Shoulder Instability

Get It Right, from the start


Arthroscopic Stabilisation for shoulder instability

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Latarjet for Instability

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Shoulder Impingement  

Care By Professionals You Can Trust


Rotator Cuff Tears

Evidence Based Management

Arthroscopic Rotator Cuff Repair

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Shoulder Arthritis

Adding life to years not years to life


What is Arthritis?

Anatomic Shoulder Replacements

Reverse Shoulder replacements

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Anatomic Total Shoulder Replacement

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Anatomic Total Shoulder Replacement

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Adhesive Capsulitis

(Frozen Shoulder) 

All what you want to know about Frozen Shoulder.

Reverse Shoulder Replacement

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Shoulder Trauma

Evidence Based Management

Complex Regional Pain Syndrome

Evidence Based Management

Acromioclavicular (AC) Joint Injury

Acromioclavicular joint (ACJ) injuries are very common sporting injuries. Acute traumatic injuries occur with contact and collision sports, horse riding and motorsports. Repetitive traumatic injuries occur with overhead sports, boxing and weightlifting. Many ACJ injuries can be managed with rest and activity modification, however sometimes surgery is indicated. There is a traditional consensus that dictates surgery is indicated for higher-grade (IV–VI) ACJ injuries and lower grade injuries can be managed non-operatively, however treatment based purely on classifications have been shown to be unreliable. Therefore, a more symptom-based management approach is more pragmatic. Traditional surgical fixation techniques have also had high failure rates, but recent anatomically-based reconstructions with stronger materials and biomechanics seem to provide more reliable outcomes in athletes. 


The development of strong anatomical reconstructions and a more patient-specific approach to management, based on careful patient and procedure selection, has improved the management and outcomes for athletes. In this chapter, we aim to summarize the anatomy and biomechanics of the AC joint as well as the assessment, diagnosis, and treatment protocols, including our preferred protocol, for the range of ACJ injuries.


Osteoarthritis (os-tee-o-arth-ri-tus) is a very common condition of the joints. It’s most common in people over the age of about 45, but younger adults may sometimes develop it.

It can affect any joint in the body. However, it’s most likely to affect the joints that bear most of our weight, such as the knees and hips. Joints that we use a lot in everyday life, such as the joints of the hand, are also commonly affected.

A joint is where two or more bones meet. In a healthy joint, a coating of tough but smooth and slippery tissue called cartilage, covers
the surface of the bones and helps the bones to move against each other without friction

Rheumatoid Arthritis

Rheumatoid arthritis (roo-ma-toy-d arth-ri-tus) is a condition that can cause pain, swelling and stiffness in joints.

It is known as an autoimmune condition. This means that the immune system, which is the body’s natural self-defence system, gets confused and starts to attack your body’s healthy tissues.

In rheumatoid arthritis, the main way it does this is with inflammation (in-fla-may-shun) in your joints. 

Rheumatoid arthritis affects around 400,000 adults aged 16 and over in the UK. It can affect anyone of any age. It can get worse quickly, so early diagnosis and intensive treatment are important.

The sooner you start treatment, the more effective it’s likely to be. To understand how rheumatoid arthritis develops, it helps to know how a normal joint works.