Traumatic Injury at any age


Under 40 years of age


Over 40 years of age stiff and painful shoulder

(especially external rotation)


Over 40 years of age with a painful arc

ACJ Instability

 Xray ACJ Instability

A dislocation of the collarbone at the shoulder usually results from a direct fall on to the shoulder.  Initially it will cause significant pain and swelling with an obvious lump over the end of the collar bone. Most of these acute injuries can be treated without any surgery and will allow a return to normal function, although the lump will remain.  Occasionally surgery will be required to fix the collarbone back in to position shortly after the initial injury.


Sometimes if the acute injury has been treated without surgery, the pain and loss of function will continue.  In this situation a reconstruction of the joint may be considered.  This is usually performed as a day-case procedure with a combination of keyhole and mini scars to insert a synthetic ligament which will keep the collar bone in the correct position.  This is done in conjunction with a transfer of a ‘spare’ shoulder ligament to help with the healing of the collarbone back in it’s correct position. Recovery from the operation usually takes about 12 weeks (click to read more about recovery).


Biceps problems

 Xray Biceps Problems

The biceps is a tendon that splits into two parts at the level of the shoulder.  It is unusual for a tendon, as one part of it (the long head of biceps) is found right within the shoulder joint.  This unfortunately makes this part of the tendon susceptible to being damaged after an acute injury or after wear and tear of the shoulder joint.  This can usually be diagnosed with a specialist shoulder examination, but may also require an ultrasound or MRI scan to confirm the diagnosis.   Occasionally an ultrasound guided steroid injection (click for more information) will be used to give pain relief and help with the diagnosis.


If the biceps tendon is damaged after an acute injury, the tendon tears away from the shoulder joint at the point at which it attaches to the socket.  If this is causing pain, a small day-case keyhole operation may be considered.  The long head of biceps can be reattached to the socket with metal anchors that sit in the bone and the sutures that are attached to the anchor tie through the tendon.   This is called a  Superior Labral Anterior-Posterior (SLAP) repair (click for more information on rehabilitation).


Occasionally, the tear is not capable of being repaired successfully, in which case the tendon is completely released and reattached to the bone of the ball of the shoulder joint, but outside the joint.  This can give good pain relief and does not affect the function of the biceps.  This is called a biceps tenodesis (click for more information on rehabilitation).


If the tendon is worn out rather that torn by an injury and is painful, a keyhole operation can be considered.  This may be part of another keyhole operation or it can be carried out on its own.  In this procedure, the long head of the biceps is released within the joint, but the other part of the tendon is left alone.  This is called an arthroscopic biceps tenotomy and can give good pain relief.  It does change the shape of the biceps on the front of the upper arm, but rarely causes any noticeable difference in strength.

Shoulder Anatomy




Calcific Tendonitis

 Calcific Tendonitis

This is a condition whereby a lump of bone develops within the inner tendons of the shoulder. It can be present without presenting any symptoms whatsoever, or it can cause extreme pain and difficulty in moving the arm in certain positions.  The reason why bone is formed in the tendon is not completely understood, but it is probably as a result of irritation of the tendons.  It can be diagnosed via a specialist shoulder examination and x-ray.


The condition is usually treated by a specialist shoulder radiologist who will try and break down the bone within the tendon using a needle and water pressure.  This technique is performed as an out-patient appointment under local anaesthetic and is called a ‘barbotage’ (click to read more about barbotage).  There is a high chance that this will resolve the problem and eliminate the pain. Occasionally the pain returns and a second course of ‘barbotage’ is required.  In rare cases, the pain can return after a second ‘barbotage’ and may require surgery.