Shoulder Surgeries

For painful, stiff, unstable or injured shoulders – Assessment and treatment with Dr Murtuza Rassiwala at Hakimi Ortho Care

Most of us only notice our shoulders when they go wrong. Suddenly, it is difficult to comb your hair, reach for a shelf, fasten a seat belt, lift a child, or sleep on your side. The shoulder has more movement than any other joint, so even a small problem with one of its structures can interfere with a surprising number of daily activities.

Treating a variety of shoulder conditions including tendon tears, recurrent dislocations, frozen shoulder and fractures of the upper arm and collarbone is Dr. Murtuza Rassiwala, orthopedic and arthroscopic surgeon in Indore. This page gives an overview of the development of shoulder problems, diagnosis, when surgery is helpful and what procedures are available. Each procedure also has a detailed page.

Many shoulder problems get better without surgery. Guided exercise, pain management and time can improve shoulder pain. Surgery is recommended when there is a clear structural problem that is unlikely to heal without surgical intervention or when non-surgical care has not been effective.

Quick answer: Hakimi Ortho Care, Indore provides shoulder surgery including arthroscopic rotator cuff repair, Bankart and SLAP repair for instability, arthroscopy for impingement and frozen shoulder, biceps tendon surgery, superior capsular reconstruction for massive cuff tears and fixation of clavicle, humerus and AC joint injuries. “Surgery is only recommended if examination and imaging suggest it is likely to help, says Dr. Murtuza Rassiwala.

Shoulder Surgery at Hakimi Ortho Care at a Glance

Understanding the Shoulder

In fact, the shoulder is a collection of joints and soft tissues working together. Understanding the basic parts helps in understanding your diagnosis.

• A ball in a shallow lie: The shoulder’s main joint, the glenohumeral joint, is made up of the round head of the upper arm bone (humerus) and a shallow socket on the shoulder blade, called the glenoid. The socket is much smaller than the ball, and is often compared to a golf ball sitting on a tee. The design provides the shoulder with a very large range of movement but stability is dependent on soft tissue.
• The Labrum: A rim of fibrous cartilage, the labrum, deepens the socket and anchors ligaments and the biceps tendon. Tears of the labrum are a frequent source of instability and deep shoulder pain, particularly in young athletes.
• The Capsule and The Ligaments: The joint is surrounded by a fibrous capsule, strengthened by ligaments that become taut at the limits of movement. If they are stretched or torn, the shoulder can come out of joint, or dislocate. Frozen shoulder When the capsule is inflamed and contracts, movement is severely restricted.
• The Rotator Cuff: The rotator cuff is a group of four muscles: supraspinatus, infraspinatus, subscapularis and teres minor, which surround the ball via their tendons. They hold the ball in its socket and assist in lifting and rotating the arm. The most commonly torn is the tendon of the supraspinatus which passes beneath the bony roof of the shoulder.
• Acromion and AC joint: The acromion is a bony roof over the shoulder. It is attached to the collar bone (clavicle) by the acromioclavicular (AC) joint, which you can feel as a little bump on the shoulder. This joint is commonly injured by falling directly on the point of the shoulder.
• The Tendon of the Biceps: The long head of the biceps tendon runs through a groove in the front of the humerus and into the joint, attaching to the socket. It can become inflamed, frayed or unstable, often in conjunction with rotator cuff problems.
• The Scapula: The scapula (shoulder blade) slides on the back of the ribcage, giving a stable, well-placed base for the arm. Poor control of the shoulder blade is a major focus of rehabilitation for many overuse shoulder problems.

Common Shoulder Problems

• Rotator Cuff Tear: Tendon tears can happen from a fall or heavy lift but many develop gradually as tendons weaken with age. They cause pain on the outside of the upper arm, pain lying on the side of the body and weakness lifting the arm. Some tears grow bigger over time.
• Subacromial Pain and Impingement: Pain when lifting the arm between shoulder and head height (a so-called painful arc) is caused by irritation of the rotator cuff and the bursa below the acromion. Most cases get better with physical therapy and activity modification.
• Adhesive Capsulitis (Frozen Shoulder): The shoulder capsule becomes inflamed, then thickened and tight, limiting movement in all directions, especially rotation. It is more common in people aged 40-60 and in people with diabetes or thyroid disease. It typically progresses through painful, stiff and recovery stages over many months.
• Shoulder Instability and Dislocations: A first-time dislocation, usually caused by a fall or collision in sports, can tear the labrum and stretch the capsule. Younger people, especially those under 25 years playing contact or overhead sports, are at significant risk of repeat dislocation.
• SLAP Lesions: Tears of the upper labrum (found in throwing athletes and following falls on an outstretched arm) where the biceps anchor is located They cause deep pain clicking and weakness when overhead.
• Biceps Tendon Disorders: Pain in the front of the shoulder from inflammation of the biceps tendon, or partial tearing or dislocating of the tendon from its groove. The pain often gets worse with lifting and reaching.
  Injuries to the AC Joint: A fall on the point of the shoulder can sprain or dislocate the AC joint and sometimes leave a step deformity at the shoulder.
• Proximal Humeral Fractures: Collar bone fractures are common injuries in cyclists, two wheeler riders and sportspersons. A simple fall in older adults can easily fracture the upper end of the humerus, especially if the bones are weak. Humeral shaft fractures are most often seen in high-energy injuries.
• Massive and Irreparable Rotator Cuff Tears: If tears are very large, longstanding, and the muscles are wasted, the tendon may not be able to be repaired to bone. These shoulders may lose their ability to lift the arm properly. In selected patients specialized reconstructive options may be considered.

Symptoms That Should Prompt a Shoulder Assessment

If you are: Arrange an orthopedic assessment if you are:

• Shoulder pain that wakes you up at nite or keeps you from sleeping on that side.
• Weakness when you try to lift your arm, or your arm “drops” when you try to hold it up.
• Even dislocating a shoulder on occasion, especially if you are young and active.
• Feeling of slipping, clunking or apprehension when the arm is lifted and rotated.
• Stiffness that makes it impossible to reach behind your back or overhead.
• Pain and swelling after a fall, especially if there is a deformity or bruising down the arm.
• A raised bump on the shoulder after an injury.
• Continuous shoulder pain continuing for more than a few weeks despite rest and simple pain relief.

If you experience chest pain with shoulder or arm pain, or if you are breathless, sweating or have pain radiating into your jaw, seek urgent care as heart problems can present with pain felt in the left shoulder or arm.

Which Shoulder Problems Affect Which People?

Age, occupation and activity have a strong bearing on which shoulder condition is most likely and thus which questions the doctor will be focusing on.

• Students and Young Athletes: Dislocations, labral tears and SLAP lesions are common in the mid teens to late twenties. In football and kabaddi, the stabilizing structures are under great load in the collisions; in cycling in the falls; and in cricket or baseball in the repetitive stress of throwing or pitching. Tissues at this age heal well but recurrence after a dislocation is high. Early and accurate diagnosis is especially valuable.
• Fitness Buffs and Gym Goers: Heavy bench pressing, overhead pressing and dips done with poor technique or without enough rest can all irritate the rotator cuff, strain the biceps tendon and aggravate the AC joint. People who lift heavy loads over many years show wear of the outer end of the collarbone, sometimes called weightlifter’s shoulder.
• Office Professions: When you sit at a laptop for long hours with rounded shoulders and a forward head posture, the shoulder blade position changes. This can eventually lead to rotator cuff irritation and impingement type pain, often associated with neck stiffness.
• Manual and Overhead Staff: Electricians, painters, construction workers and loaders who are often at work with arms above shoulder height are at greater risk of rotator cuff tendon degeneration and tears.
• Middle Age: Frozen shoulder is most common between the ages of 40 and 60, and rotator cuff tears become more common from the fifth decade onward, often without a clear injury.
• Older Adults: More common are degenerative cuff tears, shoulder arthritis and fractures of the upper humerus after a simple fall. Treatment plan includes bone strength, balance and fall prevention.
• People With Diabetes or Thyroid Disorders: These conditions can increase the chances of frozen shoulder and may delay recovery. Good sugar control favors conservative and surgical treatment.

How Shoulder Problems Are Diagnosed

• Conversation First: There are many potential sources of shoulder pain, including the neck, and, in rare cases, the heart or lungs. First, Dr. Rassiwala determines precisely where the pain is, if it radiates down the arm or up into the neck, what movements elicit it, whether there has been an injury or dislocation, and if you have diabetes or thyroid disease.
• Physical examination: The exam compares posture, muscle wasting and shoulder-blade movement in both shoulders. We assess active and passive range of motion – an important distinction, as a frozen shoulder is stiff whether you move it or the doctor moves it, while a torn rotator cuff often moves well passively but not actively. Individual cuff muscle strength testing . Impingement testing . Instability and apprehension testing . Examination of the biceps and AC joint . The neck is examined to exclude referred pain.
• X-Rays: X-rays can show fractures, dislocations, arthritis, calcific deposits in tendons, the shape of the acromion, and bony damage to the socket after dislocations.
  Ultrasound: Ultrasound can show rotator cuff tears and biceps tendon problems. It also allows viewing the shoulder during motion. It is subject to operator error.
• MR Arthrograms and MRI: MRI can make detailed pictures of tendons, muscles, the labrum and cartilage. It also indicates how much a torn muscle has wasted or turned fatty that influences whether a tear can be repaired. MR arthrogram, in which contrast is injected into the joint, may provide a better evaluation of labral tears.
• CT Scan: CT is useful for complex fractures and to assess bone loss from the socket in patients with recurrent dislocation which will influence the choice of stabilization surgery.

Non-Surgical Shoulder Care

For most shoulder pain, a structured non-surgical program is the place to begin.

• Physiotherapy (physical therapy): Shoulder rehabilitation consists of exercises to strengthen the rotator cuff and shoulder-blade muscles, restore range of motion, and improve posture. For impingement, many partial cuff tears and early frozen shoulder, physiotherapy alone often results in significant improvement.
• Modification of Activity: Irritated tissues are allowed to settle without causing the shoulder to stiffen by avoiding repetitive overhead activity, heavy lifting or aggravating sport for a time.
• Medications: You may be able to keep exercising if you take painkillers or short courses of anti-inflammatories to control the symptoms.
• Injections: A steroid injection into the subacromial space or the joint may reduce inflammation and pain especially in impingement and in the painful phase of frozen shoulder. Injections are used sparingly as repeated steroid injections may affect the quality of the tendon.
• Immobilization and Slings: Slings are used for a short time after dislocations and for many fractures. Generally, prolonged immobilization is avoided as the shoulder will stiffen very quickly.

When is Shoulder Surgery Considered?

Surgery is usually considered when:

• A full thickness rotator cuff tear can result in pain and weakness. In particular if it occurs following an injury or in younger, more active patients, early repair may offer the chance of healing.
• More than one shoulder has luxated, or the first luxation has occurred in a young athlete with significant labral damage.
• Pain is still present at 3-6 months of good physiotherapy for impingement or partial tears.
• A frozen shoulder that remains severely stiff after prolonged conservative treatment and injections.
• Fracture displaced, unstable or intra-articular.
• AC joint dislocation with severe or persistent pain and disability.
• Your age, occupation, sport, the dominant arm, general health and how much the problem affects your life are all taken into consideration for the final decision.

Shoulder Procedures Offered by Dr. Murtuza Rassiwala

Each of the following procedures has a dedicated page that will explain the condition, the surgical procedure, and the recovery.

• Shoulder Arthroscopy Procedure: Shoulder arthroscopy is performed using a small camera and special instruments that are inserted through a few small punctures made around the shoulder. This allows the surgeon to see the joint and the space under the acromion and to repair or remove damaged tissue. Many of the below procedures are performed with arthroscopy.
• Rotator Cuff Repair: Suture anchors are small implants inserted into the bone that have strong sutures in them to hold the tendon down, and they can be used to fix a rotator cuff tendon that has pulled away from the bone back in place. The arm is then placed in a sling for several weeks before beginning strengthening, allowing time for the repair to heal.
• Superior Capsular Reconstruction (SCR): Superior capsular reconstruction is a technique that uses a graft attached from the superior aspect of the glenoid to the greater tuberosity for selected patients with a large rotator cuff tear that cannot be repaired back to bone. The goal is to restore stability at the joint, decrease pain and improve the ability to lift the arm above the head, especially in those patients who do not have significant arthritis.
• Shoulder Instability Surgery: Repeated dislocation or subluxation causes damage to the structures that hold the shoulder in place. They are stabilized by surgery. The exact procedure will depend on the direction of the instability, the amount of bone lost from the socket and the activity level of the patient.
• Bankart Repair: The most common injury following an anterior shoulder dislocation is a tear of the front-lower labrum called a Bankart lesion. In a Bankart repair, the torn labrum and ligaments attached to it are reattached to the rim of the socket with anchors, restoring the “bumper” that holds the ball in place.
• SLAP Repair: In some younger patients with SLAP tears, the detached upper labrum is sutured back to bone. In older patients, or in some patterns of tear, it may be more reliable to treat the biceps tendon itself.
• Surgery of Biceps Tendon: The painful, damaged long head of biceps tendon can be released (tenotomy) or released and reattached lower down on the humerus (tenodesis). The choice depends on age, activity level and cosmetic appearance, as tenotomy may sometimes produce a noticeable bulge in the upper arm.
• Arthroscopic Management of Impingement Syndrome: If the pain of impingement does not settle with physiotherapy then arthroscopic subacromial decompression can be offered. The bursa is removed and the underside of the acromion may be smoothed if a bony spur is encroaching on the space. To date, the evidence suggests that careful selection is important as many patients improve with exercise alone.
• Arthroscopy of the Frozen Shoulder: For frozen shoulders that are still stiff and limiting after conservative care, the tight capsule can be released arthroscopically, sometimes combined with gentle manipulation. Afterward intensive physiotherapy is required to maintain the movement which has been regained.
• Management of Acromioclavicular (AC) Joint Dislocation: For mild AC joint injuries, treatment includes a sling and rehab. Severe or painful dislocations may require stabilization of the collarbone to the shoulder blade using fixation devices or ligament reconstruction.
  Treatment for Clavicle Fractures: Most collarbone fractures heal with a sling. If the bone ends are widely displaced or shortened, the skin is compromised, or the patient has high functional demands, surgery with a plate or other fixation may be indicated.
• Proximal Humerus Fracture Management: Older adults who fall are prone to fractures in the portion of the arm bone, near the shoulder. If the break is minimally displaced, it is often put in a sling and early gentle motion is encouraged. If the fracture is displaced, fixation with a plate or nail may be necessary. In elderly patients, some severe fractures are treated with shoulder replacement.
• Treatment of Fracture of Shaft of Humerus: The arm bone may be fractured in the middle and treated in a functional brace as many heal well without surgery or with a plate or nail if it is difficult to maintain the alignment, there are other injuries or a faster return to function is needed. The radial nerve lies close to this bone and is carefully examined before and after treatment.

Arthroscopic Shoulder Surgery – What It Means for You

Keyhole surgery is less invasive of the large deltoid muscle than many open approaches, but the internal repair still occurs at the pace of biology. Therefore, patients who feel good early on still need to adhere to sling and lifting restrictions.

Recovery and Rehabilitation After Shoulder Surgery

The general principles apply to most shoulder surgery, but the timing is specific for each type of procedure.

Phase 1 – Defense

The sling supports the repaired tissue. Exercises for your hand, wrist and elbow keep the rest of your arm moving and help to reduce swelling in your hand. Pendulum exercises and assisted movements may start within the limits set by the surgeon. In the first few weeks it is often more comfortable to sleep semi-upright, propped up with pillows or in a reclining chair.

Phase 2 – Restoring Movement

As the repair becomes more secure the physiotherapist will gradually increase the movement of the shoulder, using assisted, then active exercises.

Phase 3 – Solidifying

Resistance bands and light weights restore strength in the rotator cuff and shoulder blade. This phase is typically started at about 3 months after a tendon repair.

Phase 4 – Return to Work and Sport

Overhead work, heavy lifting and throwing or contact sports are reintroduced step by step. Return to full sport after stabilisation or cuff repair commonly takes several months.

Stiffness is one of the most common problems after shoulder surgery, so regular, correct exercise – neither too little nor too aggressive – has a large influence on the result.

Everyday Life During Shoulder Recovery

• Dressing: Put the operated arm into sleeves first and take it out last. Loose, front-opening shirts and kurtas are easiest in the early weeks.
• Sleeping: Many patients find it easier to sleep propped up. In the sling the arm is supported in a pillow under the forearm.
• Labor: A couple of weeks after arthroscopy it is possible to return to desk work with the hand that was not operated on, and several months after repairs manual and overhead work.
• Driving and Two Wheelers: Don’t drive with a sling on. You need good shoulder control and strength to ride a scooter or motorcycle, so you’ll usually end up back later than if you’d taken a car.
• Household chores: Plan for cooking, taking utensils from high shelves, drying clothes on overhead lines, and lifting children. Organize family help during the sling period.

Planning Shoulder Surgery Around Your Life

There is a period in shoulder operations, especially repairs, when one arm is mostly out of commission. This is a lot easier with proper planning.

• Timing: If it’s not life-threatening surgery, try to schedule it when work is slow and family members can help out for the first couple of weeks. Many patients choose to avoid major festivals, weddings or travel during the sling period.
• Bulldozer: Surgery on the dominant arm impacts writing, eating, grooming and using a phone or computer mouse. Do these with the other hand before surgery and cut down on frustration later.
• House Setup: Keep everyday items at waist height, have a reclining chair or several pillows available for sleeping, and choose clothing that is easy to put on with one hand. Slip-on shoes mean no bending to tie laces, and a one-handed electric toothbrush or pump-action soap dispenser can greatly simplify personal care.
• Transports: Have someone drive you home after surgery and to the follow-up visits while you are in the sling.
• Access to Physiotherapy: Decide in advance where you will go to physiotherapy and how you will get there, as regular sessions in the first months have a big impact on the end range of motion.

Special Considerations for Older Patients

For older people, the decision is a balance of the potential benefit of surgery with bone quality, tendon quality and general health. Very large degenerative cuff tears may not heal reliably even after repair. For some patients, a well-structured exercise program provides worthwhile pain relief and function without surgery. For elderly patients sustaining upper arm fractures many minimally displaced injuries heal well in a sling with early mobilization. Where surgery is appropriate, bone health, fall prevention and help at home supports a safer recovery.

Shoulder Surgery Cost in Indore

The costs of the procedures vary enormously. The main factors are:

• The nature of the procedure – diagnostic arthroscopy, tendon repair, fracture fixation or stabilization.
• Number and type of anchors, plates, screws or grafts needed;
• Hospital, room type and length of stay.
• re-operative imaging (e.g. MRI or CT scan)
• Physiotherapy sessions post-surgery.

We will confirm your diagnosis and send you a written estimate.

Insurance and Cashless Medical Treatment

In general, medically necessary shoulder surgery is covered by health insurance, subject to your policy, waiting periods and limits. The cashless treatment is applicable only if the hospital is tied up with your insurer or TPA. The clinic can assist you with pre-authorisation.

Taking Care of Your Shoulders – Prevention in Daily Life

Here are some habits that will help to reduce the strain on the shoulder and lower the risk of overuse injury:

• Don’t just beef up the big “mirror muscles” of the chest and front shoulder. Add some light resistance-band work for the rotator cuff and shoulder-blade muscles.
• Adjust your workstation so you look straight at the screen and keep your elbows tucked in to prevent hunching.
• Do not make sudden jumps in training load in throwing sports, swimming or gym work and have recovery days.
• Use correct lifting technique, keep loads close to the body and avoid repeated heavy lifting above shoulder height where possible.
• Warm up before sport, like gentle arm circles and band exercises.
• After minor strains, keep the shoulder moving within comfortable limits, not holding it still for long periods which encourages stiffness.
• Don’t wait for a first dislocation to settle down on its own, especially if you’re young and active.

Shoulder Pain That Comes From Elsewhere

Not every shoulder pain starts in the shoulder joint. A pinched nerve in the neck can cause pain over the shoulder blade and down the arm with tingling or numbness in the fingers. Gallbladder problems can cause referred pain to the right shoulder tip and heart problems can cause pain in the left shoulder or arm. A careful history and examination helps to separate these causes so that treatment is aimed at the right source. If the neck is likely the problem, treatment is directed to the neck and not the shoulder.

Questions to Ask About Your Shoulder

Questions to ask before or during your consultation:

• What structure in my shoulder is causing the pain or instability?
• Will my tear or injury get better or heal without surgery?
• If I wait, will the tear get bigger or will the shoulder dislocate again?
• If surgery is recommended, will it be arthroscopic and what exactly will be repaired?
• How long will I have to wear the sling and how much help will I need at home?
• When can I get back to work, driving and my sport?
• How likely is stiffness and how can I minimize this?
• How many physio appointments will I have?

A Second Opinion for Your Shoulder

If you have been advised to have shoulder surgery or told the tear is not repairable, a second opinion can shed some light on the situation. Take your MRI images (not just the written report) and any previous X-rays and physiotherapy notes as the size of a tear, how far it has retracted and the condition of the muscles are assessed by looking at the images with a fresh examination. Dr. Rassiwala will discuss whether he agrees with the plan, why he does, and what are reasonable alternatives, if any, for your specific shoulder and lifestyle.

Why Consult Dr. Murtuza Rassiwala for Shoulder Surgery

• Practice Focused on Arthroscopy: Dr. Rassiwala is performing many arthroscopic knee and shoulder surgeries.
• Orthopedic Qualifications (Formal): MBBS, Baroda University 2013 DNB (Orthopaedics), National Board of Examinations 2018 MNAMS F.I.A.S.M. F.I.A.J.R. Academic title: Associate Professor
• Sports Care and Trauma Under One Roof: His practice includes arthroscopy and fracture managment, so patients with sports injuries and patients with fractures around the shoulder can be assessed and treated by the same surgeon.
• Conservative care first when appropriate: Other patients with impingement, partial tears or early frozen shoulder are treated non-surgically with reassessment prior to consideration of a surgical approach.

Book a Shoulder Consultation in Indore

If shoulder pain, stiffness, weakness or instability is affecting work, sleep or sport, a detailed assessment can help identify the cause and most appropriate treatment. For details or to book an appointment with Dr. Murtuza Rassiwala at Hakimi Ortho Care, 106 Badshah Chambers, Jawahar Marg or 6 Phadnis Colony, Manik Bag Road, Indore,

Book your appointment with Dr. Murtuza Rassiwala at Hakimi Ortho Care, 106 Badshah Chambers, Jawahar Marg or 6 Phadnis Colony, Manik Bag Road, Indore. You can call +91-7224888071, 0731-4981538 or 0731-3695285 or Book Online.

Medically reviewed by: Dr. Murtuza Rassiwala, MBBS, DNB (Orthopaedics)

This page is for general information only and does not substitute for personal medical advice.