Cape Shoulder Institute


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Questions & Answers – Page 2

Questions relating to shoulder pain or previous surgery answered by Dr Joe de Beer.

Ask Dr Joe de Beer

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

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Hi.  This is a fantastic website.  I wish I had read it before having my shoulder surgery; perhaps I would not done the surgery.  

I am 3.5 weeks post-op.  I am a 58 yr female and had surgery due to calcific tendons on the right shoulder.  I have always been athletic and active in the yard.  I have yet to get surgery notes from the doc.  I have trouble doing the second phase of exercises -too much pain to push through.

When should I become concerned about developing a frozen shoulder?  I have been somewhat active, but have to slow down due to pain in the left shoulder. Any suggestions or words of experience/encouragement?

In post removal of calcific deposits, frozen shoulder often develops in middle-aged females, which can be treated successfully with intra-articula (gleno-humeral joint) cortisone injections. The other cause of pain post removal of calcium is incomplete removal of calcium and an xray would show this. if tou want us to have a look, you can phone our rooms on (021) 9111 017.

Dr Joe de Beer

Goeie dag Dr de Beer. My pa het in Junie 2008 sy regter skouer seer gemaak by die werk(werksbesering) en in daardie selfde jaar toe beseer hy sy linker skouer by die huis, en van daar af was hy by Dr. Cronje wat die eerste operasie gedoen het op die regter en linker skouer, wat nie herstel het nie, van daaraf het was hy by Dr. MD Verrier wat die 2de operasie gedoen het op sy regter skouer, dit was nou in Januarie 2012, Dr Verrier het in Junie 2012 weer xstrale geneem, wat ek vir u aanheg. My pa het nog al die pad pyn en drink al vir amper 2 jaar pynpille en die pyn word nie beter nie, en of die skouers ten volle herstel het weet ons nie, ek dink net dit kan nie goed wees vir hom nie, hy is nou al 57 en ons bly op oudtshoorn, maar ons sal ‘n plan kan maak as dokter hom wil sien.Die pyn is besig om hom onder tekry en ek wil hom baie graag help om beter teraak. Die pynpille wat hy drink is Tramacet. Ek sien op die verslae wat die dokters al gegee het word daar beskryf van “The subscapular tendo appears hypoechoic and irregular. The bicipital groove is empty, with the long head biceps tendon taht could not be located.Extensive full thickness tear of the supraspinatus tendon, with tendon retractrion, and complete absence of the distal tendon. The tendon gap is filled with compressible hypechoic fluid. The infraspinatus tendon apeears unremarkable”. Dit was vir regter skouer en dan linker skouer “a very thin redundant long head biceps tendon is noted in the bicipital groove. The subscapular and infraspinatus tendons appear unremarkable. Just proximal to the footplate of the supraspinatus tendon there is focal loss of the normal fibrillary tendon structure, with inhomogeneity of the tendon at this level, with loss of the normal superior convex tendon contour, with the involved area measuring approximately 5 mm in diameter, suggesting a non retracted full thickness supraspinatus tear.” Sal u ons asb kan help of raad gee, want ek kan nie meer my pa so in pyn sien nie. Baie dankie, groete. Suzanne (dogter).


Beste Suzanne,

Ons sal hom moet sien en julle kan dan die MRI saambring. Ons kan dan ‘n redelike plan uitwerk om hom te behandel. Ons kan dit so reel  dat  ons hom sien op ‘n dag  en moontlik ‘n operasie doen die volgende dag

Bel 021 9111017 en vra vir Sam wat my sekretaresse is  noem aan haar dat hy die pasient is wat die navraag op die website gemaak het


Dr Joe de Beer

Hello I am writing from Edinburgh in Scotland.I have acute tendonitis due to calcification (xray yesterday but not available to me).  I am due to travel to Cape Town for work on 16 Oct for one week.  If the pain does not improve I will need to seek further treatment.  Could you tell me what are your fees and also would you be willing to treat me on this basis?  I had a total shoulder replacement on the other shoulder last January from Miss Julie McBirnie on the NHS.  I know what a difference it makes to lose the pain.Unfortunately she is on holiday so I will not be able to ask her advice before travelling. Thanks very much for your help. 


Dear Judith

Thank you for your enquiry.

We will most certainly be able to help you.  You can contact our rooms on 0219111017 and make an appointment.  Our consultation fees are R600.  If we do an ultrasound and cortisone injection it can go up to R1700.  We can decide on further treatment once we have assessed and diagnosed your shoulder problem.

Thank you,

Dr Joe de Beer

Hi Dr De Beer

Het dr nie vir my n verwysende dr in Pretoria wat kan die botox injection vir my gee in die skaleen spiere. Ek het met dr kontak gemaak en dr het gese my probleem kan thoracic outlet sindroom wees. Is n cardio thoracic surgeon die regte dr om te gaan sien ivm my tipe probleem.



Die regter persoon is ‘n Neuroloog wat u moet sien. Vind ‘n Neuroloog wat wel die Botox inspuitings gee. Die meeste van hulle doen dit.


Dr Joe de Beer

Dr. deBeer,

What a great opportunity to be able to ask you a question!  Thank you.  

My 16 year old son has dislocated 4 times and had two labral surgeries, I shopped for a new ssurgeon and found Dr Aubrey Smith in Amarillo TX.  He indicated that he would do the Latarjet surgery and that he was taught in France. Is this where you trained.  How do I know if he is doing the surgery just as you have on You Tube?  What are some questions we should be asking?  He has done 22 Latarjets in under 3 years.

Thank you so much for your time.


Hi there,

The french technique of Latarjet is an excelent one, importantly is to ask if the operation is done through a subscapularis split and NOT by detaching the subscapularis.

Thank you,

Dr Joe de Beer

I am a manual therapist from New Zealand,practicing in the US currently. I am also a Mulligan practitioner and have a technique which often eliminates meniscal pain at the ac joint. Are you aware of this conservative approach? For many years in NZ I treated rugby injuries for visiting teams,including Springboks,in the days of Danie Craven.Am interested in reading any publications re the presence of meniscus in ac joints.

Anatomically there is obviously a meniscus in the AC joint but I am not aware of the technique that you are refering to, kindly share this info. Our email address is


Dr Joe de Beer

Dr thank you for a wonderfull platform where we can express our concerns. Doc i saw you on the 10/09/2012 with a shoulder problem. You did a rotator cuff repair on my left shoulder in 2008 and it was a sucess and let me add that i’m a paraplegic in a wheelchair. The last two months i started having the pain again especially at night time when sleeping on the side. You injected the shoulder and for the first time in two months did i not wake up during the night but moving my arm still hurts. i have confedence in you that if i need your help that you would be able to help me. Although i’m in a wheelchair i’m a very independent person. Thanks doc. 

Debbie Bedien

Dear Debbie

It’s nice to hear from you.  Please do let us know if you need any further help.

Thank you,

Dr Joe de Beer

Middag Dr Joe

Ek is ‘ n dame van 45 jaar.  Ek het twee vrae.

As tiener (± 1980)het ek infeksie in die murg van my sleutelbeen gekry.  Drie gaatjies is geboor vir dreinering.  My sleutelbeen het kort daarna gebreek en ek het drie operasies ondergaan:  die eerste ‘n pen en beenoorplanting, tweede ‘n draad en weer beenoorplanting.  Die derde operasie was ongeveer 20 jaar gelede, waar ‘n plaat, skroewe en ‘n stuk draad gebruik is, plus weer beenoorplanting.  Na hierdie operasies het ek nog steeds aan sport deelgeneem.

Oktober verlede jaar (2011) het ek probleme met bursitis en die AC gewrig geky en dekompressie is artroskopies gedoen.

Op 13 Augustus 2012 moes ek weer ‘n artroskopie ondergaan, omdat daar ‘n skeur in die labrum was en weer ‘n groot bursa.

Ek heg hierby aan x-strale wat van my skouer geneem is.  Volgens die een x-straal, lyk dit of die draadjie en lang skroewe probleme kan veroorsaak.

Die twee vrae wat ek het, is:

1.  Sou dokter met die inligting beskikbaar, aanbeveel dat die huidige plaat, skroewe en draad verwyder word?  Moet dit dalk vervang word?

2.  Daar is probleme en degenerasie in my nek gevind met ‘n MR (C3/4, C4/5 en C5/6).  Ek het die MR verslag beskikbaar, en sou net graag advies wou inwin of ‘n operasie regtig nodig is.

Dankie vir dokter se geduld met my lang e-pos.  Ek sal u advies hoog op prys stel.


Estelle Joosten

Ek kan nie die XS te sien kry hier nie – stuur dit na ons praktyk: sodat ek  dit  kan sien.

Dr  Joe de Beer

Dr Joe de Beer

I’ve had a painful shoulder injury for a few months now. (not sure how i injured it) My OS diagnosed moisture in ball & socket joint of the left shoulder and a hairline tear in the muscle. After 2 cortizone injections & physio therapy its not healed. What now? how serious is this problem? I cringe to to think of the pain again of those injections so I’ve just stayed away from all drs and surgeons.

Dear Christelle

Dear Christelle,

It would be best that you are seen and examined by a shoulder specialist for a diagnosis and further treatment to be discussed. Phone us on (021) 9111 017 for an appointment.


Dr Joe de Beer

Hello Dr. Beer, Your discussions are appreciated and quite informative. After an MRI on 7-14-2009, I was diagnosed with a complete rotator cufff tear. Insurance would not cover an operation and I could not afford to pay for it myself. As a result, I have lived with pain and limited use of my shoulder for about 3 years. Recently, insurance is now paying for tests, etc. An arthogram / MRI w/injection was performed a couple of days ago. Findings, (Now) are “Prominence of the AC joint, mildly compressing the tendon of the supraspinatus” “No evidence of a rotator cuff tear”, Enlarged greater tuberosity of the humeral head, consistant with chronic impingement” I am an active guy, I haven’t been able to work-out in some time, have limited strength of the (L) shoulder, and under consistant use, the shoulder fails and becomes extremely painful. Question: I have been told that rotator cuff tears do not heal themselves, Why does an MRI, (from 3 Years ago) show a “Complete Tear”, while the current MRI shows “No Tear” Use and or therapy of the shoulder only increases pain and discomfort, I don’t want to take any drugs for this condition, and I want full use of my shoulder back again.—What do I do? Would a surgical proceedure show anything that the contrast MRI does not show? If I start working out again, could the tear reappear and become evident again? What is your opinion on these matters?

You should see a shoulder specialist to examine you and work out the diagnosis and prospective treatment. If you would lilke  us to have a look  at you you may phone 021 911 1017.


Dr Joe de Beer

My mother 0f 83 has recently been to see an orthopedic surgeon. He has said that there is nothing that he can do and has referred her to Dr Osman in Durban. We alive in Kloof.  I attached a copy of the x ray. Please advise.


Dear Claire

This is an ideal case where a Reverse prosthesis will help her to reduce her pain and afford her active mobility again.  She suffers from cuff arthropathy, and this prosthesis is specially designed for this condition.  If you want us to help her, phone my rooms on 021 911 1017 or mail us at  We have been doing this procedure for almost 20 years, and the results are great for patients of her age.

Thank you,

Dr Joe de Beer

Hi docter ek het n pyn in my arm gekry en bors het n ekg gedoen en bloed getrek dit is amper 2 maande en pain is in my nek bors onder arm en kakebeen wat kan dit wees ek kan nie meer uit hou ni

‘n Mens sal jou moet  ondersoek om die diagnose te  maak- klink nie soos ‘n skouerprobleem nie.

Dr Joe de Beer

Hello, my name is Garth Campbell, I have had a subscapularis tear, significant but incomplete in a mva 01 -07-12 there is a fracture of the scapula transversely below the spine which is approximated nicely laterally but not so well medio-distally. There is also a fracture across the neck of the acromian which is healing nicely, to top it off i have a failed pectoralis major from brachial plexus surgery. The problem is that the arm wont flex anteriorly nor is there any function in front of my face or above my head with any kind of strength, and the suggestion is to fix the subscapularuis arthroscopically and plate the neck of the acromian but not attempt any work on the pectoralis. suggestions please


Dear Garth

For a complex situation like this, I would ideally have to access you myself to work out an appropriate surgical solution.  If you need to contact us you can call the rooms on 021 911 1017.

Thank you,

Dr Joe de Beer

I am a certified personal trainer looking for advice with a torn rotator cuff.  is it safe to perform Chest Flys with a torn rotator cuff.


Dear Joseph

If the flyes are not painful it is safe, but if you have a definative rotator cuff tear it should be fixed surgically.

If you have any further queries you can contact the rooms on 021 911 1017.

Thank you,

Dr Joe de Beer

Dear Doctor. I have recurrent right shoulder dislocation, upon MRI, I have been detected have  1. Hill-Sach’s defect involving the right humeral head  2. Bony Brankart Lesion with anterior glenoid labrum tear.  I am here by attached the MRI report and related MRI images for your kind advice. Please advice whether I need surgery, whether it is for both the problems or only one. Provide me with the costing details. Regards Vijay 


Dear Vijay

A congruent arch latarjet procedure will deal with both lesions, and we do that usually for professional athletes as well with great success.  If you want us to help you, you can contact our rooms on 021 911 1017 to arrange an appointment.

Thank you,

Dr Joe de Beer

Hi Dr De Beer

I am a female aged 45 years.  My collarbone was broken as teenager, and at about 20 years of age, the 3rd operation was successfully done (plate with screws and piece of wire, plus bone transplant).

In October 2011 I a decompression was performed, the ac-joint started degenerating and a small tear in a muscle was repaired.

I’ve been in a lot of pain for the past few months, to the front of my shoulder.  I’ve used anti-inflammatories and received physio.  Last week I saw a new physio, and he suspects that the ac-joint is again degenerating (is this possible?), and that I might have bicep tendonitis.

A sonar scan showed nothing wrong?

Apart from seeing the orthopedic surgeon again, what is you opinion with this minimum information?



Dear Estelle,

There are so many aspects to your history and diagnosis that you need to be seen by a shoulder specialist. Please phone us on (021) 9111 017, we would be happy to help.

Dr Joe de Beer

Dr Joe,

Thanks for the wonderful platform & useful advices.

My 11 yr daugther suffered Right Mid Shaft Clavicle Fracture exactly 14 days ago playing hockey. The fracture ends are overlapped and definately more than 2 cm. The 2 Orthos seen are not keen on surgery and put her on sling and figure 8.

I’m worried about the impact of overlapping and misalignment during the healing process. I’ve actually felt the bones rejoining but the small part of the top bone going to the inside of the clavicle. Going for further X-Rays on 10/07/2012 but not so positive.

The ovelapping obviously will cause the clavicle to be shorter and the shoulder drool. Would this not affect her future strenght and functionality of the right arm & shoulder? She told us she wants to play hockey for the SA team in future.

How safe would it be to do surgery on a young girl like this and possible size of scars? pictures of previous surgery and healed sacrs on young kids would assist.

Need to make the correct decision for my daugther urgently before improper healing is completed.

Your advise would be greatly appreciated.

You are welcome to recommend your trusted Ortho in Bloemfontein.


Dear MJ,

Thank you for your kind comments about our site. My reply to your question is short and simple: the remodelling  of the clavicle  of an 11 year old child is so good that the shortening and angulation will be totally corrected over the following few months. There is no need for you to get another opinion and not even a reaon to do a repeat x-ray in a few days’ time as you will see a fracture which is uniting and expose your child to unnecessary radiation.

Dr Joe de Beer

Hi Dr

Dit voel ook ek het baie drukking in my shoulder and blade.

Dit is tipies die verwysde pyn van die Torakale Uitgangsindroom.

Dr Joe de Beer

Hi Dr De Beer

Help my asb. Ek sukkel nou al vir n lang tyd met my linker skouer. Ek kan nie lank reop sit of staan nie, dan raakmy linker skouer baie lam. Dit pyn ook in die middel van die bo arm en langs die Shoulder blade. Dit is meer ongemak in die shoulderblade as pyn. Ek kry meer confort as ek le. Dit is meer soos iets wat brand in my blade. Dit maak my ook baie moeg. Ek voel ook ek kry nie my asemhaling deur na my linkerkant. Dit affect my borsbeen voor ook. My linker skouer is baie dikker as die regter een. Ek het MRI en CT scan van my skouer. Is dit moontlik om vir doctor deur te stuur. Ek weet net nie hoe om dit te doen nie. Dit blyk nieman kry ‘n diagnose vir my nie. Ek is baie moedeloos. My shoulderblade voel ook baie swaarder as my regter skouer. Dit voel asof iets op my shlouderblase vassit. Ek het ook weakness in my skouer and blad. Ek kan dit ook nie vir te lank in die lig hou nie, dan word dit so lam. Ek kan my arm swaai op en af. Ek kan net nie iets vir te lank vas hou nie. Help my asb.

Baie Dankie.


Beste Maritha, dit klink of jy aan Torakale Uitangsindroom ly ( Thoracic Outlet Syndrome) – kyk na my website en jy sal dit daar kry. Ons eerste behandeling daarvoor is gewoonlik om Botox in die skaleen spiere te spuit om die drukking op die senuwees te verlig


Dr Joe de Beer

Dear Dr De Beer,

I’ve been waking up at night with numbness and tingling forearms and fingers.  This has been getting worst over a two week period.  And I’ve been experiencing the same feeling during the day. I’ve ended up going to a chiropractor. He has diagnosed Thoracic Outlet Syndrome  I have been for 3 sessions and I am still experiencing the numbness and tingling at night.

During the day the sensation is not as bad as it was before.  But it’s still there at night.

How many session will it take to clear or go away? I am going for my fourth session on Monday.


Wayne Bruton

Dear Wayne, it certainly sounds as if the diagnosis of Thoracic Outlet Syndrome is correct. What we do for resistant cases is to inject Botox into the scalene muscles to relieve the pressure on the nerves of the brachial plexus.

Dr Joe de Beer

Dear Dr De Beer

Could I ask you whether you think I need surgery?

I have severe shoulder pain when making certain arm movements, like the breast stroke swimming motion, or reaching up above my head or certain cross chest reaching movements. I’ve had it for almost a year and it’s getting worse, despite 3 successive injections of different types over 3 months and pain pills such as tramaldol with paracetemol.  I’m 57 years old and very active physically, exercising every day, though now I can’t do press ups or push ups because of pain. I saw Dr Harvey and he said it may be half way between Rotator Cuff or Frozen Shoulder and my X Rays show “normal glenohumaral alignment, but early osteophtic lipping along the inferior aspect of the glenoid. The subacromial space is well maintained. AC joint osteoarthritic changes noted. The remainder of the prjected osseous structures are normal” Comment. Early osteoarthritic changes in the left shoulder joint noted.

I have no further medical aid consultation funds left, only a hospital plan. What do you think I should do?

THanks for your attention

Yours sincerely,

Michael Philip Makin

I hope your problem is being sorted out as i suggested in my mail to you.

Dr Joe de Beer

Goeie naand Dr de Beer. Voordat ek  fotos en xtrale begin aanheg wil ek graag weet hoe ek te werk kan gaan om my skouerbesering deur u te laat regmaak. Ek is ‘n onderwyser op Somerset-Oos en onderwind tans redelik las van pyn in die L skouer. Veral saans is die pyn kwaai. Ekl reeds i kortisoon toedining van my huisarts gekry en dit het vir 4 weke verligting gebring!! Maar nou is die pyn weer terug. Anti-inflamatriese pille (Coxflam) het ook nie juis die gewenste uitwerking nie. Ek is 51 jaar oud en is aktief en speel nog van ‘n 3 voorgee gholf en verteenwoordig tans OP Seniorspan. Wil graag die pyn wegkry sodat ek my gholf kan geniet.  Dankie by voorbaat. 

Etienne Keyser

Hello Etiienne, ek vertrou dat jy nou ‘n afspraak het om ons te sien binnekort? 

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.

Dr Joe de Beer Orthopaedic Surgeon Cape Shoulder Institute