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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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Hi, can you help me figure this out? AT first I was presumed to have frozen shoulder, but now possible TOS, or is it a mechanical fault / injury. Which way to turn? Pain in Right AC joint, at the distal end of the clavicle. It is likely to be caused by a repetitive strain injury as my work is fairly physical. I often have to lower heavy loads by extending my arm and sometimes have push downwards, as I using a spring loaded contraption for work. This apparatus has occasionally failed me leaving me with discomfort. My symptoms now are: posterior and lateral arm extentions above 80 degrees or so cause pain in the anterior area of AC joint, and a brusied sensation over the AC joint. Cannot lie on shoulder but otherwise am able to cope without any pain meds etc. provided I moderate my movements. At first it was very painful and all movements were difficult – like a frozen shoulder. This eased after about eight weeks and now pain is very “localised” in the joint itself. However, lately have been experiencing numbness extending from elbow to include lateral forearm, little and ring fingers. Numbness does not result in loss of function, just feels a bit cold and like a local anaesthetic when bad. I avoid carrying heavy loads as low carrying (groceries etc) at times causes a “stretching” sensation at the elbow into the forearm. There is lately some weakness in the hand, but not severe, just with movements like turning a key in a lock or opening a jar. No xrays as yet because want to be sure where to start due to limited funds and a preference for no surgery. Really appreciate this opportunity and would be grateful for any advice to help with steering me in the right direction regards diagnosis and conservative treatment.

Mrs. M.Mitchell

This sounds like TOS. We would be quite happy to see you and confirm the diagnosis. We lso have a physio who specialises in the condition and gets results. Alternatively we can also treat TOS by injecting botox into the scalene muscles. This can all be discussed during the consultation.

Dr Joe de Beer

Hi, my husband has a nerve that has pinched – TOS which is affecting his circulation, breathing, etc. He has seen GPs, orthopedic surgeon but no one has been able to diagnose TOS, After much research, we have found that it definitely is TOS. What are the solutions? Thank you, Amy.

Amy

Dear Amy,

The solution is for your husband to see a thoracic surgeon to decompress it. If there is also vascular compression, it is an urgent matter because a thrombosis-anuarysm can occur. The surgeon who we usually send our patients to is Dr Dave Harris in Kuilsriver hospital – (021) 900 6411.

Dr Joe de Beer

Dear Dr De Beer,

I’m not sure if you received my question, so I rather send it again. Could you kindly let me have a second opinion on the following:

Shoulder pain started in January 2013. I went to the doctors in June 2013 and went for x-rays and an Ultrasound. Full thickness tear on right shoulder – supraspinatus tendon.

We first tried with cortisone injections. I had 3 in total. July 2013, September 2013 and November 2013.

The inflammation/pain always came back after +/- 8 weeks. In January 2014 (21/01/2014) I had an MRI and the doctors decided to operate.

Had surgery on 11-02-2014. For 8 weeks in an arm sling. All went well and no pain.

Went to Physiotherapy after 6 weeks.

After +/- 12 weeks pain started, this time in both shoulders and the pain moved all the way down into both underarms.

They first thought it must be pinched nerve.

In between doctors put me on different painkillers again.

My GP sent me for a sonar on both shoulders, to see what is going on (20.08.2014) As per the report, now both shoulders got an inflammation and suggestive torn tendon again in right shoulder and cannot exclude torn tendon in left shoulder. (I tried to attach the rapport, but the format was not allowed)

Could you kindly give me some advice. If you need any of the other reports, x-rays, MRI, scans or anything else. Please let me know

 Thank you very much in advance.

Manuela Rechter

Dear Manuela,

From that report, you may as well have re-torn the operated shoulder and have a tear on the other shoulder. consideration should be given to a revision of the repair. What we would normally do, is do our own ultrasound, confirm the pathology and go for the appropriate treatment. If you need our help you may phone our rooms @ 021 9111 017

Dr Joe de Beer

My mom is 84 & tripped 3 tmes at work (she worked waitressing F/T) The 3rd time she fell & hit her shoulder on a chair on the way down & broke the top humerous bone. That was 2/12/2014, she was in skilled nursing facilityfrom approx. 2/15 to 5/7. She has been going to therapy twice weekly & they had a measuremnet of 52% (guess that was how high she could raise it. She also cannot grasp or forma fist. It was a clean break, no surgery, then one of the aids in Nursing Facility got impatient with her & grabbed her by both arms in order raise her up higher in a sitting position. Now it sems the break is not aligned & is outward & forward. Soory that was just some background. While in therapy the therapist notice the broken shoulder is higher than than the normal shoulder. What would cause that to happen? The first 2 xrays were done at hospital. The last image from CT April 9th. Hope you can open them! I appreciate any input! Thank you

Hi there

Where did your mom have her x-rays taken?  We may be able to access them online and have a look. Please email us the necessary information to info@shoulderinstitute.co.za, and we will see what we can do for her.

Dr Joe de Beer

Dr. de Beer en span, goeie naand, hoop dit gaan goed. Ek het u gekontak 2010/2011 ivm TOS simptome en inligting, waarop u my geantwoord het met baie volledige epos. Baie dankie. Ek is toe verwys deur my GP na Panorama Hopsitaal waar ek gediagnoseer is met Arterial TOS en in 2011 is my linker boonste 1ste rib verwyder. Geen komplikasies, dankie tog, maar ongelukkig baie min tot gee verligting. Omstandighede was egter so dat ek nie regtig kon gaan vir ‘n opvolg of om die 2de operasie aan die regterkant te kon doen nie. Ek kon “cope” tot datum maar die afgelope 2 weke het ek geweldig, mper onuithoudbare pyn aan my linkerkant. Konstante pyn agter op my linker skouerblad, nekspier bo my sleutelbeen, agter links by my nek, my bo-arm by my skouer het ‘n brandende pyn asook my linker arm by die elmboog, my pols brand permanent en my hand se gebruik aksie is definitief stadiger as gewoontlik. By die werk vandag het ek verskeie items laat val, my linkerkant heeltyd gestamp en ek voel effens van balans af. Dit kan ek alles hanteer maar die konstante pyn (bruised or pulled burning muscle) gevoel is regtig besig om my onder te kry. Ek kan nie aanmekaar pynpille drink nie, dis nie gesond nie en dit verwyder nie regtig die pyn, dit verdoof dit net. My kinders is nog jong en ek is baie op die pad, dis gevaarlik, gelukkig is die week vakansie. My vraag (na al die gekla, hiehiehie) is dit ‘n probleem wat kan voorkom na “rib removal, armpit surgery” of is dit ‘n kruis simptome van my regterkant wat nooit gedoen is nie? Ek vra onverskoning dat ek afpak, maar ek is regtig moeg en voel opgesny en moedeloos want ek kry nooit regtig antwoorde of hulp van plaaslike Weskus dr’s. Hulle dink ek ly aan ippikonders.

Vriendelike groete

Tania Mouton

Die linkerkant kan ook TOS wees- maak ‘n afspraak met dr Dave Harris vir ‘n opinie.

Dr Joe de Beer

Hi dokter

Ek het 2 maande terug my skouer seer gemaak in rugby en het ‘n sling gedra vir omtrent 2 weke en was by 4 fisio sessies. My skouer was nog seer na dit maar ek het reg gevoel om weer rugby te speel en het ‘n week terug weer rugby gespeel en dit weer van vooraf seer gemaak. dit is ‘n pyn van van agter my skouer tot in my tricep? Ek weet dit is nie ‘n been nie maar dalk ‘n ligament of spier. Ek het ‘n afspraak, maar kan dokter net vir my sê wat dokter dink dit mag dalk wees asb?

Groete 

Dit kan ‘n labrum besering wees maar dit sal kan bepaal word tydens ondersoek. As jy ons wil sien laat weet  :021 911 1017.

Groete,

Dr Joe de Beer

I had pec major transfer to scapula for scapular winging I lifted something heard a pop now I’m having trouble lifting my arm and the muscles in arm and chest are killing it hurts to cough or take deep breaths also what could it be?

Dear Jean,

The pec major transfer may have ruptured. You must see your surgeon or if you want us to have a look please phone (021) 9111 017 for an apointment.

Thanks

Dr J de beer

Dr Joe de Beer

Hi Dr De Beer

Thank you for a very informative web site. I had a mountain bike accident about 3 years ago. A plate with  screws was used to  repair the fracture. Since then I have been experiencing pain and discomfort in the shoulder. With numbness and swelling of the shoulder. Making it very difficult to ride my bike. Would you suggest taking the plate out.

Thanks

Sharon

Dear Sharon,

You do not mention what fracture was it. Is it a fracture of the clavicle? If so, xrays must be done to make sure the facture has united. If it has, then the plate can be taken out. Another cause of pain could be that the screws are too long and irritate the brachial plexus (which are nerves below the clavicle). You may get such an xray and mail it to us for our opinion.

Thank you.

Dr Joe de Beer

I have a bankart + a HAGHL lesion , should I have surgery?

Thanks, regards Mauro

Sharon

Dear Mauro

Yes indeed – the combination of those two lesions renders your shoulder highly unstable, and it should be fixed.  

You can contact our rooms on 021 911 1017 to arrange an appointment.

Thank you,

Dr Joe de Beer

Hi Dr De Beer

 I at gym bench pressing when sudddenly my should made crunching sound, close to that sound of biting into chicken gristle, i have given the benching a skip for 2 months and i still can not move or press any weight hevier than 22kg without it being Debilitating, and if i rest the back of my shoulder against a object i can feel a pain shooting from the back to the front…

PS* sorry no xrays

Kind regards

Shaun Browne

Dear Shaun,

You could have torn your Labrum (cartilage) or a tendon. It would be best if you see a shoulder specialist for a diagnosis and treatment. For our help phone (021) 9111 017.

Dr Joe de Beer

Hi Dr de Beer,

a follow-up on my previous enquiry. My daughter experiences severe pain when she lifts her arm up to shoot the ball, do a breast stroke swimming motion, or reaching up above her head or certain cross chest reaching movements. She is very dispondent at this moment as she has quite a few big tournaments coming up this term for water polo. Regards Margo (Photos the same as with previous question)

Please remind me of what was on the previous enquiry. It sounds like your daughter is suffering from Thoracic outlet syndrome (TOS)http://www.shoulderinstitute.co.za/Thoracic_outlet_syndrome, and needs to be seen and examined by a shoulder specialist to confirm this and for further treatment. You may contact us on (021) 9111 017.

Dr Joe de Beer

My right sholder has drooped and i have pain in sholder and bicept 1 year after rotator cuff and bicept tendon repair What causes this?

Could you send us a picture of what it looks like so we can make a diagnosis? send it to info@shoulderinstitute.co.za

Alternatively come  and see us – phone 021 911 1017.

Regards,

Dr Joe de Beer

My husband  recently passed a kidney stone dr told him he may have calcium deposit .going to see urologist. Last week he  hurt his  sholder could this pain be related to the calcium deposit  he has?

If there is Calcium in his shoulder it could be.

Dr Joe de Beer

AC removed 12 months a go, every day very much in pain.

The cause of your pain could be due to incomplete removal of the AC joint or the initial problem was not of the AC joint – Thoracic outlet syndrome can also cause pain in the AC joint.

Dr Joe de Beer

AC removed now more painful then ever shoulder buns when I pick up arm for to long.

The cause of your pain could be due to incomplete removal of the AC joint or the initial problem was not of the AC joint – Thoracic outlet syndrome can also cause pain in the AC joint.

Dr Joe de Beer

Good morning Doctor, I had a shoulder op on the 30 September 2013. They removed calcification. I have no pain but my muscles has been in spasm from the moment they removed the pain block. I have had spasm ever since. I was re-admitted. I have been back to the specialist and normal doctors for them to help me get my muscles to stop going in to spasm but the moment I start using my arm, I am in pain again due to my muscles. All the doctors do is give me more meds to use and my muscle spasms do not subside.Can u give me any advice please.

Charlotte

Dear Charlotte,

 Because of the spasm and pain, could be that there is still calcium left on the shoulder or the block has affected one of the nerves. You need an x-ray to verify complete removal of the calcium and an examination to check if the nerves are ok. If its possible for you, we could check it for you – tel for appointment (021) 9111 017.

Thank you,

Dr Joe de Beer

Hi there. I have dislocated my shoulder in February, posterior. It then re-dislocated, posterior, again in July and last weekend. I haven’t seen an Orthopaedic yet as I can only do surgery next year as I am playing on going to work at a ski resort this year. What is the best support brace I can get in the mean time?

Unfortunately a brace will not prevent the shoulder from dislicating – you will need to see a surgeon for it. You would be welcome to see us : 021 9111017

Regards,

Dr Joe de Beer

Dr. Joe, I have dislocated my shoulder about 4 times in the past 4 years playing rugby. I’ve been for many physio sessions and only recently was my should relocated properly. I’ve been doing all my rotator cuff workouts that the physios have given me but still to this day it feels very unstable. I really want to be able to go back onto the rugby field and perform to the best of my abilities. Do you by any chance have any advice for me?  I havent had any x-rays or anything of that sort done. Kind regards,   JP.

Dear JP,

We fix large numbers of shoulders for  rugby players with recurrent dislocating  shoulders including professional players. We do a surgical procedure specially designed to allow the players to get quick rehab and early return to play.

You are welcome to come and see us and we can discuss it: 021 911 1017.

Dr Joe de Beer

Good day Dr de Beer, I have been experiencing shoulder pain for many years, including pins and needles running down my right are,I have recently had a should op  but have since experienced severe pain at times even when at rest.I have had a neck MRI as my doctor wanted to ensure that the problem did not arise from there..nothing detected. In desperation whilst in Joburg last week I saw a GP and he has told me to contact you.Reading through your website I as sure that I have T0S.The pain at times is unbearable, sharp pain in shoulder blade ,top of the shoulder and sometimes up towards the neck. At times is feels as if worms are running inside my arm.Please help.Thanks Ben Burger P.S.I am in East London but do think that I will be coming to see you A.S.A.P.

Dear Ben,

I agree with you that this could well be TOS. If you will have a chance, i can see you this weekend in Port Elizabeth, I’m doing a clinic there.

 You may phone my rooms: 021 911 1017.

 Regards

Dr Joe de Beer

Hello dokter Jy het my op die 3de okt geopereer vir n klas 3 ac joint separation. Wil net weet hoe lank sal die hele rehab vat tot ek weer sport sal kan doen(rugby, krieket en golf)? Groete Marius.

Se net Marius – was dit 3de Oktober 2013? As dit nog nie reg voel nie is daar fout en moet ons jou sien. Gewoonlik dan die pasiente na daardie operasie binne twee maande begin met sport. Wil jy nie vir ons kom sien nie – Soos jy weet kom ons gereeld Stellenbosch toe. Ons het mos gesien dat ‘n klein stukkie been afgebreek het by die gewriggie en jy het gevoel op die stadium (konsultasie  21 Mei 2014 ) dat dit jou nie veel pla nie. Miskien moet ons jou sien en die saak heroorweeg.

Hoekom skakel jy nie my dames nie (021 9111017) en ons maak ‘n tyd.

Groete.

Dr Joe de Beer

My arm started paining (between the elbow and shoulder) and the pain has spread up tp my shoulder and the back of my shoulder.. it hurts when i lift my arm or use it. it has gotten worse over the last couple of weeks. i have gone to the doctor but only received pain medication.. the whole shoulder, arm and neck feels stiff.

The cause of this could be one of a few things – frozen shoulder, rotator cuff impingement, calcific tendonitis or even a rotator cuff tear. You should see a shoulder specialist to make the diagnosis and suggest the appropriate treatment. You are welcome to contact us on 021 9111 017 for an appointment.

Dr Joe de Beer

HI DR JOE I HAVE SEVERE WINGING OF THE SCAPULA, WHICH OCURED AFTER HAVING A LYMPH NODE REMVED ON MY NECK OVER 15 YRS AGO,AND SOME NERVES WERE SEVERED. IT IS NOW CAUSING EXCESSIVE PAIN AS THE SHOULDER IS VERY HEAVY, IM 48 FEMALE, LIVING IN DURBAN, AND WAS WONDERING IF THERE IS ANYTHING THAT CAN BE DONE TO HELP WITH THE PAIN, IT HAS BEEN SUGGESTED THAT A TRANSFER OF THE PECTORIAL MUSCLE CAN BE USED TO HOOK UP THE SCAPULA, IS THIS CORRECT, LOOK FORWARD IN HEARING FROM YOU, I CAN SEND PICS IF REQUIRED. THANKING YOU ERIKA COLLINS

Dear Erika,

Yes it  is correct, the previous pec major transfers we did for this problem worked very well.

Regards,

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.