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Ask Dr Joe de Beer

Ask Dr Joe de Beer a question regarding your shoulder problem or surgery you have had in the past on your shoulder.

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My brother accidentally broke my arm when I was around seven years old. I am now a 20year old student.

I think my clavicle has been broken or something is wrong ever since then because I can’t circle my arm around as well as I can with my left arm. I can’t tell you when the bone appeared because I honestly can’t remember and there are no pictures of me with it when I was a baby.

And sometimes I experience a lot of uncomfortable pain from my shoulder which sometimes extends into my neck. I also find it extremely uncomfortable to raise my arm up, completely striaght.I am right handed so sometimes after playing a sport/exercising or after I’m making notes for my subjects my shoulder will be ‘sore’. 

Could you please tell me if I need surgery and how long the recovery process will be because I don’t want it to interrupt with my studies (I’m in my 2nd year of a Bachelor in Accounting Sciences).

Thank you

P.S-if you could also tell me what the average cost of having surgery done would be, I’d be very grateful.

Dear Anonymous,

in you case i cannot really give you a good opinion without examing you and looking at an X-ray of your shoulder. You would be welcome to make an appointment and come to see us (021 9111017).

Dr Joe de Beer

Dear Dr de Beer,

Firstly, thank you for your excellent website. I am a former rugby player/martial arts etc. sportsman in my fifties from Wales – but living in Germany – suffering from severe pain from various injuries but with restriction and pain in my left shoulder since an injury sustained doing lat pull downs in about 1994. I also have a catching sensation in my right shoulder which isn’t resticting me at the moment. In 1996, an operation to wash out and trim the glenoid labrium and an excision of the lateral end of the clavicle was performed in Britain which solved the original pain. I’ve had various other “bumps” from contact sports but I assume this to be the cause. I had open heart surgery to replace my aortic valve in 2007(Ross op) and haven’t done any contact sports since. Within the last two years however, the r.o.m. in my left shoulder has reduced considerably and the pain has increased dramatically even though I haven’t had a new injury in this area. My quality of life has been badly affected i.e. sleeping is difficult, as is dressing, showering etc. Up to this point, I could still do pull ups and dips for example and I am still a very keen sportsman but the severe pain and r.o.m. problems now make this virtually impossible. I have had different opinions from two different shoulder surgeons – a complete replacement (reverse shoulder) or Copeland a replacement. I was also advised a.s.a.p. in one opinion but within about 6 months by another.

I would be greatful for your opinion on what would be the best procedure for me and whether you yourself could help me.

Many thanks,

Mark Davies

Dear Mark,

 Thank you for your complimentary remarks on our website. The problem of osteoarthritis in a relatively young man is  big one as we do not want to do prostheses which would fail after a few years.There are different options like biological resurfacing of the glenoid, resurfacing of the humeral head ( i would NOT go fot the Copeland prosthesis specificallly as there are bettet ones than that), and even the Inspyre ball from Tornier. I would suggest that you send me your X-rays electronically to my e-mail address ( jodebeer@iafrica.com) and i would be able to  get an idea of wihich woudl be the most appropriate option for you. 

Just one last thing: there is never urgency in arthrtis surgery  as you were lead to believe by one person!

Regards,

Dr Joe de Beer

Good afternoon,

I have been experiencing some pain at the top of my arm on the outside when I raise my arm outwards past 90 degrees. Having been to a phyisio who said it was a problem with a tendom. She could put her finger in my shouldr and find a painful point in the joint.

 A few physio sessions and doing the exercises recommended have not made any improvement. She has suggested cortisone injection, I am hesitant without a second opinion. Any advice?

You could have a tear of the rotator cuff tendon or even a calcific tenditiis of the tendon.  You should see an orthopedic specialist ( preferably a shoulder sugeon) and get the correct diagnosis made so that the appropriate treatment can be instituted. You can aso look at my website at those two conditions to learn more about it.

Dr Joe de Beer

Hi Dr. De Beer what a cool sit to get information. I’m Deborahand a paraplegic in a wheelchair. About two years ago i had a rotator cuff repaired on my right shoulder two tendons was repaired. After spending seven weeks in hospital and about six months of physio therapy. i have gained full strenght in my arms and full range in my shoulder movement and thanks to yoy dr. Those weeks in hospital was not always easy but it was worth it.It is as if i never had any shoulder problems before. I will recommend any physically challenged paraplegic with shoulder problems to you. Thanks Dr.

Thank you for all your kind words Debrah. i am so pleased that we could get your shoulder to  become functional again as we all reallise how imortant that shoulder is for your everday functions like transfers, propelling your wheelchair and the like!

Best regards,

Dr Joe de Beer

I’ve had 2 shoulder surgeries in the past 2 years. The first was a slap leasion and the second was a resection of the AC joint. In between surgeries i’ve had an frozen shoulder as well. After the last surgery the pain went away, but after my first fielding session during cricket training i heard and felt a tearing noise and my shoulder started to hurt again. My phsyical therapist says that it’s probably an inflamnation of some sort. My question is: Should i take this season of to let everything rest en heal properly or should make a appointment with my shoulder surgion?

You should see an exprert and make sure of what the diagnosis is so that you do not wast time and rest with an injury which may not heal.

Dr Joe de Beer

Several years ago I dropped a gurney while working for a funeral home. The wheel did not lock when I pulled it out of the vehicle and I hung on to it instead of letting it go. I have horrible muscle spasms on my right shoulder. When it spasms I get this knot just below the surface. I have tried PT, Acupunture, and the chiropractor which gives me temporary relief. I have to take a muscle relaxer 4 times a day to keep it under control. My doctor and PT thinks I shortened those muscles so after I am active and stretch those muscles they go back to that shortened state and spasm. I am going to the pain clinic to see if they can help. Any ideas or suggestions?

The most likely injury is a nerve traction injury of your brachial plexus nerves. Someone should at least examine you and confirm the diagnosis before approprriate treatment is decided on.

Dr Joe de Beer

Hi Dr de Beer, I saw you last about 20 years ago with my right should which had to be operated on as the ligaments were torn well I have since been to Dr J Sagor for my left shoulder as I dislocated that one too and have since found out that i have stretched ligaments and am prone to dislocations, I’ve even dislocated my thumb on my car door. Well lets get back to the point, my right shoulder has for the last couple of years now been having these spasms and feelings of not been in the socket right (it even is lower than the other one) been to physio to no avail it just keeps coming back. At the moment I’ve hurt it again with a slight back/side movement and it felt like i was about to dislocate and immediately moved it forward, that was last night. Currently i have been in constant pain since with numbness and pins and needles going down to my fingers even while typing this, my shoulder blade is in alot of pain too and I have swelling all round. (the whole arm/fingers/shoulder/shoulder blade) what should I do, feels like I need to rest it again in a sling however I can’t find a decent sling anywhere. Please help!!! I hope this makes sense to you! Thank you for your time, Samantha Montignies (Carstens).

Samantha

Dear Samantha,

it sounds like you have a nerve compression = more than likely a Thoracic Outlet Syndrome . i would suggest that you visit us and let us confirm the diagnosis and prescribe the correct therapy.

Dr Joe de Beer

I have a military injury from 1982. I recieved an open bankhart procedure without bone gafting in 2003. I continued to dislocate ( L SHLD ) within weeks of operation. I have now, as before surgery, a very large humeral head deformity. I am now told I will need a latarjet procedure. What are all of the mobility limitations I may face for the rest of my life? What are the permanent worst case scenarios of what I will have to deal with for the rest of my life? Thank you for your time. Please respond.

Sincerely, 

David Janson

Dear David,

I do Latarjet procedures often for cases like  yours and i have perfomed it on many professional rugby players who then return to the same level of contact sports afther the surgery. We alsio have a rapid rehabilitation programme where we are able to get the players back to their activities very rapidly. We do for example, not put them in a sling after the operation and they  are able to move straigh away ,

Let me know if we can help you.

Dr Joe de Beer

Hi Dr. De Beer, I am a 47 year old female diagnosed with frozen shoulder (on right side – dominant side).  I have had this condition before on my left side about 15 years ago due to injury/bursitis.  It cleared up after 3 years.  This time the frozen shoulder came on for no reason.  Unlike last time, I had nerve pain running down my right arm, through my elbow and into my right hand to the point that I could not type/work.  NSAIDS helped for about 1 month until they started giving me stomach problems so I have had to discontinue.  I rec’d a corisone injection about a month ago which helped with joint pain.  However, the muscle pain is still substaintial, waking me up every night at least twice.  I have discontinued physio therapy due to not being able to tolerate the pain, and with no improvement in range of motion since this whole thing began 7 months ago.  Over the last 2 months, I have noticed a worstening grinding/crunching noise in my scapular region.  The trap muscles in this are are sore regularly and my shoulder blade feels like it is out of alignment (winged out) but I can’t tell because I can’t see back there to compare with my good shoulder.  I would not be suprised if my trap muscles and rhomboids have atrophied.  Now I am wondering if I have developed snapping scapula syndrome in addition to my frozen shoulder.   Due to my inability to tolerate agressive therapy, and now with this other alignment problem, I am wondering if I should just allow the condition to run its course or if there is something I should do to address the scapular pain – exercises?  I am seeing my Orthopaedist tomorrow.   So far, all recommended treatments have failed.  What can I do next?  Please help.  Thank you.

Kathleen

Dear Kathleen,

I apologise for my slow response. You are clealy suffering from a very severe frozen shoulder. To develop nerve pain happens often as the stiff shoudler causes the scapula to “wing” and that exerts traction on the brachial plexus with  nerve pain down the arm. Also, due to the movement now taking place a the scapuia and  not the shoulder joint, the scapula can develop symptoms like you are describing.  The pain you experienced with physiotherapy is often found and the inflamed shoulder should not be stretched with force as that increases the inflammatory response.

I would suggest that you have more cortisone injections as that will not harm you and could give you symptomatic relieg awaiting spontaneous recovery.

Hope you recover soon,

Dr Joe de Beer

MY MAN HET PERMANENTE EN ERGE PYN IN ALBEI SKOUERS. DIE SONAR WYS DAT HY “N GR 2 SKEUR IN SY SPIERE HET. HOE KAN ONS DIE PYN VERLIG EN WATTER LAE ROTASIE OEFENINGE KAN HY DOEN, LAASTENS HOE KAN ONS DIE HERSTEL PROSES VERSPOEDIG, SONDER OPERASIES.

Indien dit werklik a skeur van die rotaorkraag sening is sal dit nie herstek sonder ‘n operasie nie – hy moet ‘n spesalis sien – vir verdere raad kontak ons by info@shoulderinstitute.co.za
Dr Joe de Beer

more dokter hoe gaan dit vandag?? ek speel ny NWU rugby maar het my skouer seer gemaak weet nie wat fout is nie!!! maar kon hom nie vir n week optel nie, maar hy beter nou het net baie krag verloor!! as ek altwee my skouers horisontaal optel dan lyk dit by die een wat seer het of daar n gat is( spiere missing) ek weet nie wat om te doen nie!!!!

Dankie vir die tyd.

Kobus

Beste Kobus,

Dit klink of daar ‘n redelike probleem is – ek dink die beste sou wees as ons jou ondesoek en die presiese skade beoordeel. Ek weet nie waar jy woon nie maar sal jy hier by ons kan uitkom. Kontak ons ook op e-pos by

info@shoulderinstitute.co.za

Dr Joe de Beer

I’ve been having trouble with my shoulder for quite some time. I went to a physical therapist and he said it was from Bicipital Tendonitis. Then once I rested and healed. I notice a shift as my Teres Minor became painful. Once that rolled over, I now notice currently what feels like my Rear Deltoid becomes strain after a Back/Shoulder Weightlifting. Is there anyway for me to pinpoint this myself? would you be able to direct me to a page where I can research what may be the problem? Thansk in advance.

The shoulder notoriously localises pain poorly and self- diagnosis is not possible . The best way is to examine a shoulder, review the X-rays and scans and so on and then to arrive at the correct diagnosis.

Dr Joe de Beer

Are correctly performed push ups contraindicated for individuals without specific injuries or conditions?

 Is there an age at which push ups (correctly performed) should be avoided?

There are no  problems with push-ups in normal individuals. You may continue them until your health and strength allows you to.

Dr Joe de Beer

We saw an orthopaedic surgeon today regarding shoulder pain.  the surgeon decided to perform an injection into the left shoulder and upon the nurse pulling his arm down, he was in excruciating pain.  the surgeon said that is not normal.  when we asked further as to why he said nothing and proceded to tell us to come back in 4 weeks.  do you have any thoughts as to what is causing htat pain?

It really depends what the primary cause of your pain was in the first instance-was it calcific tendinitis or frozen shoulder?

Dr Joe de Beer

I have had TOS for 7 years but was just diagnosed and just had the surgery for it last week by a neurosurgeon.  My pain has been excrutiating for years.  I have a winged scapula also and arm and shoulder instability and weakness.  When recovered what is the best exercises to do to strengthen all these muscles again but not cause injury.  Still having some pain so I don’t know if I am going to be 100%.

The best exercises are so- called “scapular setting” exercises – a physio will be able to demonstrate them to you.

Dr Joe de Beer

I have had shoulder pain now for five months following an injury in the gym doing stomach crunches holding weights behind my head. The pain and range of movement have become progressively worse. Following an MRI with Arthogram last Monday I have been in exrutiating pain. The results have shown calcific tendonitis and a torn capsule in my left shoulder. My consultant has given me a shot of cortisone to help with the pain but this has not worked and I have cried myself to sleep with the pain for over a week. Will both conditions heal themselves or will I need surgery? I cannot dress myself, drive, eat with a knife and fork and my daughter has to brush my hair, I have also now gone off sick from work now because of the pain. Please help. What is your recommended treatment path for these conditions?

The cause of the pain would be the calcium deposit ( look at our website under “Calcific Tendiniitis) and you will see all the treatment options there- one of which is the “needling” where we such out the calcium unde ultrasound control.

Dr Joe de Beer

Hoe kan ek ‘n tennisskouer behandel.  Ek het 3 maande gelede 300 spykers in ‘n muur op oohoogte gekap,  daarna kon ek glad nie tennis speel nie.  Help asseblief.

‘n Diagnose moet gemaak word vir die oorsaak van jou pyn- die mees belangrike is om te bepaal of jy nie die rotatorkraag tendon van jou skouer geskeur het nie. Kyk gerus na ons webwerf en spesifiek na “Rotator cuff  Tears”.

Dr Joe de Beer

Ek het al 4 nek operasies gehad en en 4 rug orals is plate en skroewe ingesit. Nou het ek vreeslk pyn in my heupe ek kn skaars behoorlik loop.

Ek het vir ”n MRI Scan gegaan vir my nek en rug. Daar is niks fout met my heupe nie dit is die skroewe wat laag ingesit is so 4 jaar gelede wat die pyn veroorsaak.Die Neuro Dr wil ”n Morfien kareter in my spinale kolom insit en dan die pompie voor by my maag sit. As die pyn te erg raak dan druk ek die pomp en dit laat Morfien vry om die pyn te verig. Dan is daar ”n andermetode van die Micro Chip met Batery wat hy die Chip in die middel van my rug kan sit maar die probleem is dit werk ie vir my nek nie. Wat stel U voor moet ek doen. Baie dankie.

Riekie

Ek het groot simpatie vir jou Riekie maar ek is ‘n skouer spesialis en nie baie kundig in die gebied van sulke pynbeheer maatreels nie.

Dr Joe de Beer

6 yr old female with stage 1 (12 yrs) parikinson’s – Fell  while running(stupid i know) about a year ago – lately symtoms got much worse – couldn’t use my arm at all – pain when doing anything as well as doing nothing – contant pain. Had MRI – it found complete tear of the subscapularis w/ retraction to the glenoid rim. Supaspinatus tendinosis. Partial tear of the articular surface of the infraspinatus tendon. Tear of the superior lbrum (slap 11). AC joint arthrosis and small joint effuson. The elbow on the other arm had tentoninosis. Doctor gave me cordisone shot in elboe . The residual effects from the shot made my other shoulder feell so much better. My doctor said inoperable (main tendon)due to length of time  gone by-What about the other tendons i ‘ve menioned – won’t things get worse .How many cortidsone shot will i be taking – iIsn’t that ike a Bandaid. Dr joe, what do you think?

The outcome of especially a persistently torn subscapularis is not good. Of all the pathologies mentioned that is the single most important component. You may have cortisone injections as a primary repair of the tendon is not possible any longer. in desperate cases one can consider a pec major transfer procedure or in certain cases even a  Reverse prosthesis ( but sounds as if you are too young for that).

Dr Joe de Beer

Hello.  I do mild weight training and over a year I seem to have developed TOO.  No other etiologies identified. What weight training exercises are appropriate with this condition? What exercises should absolutely be avoided?

The nerve compression may be aggravated by pressure from  the scalene muscles in TOS and heavy upper body exercises my cause hypertrophy of those muscles and then increased compression, The single one exercise which is contra-indicated is shoulder shrugs.

Dr Joe de Beer

4 months ago I had surgery to repair my left subscapularis. It was found to be irreparable. The tear was complete and the remaining tissue responded in a frayed-like manner. The injury, due to a fall down a flight of stairs, had occured 3 years previously and at that time no MRI had been prescribed and I was treated with PT only for a brused rotator cuff. The most recent surgeon also removed a bone spur and I have felt fine until recently when I used my shoulder in a swinging manner. What should or should not be my expectations of shoulder mobility and pain? What do you see as my prognosis?

A persistent tear of the subscapularis will usually not have a good outcome and may require a muscle transfer procedure (pectoralis major transfer ) which works well in many cases.

Dr Joe de Beer

Hi docter i had an operation about a year ag with you where i had an injury while playing rugby u manage to straighten out the shoulder bone and make it even againeverything was fine but lately(id say past 2 months)it has been giving me such pain and discomfort all the way down my neck what could it be?

Kind regards.

That sounds like an unrelated problem- could be a nerve in the neck – you should be examined some or other time.

Dr Joe de Beer

I sub located my shoulder in boxing yesterday (19/01/2012) and i have woken up this morning with a rather stiff shoulder running into my tricep. Is heat or cold the best treatment? How long after should i rest it for? I have been suffering with this sublocation problem for many yrs, what is the best way to treat it. I have managed to strength it with boxing and excercise but i am still battling everynow and then. 

Thanks.

You  suffer from recurrent instability of the shoulder and the best way forward is to have a surgical stabilisation procedure as the repeated episodes of subluxation is causing progressive damage to your shoulder.

Dr Joe de Beer

Dr Joe de Beer

Orthopaedic Shoulder Surgeon

Dr Joe de Beers’ practice is confined to the care of shoulder problems of all types, and he does both open and arthroscopic surgery. He is a keen shoulder arthroscopist, and has developed an expertise in ultrasound of the shoulder, both diagnostically and for intervention.