Treatments

Mr Durrant offers both surgical and non surgical treatments for injuries and conditions related to the shoulder, elbow, hand and wrist. His extensive training and expertise, combined with the latest advancements in his field, means that he can draw on his experience to ensure you are provided with the best options available for your treatment.

Combining your treatment options with an integrated rehabilitation programme allows for the optimal recovery, for every condition, for every patient.

Shoulder Surgery

The decision to operate on your shoulder comes as the result of a thorough consultation with Mr Durrant.

He will discuss the various treatment options with you and establish the one best suited to your injury or condition. If surgery is deemed to be the best solution, Mr Durrant will ensure you are fully informed of the process and what is involved for you – you will be involved in the decision making process.

Mr Durrant will establish if the surgery can be performed arthroscopically or if open surgery is required. This along with a range of other considerations will be taken into account for your specific injury.

Mr Durrant offers a range of surgical options and will ensure that the best decision is made for you and your condition.

Arthroscopic
AC Repair

When there is damage to the Acromioclavicular (AC) joint, which is the prominent bony ‘bump’ on the top of your shoulder, the person affected will often experience pain when performing overhead movements, such as throwing a ball, lifting something above their head, or reaching for something above head height.

Referred to as a shoulder separation, the treatment of an AC injury can involve surgery that is performed by arthroscopy. An arthroscopic AC repair involves a small narrow camera being inserted into the joint along with narrow instruments. The end of the collarbone (clavicle) is removed. The clavicle is then fixed into place. Arthroscopic surgery offers a faster recovery time when compared to open surgery, there is less risk of complications occurring, patients experience less pain with arthroscopic surgery, and scarring is reduced.

If the AC joint is very unstable surgery may have to be performed openly. A larger incision, a few centimetres in length, is made across the front top of the shoulder. After the end of the collarbone is removed, the ligament is then attached to the end of the cut bone. The recovery time after surgery is often greater with open surgery when compared to arthroscopic surgery.

With an AC injury, surgery is often the best option in order to regain movement of the shoulder and relieve pain. Arthroscopic AC repair surgery offers patients a very high chance of making a full and complete recovery from an AC injury.

Arthroscopic
Shoulder Stabilisation

Shoulder instability is a painful condition to live with. Many times it can become such a problem that range of motion and strength of the shoulder and arm are significantly reduced. With an unstable shoulder the likelihood of recurrent dislocations is high, and this can end up causing a great deal of damage to the bones, cartilage, ligaments and muscles in and around the shoulder joint. When a person suffers from shoulder instability, the best course of treatment is a surgical procedure referred to as an arthroscopic stabilisation.

An arthroscopic shoulder stabilisation involves a few small cuts being made into the shoulder, normally at the front and back of the shoulder. A small narrow camera, along with small instruments is inserted into these holes. The surgeon is able to view the inside of the shoulder without having to cut through skin, muscles and ligaments as would normally occur in an ‘open’ surgical procedure. This arthroscopic procedure, also known as a Bankart Repair, involves inserting suture anchors into the shoulder to reattach the torn or damaged ligament back onto the bone. The result is a firm tight ligament that supports the upper arm bone (humerus), holding it into place within its socket joint in the shoulder.

An arthroscopic stabilisation enables the patient to regain their shoulder strength and its stability, and the likelihood of the shoulder dislocating again is dramatically reduced. Recovery from an arthroscopic shoulder stabilisation procedure takes a few weeks. For the first three or so weeks the shoulder will remain immobilised, most likely in a supportive sling. Physical therapy exercises in the following weeks will help to build strength and movement within the joint. It will generally be a minimum of six weeks before you will be able to drive a car, go swimming, or perform any lifting. Over the following 12 months post surgery, the shoulder will continue to recover and gain in strength, stability, and range of motion.

Arthroscopic
Rotator Cuff Repair

An arthroscopic rotator cuff repair is an increasingly popular form of repairing a torn rotator cuff. The rotator cuff is a group of muscles and their tendons that surround the shoulder joint and provide stabilisation and strength to the shoulder. When a rotator cuff tear occurs the tendon that holds the upper arm bone, or humerus, into its socket has come loose or come away completely from the humerus. This causes a great deal of pain as well as destabilisation of the entire shoulder.

With an arthroscopic rotator cuff repair the torn tendon is repaired onto the bone using “anchors”. Any damaged and loose tissue is removed and sutures are threaded into the tendon. This sutured tendon end is then secured in place using these anchors which are inserted into humerus. An arthroscopic procedure involves a narrow camera and instruments into the joint through a few small incision holes, usually less than one centimetre in length.

1. Rotator cuff tear
2. Anchors introduced
3. Sutures inserted
4. Sutures passed
5. Sutures tied
6. Finished repair

The benefits of having a rotator cuff repair performed arthroscopically include a shorter recovery time, very little scarring, less pain experienced post operatively, and less likelihood of any complications occurring. Mr Durrant will discuss the option of an arthroscopic rotator cuff repair for your damaged shoulder.

Elbow Surgery

Following consultation Mr Durrant will establish if surgery is the best course of treatment for your elbow injury.

With expertise in the repair of sports-related injuries to the elbow and; overuse, traumatic and degenerative conditions such as arthritis, Mr Durrant has a diverse range of surgical experience to draw on. Once it has been determined that surgery is required, he will thoroughly discuss your procedure, and both the pre and post operative treatments that are required to ensure the best results for you.

Mr Durrant operates with both arthroscopic (minimally-invasive keyhole surgery) and open surgical procedures depending on the nature of the injury, the goals of the patient and the best procedure for the best result.

Arthroscopic
Elbow Surgery

Arthroscopic elbow surgery is an effective surgical procedure which can provide successful treatment of some elbow injuries, elbow arthritis, and other types of damage of the elbow.

An elbow arthroscopic surgical procedure involves a small narrow camera with a bright light that is inserted into the elbow joint through small cuts in the skin. Sterile water is also inserted into the joint to ‘inflate’ it and allow Mr Durrant to view the bone and tissues clearly. Using small specialised instruments Mr Durrant is able to smooth or remove any rough or damaged bone or tissue that may be causing problems; ligaments are also able to be tidied up or repaired.

Arthroscopic surgery is an excellent option for those who require surgical repair of their damaged elbow. Incision cuts are very small, and often only require one suture, making visual scaring very minimal. Post operative pain is minimal and easily managed, and recovery time is dramatically reduced when compared to ‘open’ surgical procedures. The likelihood of complications from surgery is reduced with an arthroscopic procedure. Common arthroscopic procedures performed include removing bony lumps that cause rubbing or pain, removing loose cartilage, muscle or tendon tissue, and loosening up cartilage to reduce stiffness experienced within the elbow joint.

Surgery to Repair
Elbow Epicondylitis

Elbow epicondylitis is commonly known as tennis elbow. It is a painful condition caused by overuse of the forearm and elbow joint, where the tendon that attaches the forearm muscle to the outside of the elbow becomes inflamed. For the majority of patients, up to 90%, non-surgical treatment is successful in treating elbow epicondylitis. However for those who do not respond effectively to non-surgical treatment, referral to Mr Durrant is advised.

Surgical repair of elbow epicondylitis can be performed by arthroscopy or open surgery and depends on the severity of the damage. The operation involves removing damaged tendon tissue and reattaching healthy tendon to the bone. This tendon can be reattached using suture anchors, which are small metal pins that are inserted into the bone. Attached to these pins are sutures which are threaded through the healthy tendon. The sutures anchor the tendon into place on the bone.

Usually surgery is performed to repair elbow epicondylitis if non-surgical treatment has been attempted for six to 12 months with no success. Surgery to repair elbow epicondylitis is usually very successful. Patients who undergo elbow surgery generally notice relief from painful symptoms within a few weeks. It is generally expected to take four to six months before complete recovery from the symptoms of elbow epicondylitis is achieved and full strength of the forearm and elbow are regained.

Hand and Wrist Surgery

Other than in acute circumstances Mr Durrant will trial non surgical options for treating hand injuries, in the event that this is not successful he is able to offer a range of both arthroscopic and open procedures. Mr Durrant will provide you with all the information necessary for you to make an informed decision about the best surgical option for you.

Surgical treatments for arthritis include partial removal of damaged bone to relieve pain but maintain some mobility, or fusion of some on the bones to stop them rubbing and causing pain.

Wrist surgery is the third most common joint to be arthroscopically operated on, behind knee and shoulder surgeries. The benefits of this type of surgery for the patient include minimal post operative pain, quicker recovery time, less chance of post operative complications, and very little scarring. Arthroscopic procedures are able to repair ligament tears, remove ganglion cysts, treat carpal tunnel syndrome, repair wrist fractures, and treat chronic wrist problems.

Arthroscopic
Wrist Surgery

The use of arthroscopic surgery for wrist injuries offers many benefits over ‘open’ surgery. Arthroscopic wrist surgery enables Mr Durrant to view the inside of the injured joint clearly without having to make a large incision through skin, muscle, and tendon fibres.

A very small camera is inserted into the wrist through a ½ cm incision in the skin, normally on the back and side of the wrist. A second small incision is made, through which small narrow instruments are inserted.

With arthroscopic surgery, the surgeon is able to:

• remove any loose cartilage or soft tissue
• smooth any rough bony ‘spurs’ (bumps)
• repair any torn or damaged tendons or muscle tissue.

Through an arthroscopic camera Mr Durrant is able to see clearly all of the finer details of the joint and identify the quality of the bones, tendons and ligaments. He is able to get a complete view of the joint moving together and accurately identify any problem.

Wrist surgery is the third most common joint to be arthroscopically operated on, behind knee and shoulder surgery. The benefits of this type of surgery for the patient include minimal post operative pain, quicker recovery time, less chance of post operative complications, and very little scarring. Arthroscopic procedures are able to repair ligament tears, remove ganglion cysts, treat carpal tunnel syndrome, repair wrist fractures, and treat chronic wrist problems.

Carpal Tunnel
Release

A carpal tunnel release procedure is one of the most common operations performed by Mr Durrant. This procedure may be performed openly or via endoscopy, which involves a small camera being inserted into the wrist through very small incisions into the skin.

The procedure used in carpal tunnel release surgery involves severing the ligament that creates the carpal tunnel. This is the ligament through which the median nerve runs from the inside forearm through the wrist and into the palm of the hand. This then releases the pressure on the median nerve. Symptoms of carpal tunnel syndrome include numbness, tingling, and weakness in the thumb, first and second finger, and part of the ring finger, as well as part of the palm of the hand. If symptoms persist for more than six months despite non-surgical treatment, surgery is usually performed.

With an endoscopic procedure a camera is inserted into the wrist, along with a small bladed instrument. The camera is placed so that Mr Durrant has a clear view of the inside space of the carpal tunnel. The blade is then inserted into the roof of the tunnel space and is used to cut a slit in the underside of the ligament. In an open carpal tunnel release the top of the ligament is exposed and is then cut from above. Both procedures are very effective at treating carpal tunnel syndrome. Once a patient has undergone carpal tunnel release surgery the likelihood of a complete recovery and no further symptoms experienced is very high.