more serious matter

You would be welcome to come and see us : 021 9111017

Joe de Beer

Question

i am a 64 year old female diagnosed with a full thickness tear 4mm retraction of supraspinatus muscle of left shoulder. the tear was diagnosed on an ultrasound. i have a lot of pain in the left shoulder with limited upward movement. what should i do

Answer

The best would be to do a repair of the tear which we do arthroscopically. You may come and see us and we can look at it and plan the most appropriate course forwards. Our nr is 021 9111017

Regards,

dr Joe de Beer

Question

Dear Dr de Beer, I am Barbara Mason 4806130076082 Discovery member Coastal Core. Tripped with both feet on unstable flicked up plank on mountain board walk. Fall saved with extension of right arm. Damage treated unsuccessfuly for 3.5 months with biochinetics SW. Mid April ultrasound revealed serious damgae to a lot of the shoulder ligaments. 23042015 operation performed by Dr Wahl SW - shoulder outcome; right arm cannot abduct. 24082015 Dr Wahl examined referred me to MRI Vergelegen - taken 27082015, (and he telephonically contacted you regarding my problem). Discovery member so available for viewing on their website. I would appreciate your comment regarding any chance of rehabillitating the shoulder to function effectively. At present a lot of activities are impossible. I first contacted your rooms on 31082015 and again on 04092015 to source your opinion/advice. Your reception has my contact details. I do hope to hear your verdict early this week.- 07092015. Kind regards, Barbara Mason

Answer

Dear Barbara,

I have received the MRI results.  There are chronic full thickness tears of your rotator cuff tendons.  It is not necessarily reparable.  I suggest you come in for a consultation, so that we can plan the proper way forward.

Regards,

Dr Joe de Beer 

Question

Good day Dr de Beer, you operated on my right shoulder for a frozen shoulder in the year 2000. The operation and course of physiotherapy were very successful. I remember your saying that it was highly unlikely that I would have the trouble again. During the last couple of years a niggling pain in the front of the shoulder has become severe. It does not limit the movement of the shoulder. The pain is such that it is very uncomfortable to lie on that side at night. The muscles around the shoulder and up into that side of the neck are tending to be painful from time to time.My local GP suggested a cortisone injection, but I remember (I hope correctly!) that you frowned on that as a form of treatment. Do you have any idea of what the trouble could be, and what course of action would be required? Mike Strong recommended you back in 1999 when I was building a house for him. Regards, Michael Hindon

Answer

Dear Michael,

The best would be for me to see you again to ascertain what exactly the problem is, do an ultrasound and see if it is not perhaps a tear of the rotator cuff. In other words, lets make a diagnosis and then suggest the most appopriate treatment

Regards,

Joe

Question

Dear Dr de Beer. My physio patient today, age 75, 5 year remission from Multiple Myeloma, presented with 5 day history of dominant arm, front of shoulder muscle "swelling". Twice the anterior size of the left shoulder, 5/10 tenderness on under Ant Deltoid and Infraspinatus palpation ,slight difficulty on hand behind back and flexion above 90 degrees. She had been lifting 1kg weights at gym and doing pressups to knees. I am in the dark as to what she has hurt. Thank you for this wonderful website. I have corresponded with you about 2 years ago. Kind Regards Lyn Bath

Answer

Dear Lyn,

With the history of myeloma it is important to rule out a tumour in the shoulder - so the first thing to do is an X-ray and then an ultrasoiund and or MRI to evaluate the  paathology

Let me know the findings - I will be most interested to know

Regards,

Joe de Beer (info@shoulderinstitute.co.za)

Question

Needling procedure for shoulder cuff calcium deposit.  What CPT codes are you using? 20999 and 76942? Do you have any insurance problems with reimbursement?

Answer

We don't have problems with the insurances, only thing is that some patients have "hospital plans" which means that they are only covered for procedures done in hospital. We then have to admit them for the procedure to be covered

I am in South Africa so I guess our codings are different

Question

Dear Dr de Beer, how successful is surgery for Thoracic Outlet Syndrome with regards to cervical rib?

What sort of surgeon/doctor would do the operation? (Orthopaedic / Neurosurgeon / Vascular surgeon)

Can you recomend recognised doctors specific to TOS surgery in Johannesburg?

Thank you for your assistance.

regards

Cheryl

 

 

Answer

Dear Cheryl,

The surgery is successful. We refer those patients to dr Dave Harris who is a Throracic surgeon in Cape Town and his results are good.

I do not know anybody in Jhbg but you could phone his office and ask for a reccommendation

Regards,

Joe de Beer

Question

I am a previous patient of Dr De Beer. I've had two operations, on in 1996 - a bankart and supraspinatus repair. The second in 2004.

I was told by Dr that the techniques used in my surgery were new at the time and that each are now known to cause arthritis. 

I have regular xrays and have been told by a reliable surgeon that I do have stage 4 arthritis - the shoulder of an 80 year old woman. 

My concern is that I am 34 now and my career is reliant on me being active. 

My shoulder had affected my life and how my body perform. 

 

I want to know what my options are realistically as I have heard that a replacement is required but at my age, not recommended. 

What other options are there available that is safe to perform and will prolong my ability to perform in my career and lifestyle. 

 

Thank you

Answer

Dear Previous patient,

Those operations are not known to cause arthritis but if you have developed arthritis it is obviously a great concern in such a young person.

there are various options to manage arthritis of the shoulder in a young patient and if you want ot come and see us we can discuss it all

regards,

Joe de Beer