Orthopaedic Nurse Specialists Training With Arthrex

At Shoulder Elbow Orthopaedic Group, we understand the honour and responsibility bestowed on us when patients trust us with their health. Our orthopaedic multi-disciplinary team is committed to a shared purpose to ensure the best care for our patients. 

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Hence it is not only crucial for our orthopaedic surgeons to be equipped with updated surgical skills and knowledge. However, it is also important that the Shoulder Elbow Orthopaedic Group’s orthopaedic nurse specialists receive training to update and improve their skills and knowledge. 

On 23 Feb 2022, we closed all Shoulder Elbow Orthopaedic Clinic branches so our nurses, accompanied by our orthopaedic specialists, could attend a hands-on skills training workshop. 

Arthrex Nurses Specialists Orthopaedic Training, Orthopaedic Training, Shoulder Elbow Orthopaedic Group, Orthopaedic Clinic Singapore

Thank you, Arthrex, for helping our nurses learn invaluable skills that will aid our aim always to provide better care for our patients.

What Is the Link Between Cycling and Shoulder Pain?

As an avid and passionate cyclist, Dr Desmond Ong understands  and some of the commonly seen and experienced injuries and pain points of the sport. Dr Desmond explains why some people experience pain when they first begin cycling, and when it would be best to seek medical advice. 

  1. Tell Us a Little Bit About Your Experience With Cycling As a Sport.

I currently ride a rim brake Pinarello Dogma F12 with Dura-ace Di2 and Scope R3c carbon wheels.

I have been riding seriously since 2006 and, over the years, have gotten to know groups such as Cycleworx, Smile Asia, FOTR, New Moon Khcycle.

Dr Desmond Ong, Bowtie Doctor, Shoulder Pain, Cycling,  Shoulder Elbow Orthopaedic Group

My life-long love for sports, the fellowship among cyclists, and the need to push my body to understand its limits drives my passion for road riding.

The discipline of training for better performance on the bike is similar to that needed to excel as a surgeon. Dealing with the physical demands of training and the injuries encountered along the way also helps me understand the difficulties my patients go through dealing with their own ailments and injuries and how best to help them overcome these challenges and achieve their goals.

  1. Can Cycling Cause Shoulder Pain? Is Biking Bad For Shoulders?

Cycling is a sport that engages the whole body. It is, therefore, an excellent sport for building up our core muscle strength and endurance. Therefore, cycling is not necessarily bad for shoulders. However, cycling puts the shoulder at risk of injury and pain because of the load on the upper limbs.

Firstly, a typical riding position would place 40% of a rider’s weight on his upper limbs. This is fairly considerable and may be unique to cycling. Secondly, the body may be placed in the same position for hours, depending on the ride’s duration. 

Therefore like all exercises, excessive stress in terms of frequency, duration and intensity will put the shoulder at risk of injury from overuse or repetitive strain. At the same time, falls and accidents can cause traumatic injury to the shoulder and other parts of a cyclist’s body.

  1. How Do I Stop My Shoulder Pain When Cycling?

Most of us remember cycling as trips taken in our childhood or youth to East Coast or other parks when done on a rental bike. This sense of nostalgia and recognition of cycling’s health benefits have prompted many to pursue the sport in later life. 

The Covid-19 pandemic has seen a global surge in bicycle sales and cycling participation. However, the physical fitness needed to meet more serious cycling demands is often lacking in most sedentary workers. 

Therefore, it is essential when starting out to ride with friends who are of a similar level of experience. This will aid in accommodating a beginner’s needs. At any time during a ride, cyclists should not persist if the shoulders hurt.

Pain is an indication that the load on the shoulder is too excessive. Either due to sub-optimum endurance or strength. Stopping the ride will relieve the burden on the shoulders, allowing the shoulders to get some much-needed rest. Likewise, persisting on may lead to significant injury. 

  1. How to Avoid Shoulder Pain for Cyclists? How to Prevent Sore Shoulders Whilst Cycling?

When starting out, it is important to buy a bicycle from a reputable shop as the initial outlay for a bicycle can be considerable. The shop should be able to fit a buyer with an appropriately sized bike. Additionally, they can make the various adjustments on the different components, e.g stem, handlebar, crank, seat post and saddle. Alternatively, approach a qualified bicycle fitter for a fitting session. 

The multitude of adjustments will ensure that the cyclist’s position on the bicycle is optimum to avoid issues like shoulder pain. A beginner’s position will also be very different from that of an experienced rider. Meaning the shop should adjust the position as one’s experience, and fitness improves. 

As a rule, the beginner’s position may be more upright, and less stretched out so that the load on the shoulders is less. Then as the rider’s experience and fitness improve, the position can be adjusted to a more aerodynamic one desired by the rider.

  1. What Are 3 Common Shoulder Injuries Seen in Cyclists?

Some common shoulder injuries that are associated with cycling include: 

Shoulder Pain, Shoulder Injuries, Clavicle Fracture, Shoulder Elbow Orthopaedic Group

Image of a right clavicle fracture

  • Clavicle Fractures
  • Acromioclavicular Joint Dislocations 
  • Rotator Cuff Tears
  1. When Should I Seek Help From an Orthopaedic Surgeon for My Shoulder Pain?

Cyclists should seek help immediately if they were involved in any crashes or accidents. Some injuries may not be apparent and will only be diagnosed after an investigation by an orthopaedic surgeon. 

Leaving such injuries undiagnosed puts cyclists at risk of worsening the injuries or sustaining further damages. Secondly, any pain persisting more than 2-3 days or affecting simple activities of daily living should be evaluated by an orthopaedic surgeon.

Can Cycling Cause Shoulder Impingement?

As a fellow cyclist, Dr Desmond speaks about the relation between shoulder impingement and cycling. Find out how you can take care of shoulder impingement, stay active while giving your body time to recover, and some forms of treatment available. 


  1. Can Cycling Cause Shoulder Impingement

Yes, cycling can cause shoulder impingement. Cycling is an endurance sport, and rides often last more than an hour. The load placed on the shoulders can thus be quite considerable. 

This is especially so for the rotator cuff, which is a key stabiliser of the shoulder. The position of the upper limb on the bike also narrows the subacromial space that the rotator cuff passes through, which can worsen a shoulder impingement.

  1. What Is Shoulder Impingement

Shoulder Impingement, What Is Shoulder Impingement?, Cycling, Shoulder Pain, Shoulder Conditions, Shoulder Elbow Orthopaedic Group

Shoulder impingement is characterised by shoulder pain, weakness and reduced range of movement of the affected shoulder. It is due to the inflammation of the rotator cuff tendon due to the load placed upon it and attritional damage as it passes under the acromial arch.

  1. Is It Ok to Cycle With Shoulder Impingement?

Cyclists with shoulder impingement should seek medical treatment. Your doctor will be able to confirm the diagnosis and exclude other possibilities to render the correct treatment. Persisting to cycle with the pain may make the condition worse. Therefore, it is best to always heed the advice of your medical practitioner. 

  1. How to Maintain Your Fitness Without Making Worsening Your Condition?

If you are suffering from a shoulder condition but want to stay active while giving your body time to recover, try alternative exercises that do not place a load on the upper limbs. For example, one can take up running or activities that avoid overhead movements. 

In general, activities that worsen the impingement will lead to pain, so I would advise avoiding any exercise that triggers the pain.

  1. How Do You Rehabilitate a Shoulder Impingement?

The first step in rehabilitation would be avoiding further damage or aggravation by avoiding painful activities. The next step would be physiotherapy to address the weakness and reduced range of movement.

A good physiotherapist will also look for other contributory factors and address those as well. Finally, subacromial decompression surgery may be needed to improve the available space under the acromial arch.

  1. What Happens If Shoulder Impingement Is Left Untreated?

Untreated shoulder impingement can worsen. This may be seen as an increase in the symptoms felt. It can also be increasing stiffness, progressing to a frozen shoulder which often requires more than a year to improve. 

In more severe cases, the mechanical attrition can actually lead to a tear of the rotator cuff, which will need surgical treatment. In fact, mechanical attrition like that encountered in impingement is widely accepted as a cause of rotator cuff tears. 

Treatment Options For Massive Rotator Cuff Tears | PhysioActive Talk

Date and Time: April 30 2021, 12:30pm – 2:00pm
Guest Speaker: Dr Desmond Ong, Consultant Orthopaedic/Shoulder Surgeon at Shoulder Elbow Orthopaedic Clinic

Dr Desmond Ong joined our partners at PhysioActive to discuss rotator cuff tears and how they are a common cause of shoulder pain.

Rotator cuff tears become more common with age and can rob many of their ability to do the things they enjoy and their independence in their golden years. Dr Desmond touched on how non-surgical treatment options can improve one’s pain.

Learn how to better care for patients suffering from rotator cuff tears and the various treatment options available and how each option brings its own set of benefits. For more information on rotator cuff tears and the respective treatment options go to https://sportsinortho.com/.

Dr Desmond Ong, Shoulder Elbow Orthopaedic, PhysioActive, Massive Rotator Cuff Tears, Treatment Options, Insight and Evidence

Dr Desmond Ong, Shoulder Elbow Orthopaedic, PhysioActive, Massive Rotator Cuff Tears, Treatment Options

Dr Desmond Ong, Shoulder Elbow Orthopaedic, PhysioActive, Joint Preserving Options, Classic Transfers

Latissimus Dorsi Transfer – Tendon Transfer to Repair Rotator Cuff

What Is a Latissimus Dorsi Transfer?

Latissimus dorsi refers to one of the largest muscles in your back. You may have heard it being referred to as your ‘lats’. Your latissimus dorsi, or lats, control the movement of your shoulders. 

The latissimus dorsi transfer is a treatment option for massive or irreparable rotator cuff tears. It involves the “re-routing” of the latissimus dorsi to take over the function of the torn rotator cuff. 


Why Would Someone Need a Latissimus Dorsi Transfer?

Rotator cuff tears result from either injury or as a result of degeneration due to overuse or age. They cause pain and loss of shoulder motion, which thus reduces the quality of lives of patients. If picked up early, these can be repaired with arthroscopic, minimally invasive techniques. 

Despite advances in technology and techniques, there remains a group of patients whose tears cannot be repaired. The following reasons contribute to tears that cannot be repaired:

  1. Large tears which have retracted and cannot be reattached
  2. Tears involving two or more muscles of the rotator cuff
  3. Tears that have been left untreated for too long. This length of time varies from individuals to individuals and may be as short as a few months 
  4. Older patients whose tendons may have degenerated beyond repair

Irreparability does not mean living with life-long pain and disability in the right hands. Hence irreparability does not mean untreatable. 


How Does a Latissimus Dorsi Transfer Repair a Rotator Cuff Tear?

A latissimus dorsi transfer is a specialised operation performed under general anaesthesia. The latissimus dorsi muscle is first detached from its insertion on the humerus through a small incision in the armpit. 

The muscle is then mobilised to ensure it can reach the new insertion site at the rotator cuff. The tendon of the muscle is then prepared. Finally, the tendon is attached at the rotator cuff insertion arthroscopically using minimally invasive techniques. 


Postoperative Management After Undergoing a Latissimus Dorsi Transfer?

Immediately following surgery, patients are placed in a sling for comfort and to reduce the pain. Additionally, painkillers will be prescribed. With modern multimodal analgesia, pain can be reduced to a tolerable level, and most patients may be discharged from the hospital after a night’s stay. 

Patients are allowed to use their hands for simple activities of daily living to reduce the inconvenience following surgery. Shoulder blade movements may commence immediately after surgery. At two weeks, stitches will be removed, and physiotherapy will begin. 

The rehabilitative physiotherapy process is similar to that for rotator cuff repairs. Additionally, the length of time needed to restore function is similar or may even be shorter.