Shoulder Stabilisation & Labral Repair
Arthroscopic (keyhole) surgery to reattach the torn labrum and stretched capsule to the rim of the socket using small suture anchors, restoring the shoulder's normal restraint against dislocation. Where there is significant bone loss from the socket, a bone block (Latarjet) procedure may be recommended instead.
Hospital stay: Usually day surgery; occasionally one night for pain control.
Recovery & rehabilitation milestones
- Week 0–4: sling protection at all times except for gentle elbow, wrist and pendulum exercises.
- Week 4–6: sling weaned, physiotherapy for assisted range of motion.
- Week 6–12: active movement restored and rotator cuff strengthening begins.
- Month 3–4: gym strengthening; office work from 1–2 weeks, manual work around 3 months.
- Month 6–9: return to contact and overhead sport after clearance.
Possible complications
- Recurrent dislocation or failure of the repair to heal (roughly 5–15%, higher in young contact athletes) — may need revision surgery.
- Stiffness, particularly loss of external rotation.
- Infection.
- Blood clots (uncommon in shoulder surgery).
- Persistent pain.
- Nerve injury — particularly the axillary nerve, usually temporary numbness or weakness.
- Loosening or irritation of suture anchors, and cartilage damage.
Rotator Cuff Repair
The torn tendon is released, mobilised and reattached to its footprint on the humerus with suture anchors, almost always arthroscopically. Bone spurs causing impingement are trimmed at the same time, and the biceps tendon is treated if it is a source of pain.
Hospital stay: Usually day surgery; an overnight stay if a nerve block wears off slowly or for larger repairs.
Recovery & rehabilitation milestones
- Week 0–6: sling worn day and night; passive movement only — the repair is healing and must not be loaded.
- Week 6–12: sling discarded, active movement regained with physiotherapy.
- Month 3–6: progressive strengthening.
- Month 6–12: full strength and overhead activity; final result often takes a year. Night pain settles gradually over the first 6–12 weeks.
Possible complications
- Failure of the tendon to heal or a re-tear — the most common problem, ranging from around 10% in small tears to 40% or more in large, retracted or degenerate tears; not all re-tears cause symptoms.
- Stiffness or frozen shoulder after surgery, sometimes needing further treatment.
- Infection.
- Persistent pain or weakness.
- Nerve or blood vessel injury, including nerve block-related numbness (usually temporary).
- Anchor problems and, rarely, progression to arthritis or need for further surgery.
Subacromial Balloon Spacer
A keyhole option for irreparable rotator cuff tears. A biodegradable saline-filled balloon is inserted between the humeral head and the acromion, restoring smoother gliding and helping to re-centre the joint so the deltoid works more efficiently. The balloon dissolves over about 12 months, by which time movement patterns have improved.
Hospital stay: Day surgery — home the same day.
Recovery & rehabilitation milestones
- Week 0–2: sling for comfort only; gentle movement encouraged early.
- Week 2–6: physiotherapy for active range of motion and deltoid retraining.
- Month 2–3: strengthening; most daily activities comfortable.
- Month 3–6: continued improvement in pain and overhead function.
Possible complications
- Incomplete pain relief or no improvement, sometimes leading to reverse shoulder replacement later.
- Balloon displacement or early deflation.
- Infection.
- Persistent pain and weakness from the underlying irreparable tear.
- Stiffness.
- Nerve or blood vessel injury (rare).
Clavicle Fracture Fixation
Displaced or shortened collarbone fractures are realigned and held with a contoured plate and screws (occasionally an intramedullary device) through an incision over the clavicle. Fixation restores shoulder mechanics and allows earlier movement than treatment in a sling alone.
Hospital stay: Usually day surgery; overnight stay occasionally for pain relief or associated injuries.
Recovery & rehabilitation milestones
- Week 0–2: sling for comfort, gentle pendulum and elbow movement.
- Week 2–6: active movement below shoulder height; wound healed and driving usually possible around 4–6 weeks.
- Week 6–12: X-ray confirmation of healing, strengthening and overhead work.
- Month 3–6: return to contact sport and heavy manual work once united.
Possible complications
- Non-union or delayed healing of the fracture, requiring further surgery or bone graft.
- Infection.
- Plate prominence and irritation under the skin — plate removal is needed in a proportion of patients.
- Numbness below the scar from injury to small skin nerves (common and usually permanent in a small patch).
- Injury to nerves or blood vessels beneath the clavicle (rare but serious).
- Persistent pain, stiffness and shoulder weakness.
Humerus Fracture Fixation
Fractures of the upper arm bone are reduced and stabilised with a locking plate and screws, or with an intramedullary nail, depending on the fracture pattern and bone quality. In severe fractures in older patients, reverse shoulder replacement may be the better option.
Hospital stay: Overnight stay usually required — typically 1–2 nights.
Recovery & rehabilitation milestones
- Week 0–4: sling protection with passive and pendulum movement guided by physiotherapy.
- Week 4–8: active assisted then active movement as healing progresses on X-ray.
- Month 3: strengthening begins; light duties resume.
- Month 6–12: maximum recovery of movement and strength; some permanent stiffness is common after complex fractures.
Possible complications
- Non-union or malunion of the fracture.
- Loss of blood supply to the humeral head (avascular necrosis) leading to collapse and arthritis.
- Infection.
- Nerve injury — particularly the radial or axillary nerve, causing weakness or numbness.
- Blood vessel injury (rare).
- Persistent pain and stiffness, screw cut-out or metalwork irritation requiring removal or revision.
ACJ Stabilisation & Coracoclavicular Ligament Reconstruction
For high-grade acromioclavicular joint separations, the clavicle is reduced back to its normal position and held to the coracoid with strong suture devices, often reinforced with a tendon graft to reconstruct the coracoclavicular ligaments. This restores the shoulder's contour and overhead strength.
Hospital stay: Usually day surgery; occasionally one night.
Recovery & rehabilitation milestones
- Week 0–6: sling worn continuously to protect the reconstruction; no lifting or reaching overhead.
- Week 6–12: sling weaned, range of motion regained with physiotherapy.
- Month 3–4: strengthening and return to gym.
- Month 5–6: return to contact sport once healed and strong.
Possible complications
- Loss of reduction or recurrence of the deformity, and failure of the graft or ligament to heal.
- Fracture of the clavicle or coracoid through the tunnels.
- Infection.
- Persistent pain over the joint, sometimes needing later excision of the joint end.
- Stiffness.
- Nerve or blood vessel injury near the coracoid (uncommon).
- Prominent or irritating implants.
Shoulder Replacement — Anatomic & Reverse
An anatomic total shoulder replacement resurfaces the ball and socket with implants in their normal positions and relies on a healthy rotator cuff — ideal for osteoarthritis with an intact cuff. A reverse replacement swaps the mechanics, placing the ball on the socket side, so the deltoid muscle lifts the arm when the cuff is torn or irreparable, or after complex fractures.
Hospital stay: Overnight hospital stay required — typically 1–2 nights.
Recovery & rehabilitation milestones
- Day 0–1: sling applied, gentle elbow and hand movement, discharge once comfortable and safe.
- Week 0–4 (reverse) or 0–6 (anatomic): sling protection with physiotherapy-guided passive movement.
- Week 6–12: active movement, everyday tasks at waist and chest height.
- Month 3–6: strengthening; driving usually around 6–8 weeks.
- Month 6–12: final result — reliable pain relief and improved overhead function; heavy lifting is permanently discouraged to protect the implant.
Possible complications
- Infection of the joint replacement (about 1%, with Cutibacterium acnes a particular concern in the shoulder) — this is the most serious complication and can need further surgery and prolonged antibiotics. Risk is reduced by losing weight, good diabetes and blood sugar control, stopping smoking, treating dental or skin infections beforehand, and applying Benzac (benzoyl peroxide) gel to the shoulder skin before surgery as directed. Antibiotics are given at the time of surgery.
- Blood clots — deep vein thrombosis and pulmonary embolism. Less common after shoulder than knee surgery, but early mobilisation is important; blood thinners are used if you have added risk. After knee replacement, blood-thinning medication is taken for 6 weeks.
- Persistent pain, and limits on overhead reach or rotation.
- Stiffness and reduced range of movement.
- Nerve injury — particularly the axillary nerve — or blood vessel injury (uncommon).
- Instability or dislocation of the replacement, especially reverse designs.
- Fracture around the implant during or after surgery, loosening, wear, or notching of the bone, and rotator cuff failure after anatomic replacement — all may require revision surgery.
