We treat all types of shoulder and elbow problems from common age-related conditions such as osteoarthritis to complex fractures and soft tissue injuries.

All patients receive a thorough clinical assessment of their problem with further investigations arranged if required. All specialist investigations such as X-Ray, Ultrasound Scan, MRI Scan, CT Scan, Radio-isotope Bone Scan and Nerve Tests are available on site. We plan our treatment approach for each patient taking into account the research evidence for best practice and any specific needs of the individual.

We recently developed a new pathway for the management of patients after shoulder dislocation that includes recommendations from the British Orthopaedic Association and the British Elbow & Shoulder Society.  Click here to download a copy.

FRACTURE MANAGEMENT

Fractures of the shoulder girdle, arm and forearm bones and the elbow joint are common. They can result from a simple fall, an accident, a sporting injury or as part of multiple trauma.  These injuries are incapacitating as they take you out of action for varying periods of time. If not treated in a timely fashion they can often leave you with a painful and stiff joint.
In Derby we have the combined expertise of four specialised upper limb surgeons who are able to deal with simple to complex fractures. Fractures are treated non-surgically in slings or splints when appropriate. We undertake large number of acute fracture fixations around the shoulder joint using special plates including ‘Locking Plates’. Some of these complex fractures may require joint replacement as a primary option. A number of complex elbow fractures require expertise to understand the fracture pattern to formulate a correct treatment plan. We have built considerable experience in treatment of these injuries with good results. We have an excellent support from our physiotherapy department who ensure that maximum gains are made following your fracture fixations to return you back to your daily activity and work without delay.
There are Fracture clinics with Shoulder and Elbow specialty right through the week in Derby. The four Upper limb surgeons also provide a seamless surgical service through the week so that acute injuries requiring surgery do not have to wait for long periods before having their procedures. We have regularly presented our results of fracture fixation outcomes in national and international meetings.

SPORTS & SOFT TISSUE INJURIES

Derby Soft Tissue Shoulder Injury Clinic

This clinic is run every Friday morning by Marcus Bateman, upper limb consultant physiotherapist, and Lisa Pitt, upper limb physiotherapy practitioner, in the Orthopaedic Outpatient Department at Royal Derby Hospital. Mr Clark and Mr Tambe support this clinic in parallel with their fracture clinics. New referrals will be seen within two weeks or earlier on basis of clinical priority/problem. Patients are assessed clinically and referred for further imaging if appropriate. Ultrasound scan slots have been reserved for patients coming through this pathway where urgent US scan is required. Patients with significant soft tissue injury can be fast-tracked for surgical repair on an upper limb trauma list.

Referral criteria for Soft Tissue Injury Clinic:

1. Glenohumeral joint dislocations that have been reduced successfully and have no associated fractures.

2. Acromioclavicular joint dislocations.

3. Suspected traumatic rotator cuff tear: Patients aged over 45 who have had recent shoulder trauma and are unable to actively flex the shoulder above 90 degrees. Patients must have an X-Ray to exclude a fracture.

4. Biceps tendon ruptures, Pectoralis Major tendon ruptures and any other shoulder girdle soft tissue injury requiring specialist input / early intervention.

How to refer to soft tissue injury clinic:

Referrals can be made directly by your GP with the Orthopaedic Outpatient Department reception onto Clinic code: TAOST. Please highlight this code on referral requests.

Email:  DHFT.referrals@nhs.net
Tel: Jane Garner / Christine Beveridge on 01332 783177
Fax: 01332 786783
Referral to local physiotherapy providers at the same time is also recommended.

JOINT REPLACEMENT

Arthritis can affect the shoulder and elbow joints in the same way it affects joints in the lower limbs. Arthritis in the shoulder and elbow is a painful and disabling condition as it directly impacts on day-to-day tasks.
A number of different types of arthritis are seen in the upper limbs, the most common being Osteoarthritis, Rheumatoid Arthritis, Arthritis after injury/fracture and arthritis at the end stage of tendon tears in the shoulder( Rotator cuff arthropathy).
Total shoulder replacement and total elbow replacement are now considered as well established procedures to address these painful conditions. As technology and our understanding of joint mechanics has evolved the results of joint replacements in the shoulder and elbow have improved steadily.
In Derby, we have a special interest and vast expertise in undertaking joint replacements in the shoulder and elbow joints. Our surgeons are trained in the full spectrum of these complex operations. We often have visiting surgeons wanting to learn and train in our shoulder unit.
We follow latest techniques in shoulder and elbow replacements, using proven techniques. Our unit is well established in undertaking the Reverse Shoulder Replacements for tendon tear arthropathy. We have streamlined our joint replacement pathways to give our patients a stress free journey when they have these procedures under our care. We have an excellent team of anaesthetists who provide expert anaesthetics for these operations by undertaking local anaesthetic blocks. This has reduced inpatient stay after these operations.
You will have the benefit of having a seamless care with our arthroplasty specialist physiotherapists who will monitor your progress regularly after your surgery in tandem with your consultants. This will ensure that any problems, should they arise, are picked up in a timely fashion without delay.
We publish our results for joint replacements regularly in specialist journals as well as the National Joint Registry.
Our team will be more than happy to discuss your arthritic condition with you in detail and plan an appropriate joint replacement for your painful joint if indicated. Please read the common conditions section to gain an insight into your problem. If you are having a replacement operation please read the surgery specific information sheet on our website and view our patient information video here.

SHOULDER & ELBOW ARTHROSCOPY (KEYHOLE SURGERY)

We now perform a large number of shoulder operations using a keyhole technique (arthroscopy). This involves putting a camera in your shoulder or elbow joint through little cuts in the skin and then using special instruments to complete the procedure.

Arthroscopic shoulder surgery has advanced rapidly in the last decade and now we are able to undertake quite complex procedures using keyhole methods. This means that large painful open procedures are avoided, recovery and rehabilitation is quicker and procedures can be done as day-cases, normally with the patient awake.

Our surgeons in the Derby Shoulder Unit have trained extensively in these techniques and have robust experience in dealing with a range of conditions that can now be dealt with using keyhole technology.

We regularly deal with sporting injuries, repairing the ligaments and labrum in unstable dislocating shoulders and repairing tendons.  Rotator cuff tendon tears are now routinely repaired with arthroscopy.

We also use this technique to release frozen and stiff shoulders by releasing the scarring in the lining (capsule) of the shoulder joint. We have set up a soft tissue injury clinic that has facilitated timely diagnosis and treatment for some of these injuries.

Please refer to our common conditions section to understand your condition and how it can be treated with arthroscopic surgery where appropriate.

ARTHROPLASTY REVIEW SERVICE

All of our elbow and shoulder replacements are followed up by our Arthroplasty Specialist Physiotherapist, Marie Morgan. This unique service offers specialist assessment and review both pre and post-operatively to monitor your progress. Typically patients will be seen at three and 12 months post-surgery for clinical assessment and review with x-rays. In this way we aim to optimise your post-operative recovery and monitor your improvement. You will be asked to complete a shoulder/elbow questionnaire which gives us more detailed information about how you are progressing following surgery. The specialist physiotherapist will also perform detailed physical examination checking your range of movement and strength.

Following this you will be invited for yearly/periodic review longer term to keep a check on your replacement with x-rays and further clinical assessment. All of our patients have the opportunity to request further review appointments if required at any time. In this way we can ensure that any problems or concerns are dealt with in a timely and satisfactory manner.