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ShoulderDoctor

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ShoulderDoctor

Please do get in touch today to see how we can help you. All members of the team are highly skilled and are trained to an exceptional level.

Dr Tony Kochhar has brought together a team of highly experienced healthcare professionals to ensure that you get the best treatment at a time and place convenient to you. We are a specialist team of surgeons, physiotherapists, anaesthetists, and allied healthcare professionals dedicated to delivering the highest quality care for our patients. We understand that your condition may need treatment from several fields - it's not just about surgery. We have therefore created a team of the best specialists in each field to ensure that you receive the most complete treatment from start to finish.

20/02/2026

WHAT’S ON THE OP LIST TODAY?

A classic case of weightlifter’s shoulder.

This is pathology of the acromioclavicular (AC) joint — the small but heavily loaded joint at the top of the shoulder where the collarbone meets the acromion.

In this case, persistent AC joint pain despite prolonged conservative management.

Weightlifter’s shoulder typically develops from repetitive compression through the AC joint:

• Heavy bench press
• Dips
• Repeated overhead lifting
• High training loads over time

Patients often describe very localised pain right on the top of the shoulder, worse with cross-body movements or pressing exercises.

It can easily be mistaken for rotator cuff pathology, but the source of pain is different, and so is the solution.

Through keyhole surgery, we remove a small portion of the end of the collarbone. This eliminates the painful bone-on-bone contact while preserving stability and function.

The aim isn’t to stop training. It’s to allow a return to training without chronic AC joint pain.

As always, surgery follows appropriate rehabilitation and load modification. It’s not first line, but in the right patient, it’s transformative.

Orthopaedics

19/02/2026

BURSITIS

If your shoulder pain lives here (outer shoulder, upper arm), think bursa.

The subacromial bursa sits between bone and tendon. Its job is to reduce friction.

When inflamed? Every lift, reach or press can feel irritated.

Common signs:
• Pain when lifting the arm sideways
• Discomfort at night, especially lying on that side
• Aching down the upper arm

The important part: bursitis is often part of a bigger picture involving the rotator cuff.

Good diagnosis > rushed treatment.

Pain location matters — but context matters more.

Any questions? Please ask below 👇

16/02/2026

TEARS AROUND THE GLENOMUMERAL LIGAMENT…OR HAGLs, GAGLs and the like

Let’s define the acronyms above first of all:

HAGL - humeral avulsion of the glenonumeral ligament
BHAGL - bony humeral avulsion of the glenonumeral ligament
GAGL - glenoid avulsion of the glenonumeral ligament
RHAGL - reverse humeral avulsion of the glenohumeral ligament
PHAGL - posterior humeral avulsion of the glenonumeral ligament
AIGHL - “floating” anterior inferior glenonumeral ligament (avulsion at both ends)
Axillary pouch tear indicates injury to the mid portion of the IGHL between the anterior and posterior bands

That’s a lot of glenohumeral ligament injuries.

The key takeaway in diagnosing these types of injuries is that they don’t show up on plain MRI scans - an MRI arthrogram is required.

If you’re treating someone who has a history of instability and isn’t making progress with physio after an initial MRI, then please consider referring for an MRI arthrogram.

Any questions? Please ask below 👇

15/02/2026

WHAT IS VO2 MAX

I’m currently testing a device which claims to increase VO2 max so before I discuss my results I thought it would be worth recapping what VO2 max is and why it’s important.

WHAT IS IT?

VO₂ max measures the maximum amount of oxygen your body can utilise during intense exercise.

It reflects the integrated performance of:
• Your lungs
• Your heart
• Your circulation
• Your muscles

In simple terms:
How efficiently your body delivers and uses oxygen under stress.

Your VO₂ max is not just about fitness — it’s about physiology.

WHAT DOES IT DEPEND ON?

1. Cardiac Output
How much blood your heart can pump per minute.

2. Oxygen Transport
How effectively oxygen is carried in the bloodstream.

3. Muscle Extraction
How efficiently your muscles use that oxygen.

This is why it’s such a powerful marker — it reflects the entire system working together.

Higher VO₂ max is associated with:

• Lower cardiovascular risk
• Reduced all-cause mortality
• Greater metabolic resilience
• Improved cognitive performance
• Better recovery capacity

It is one of the strongest predictors of long-term health we can measure.

And unlike genetics — it is trainable.

WHAT ARE THE MOST EFFECTIVE METHODS TO IMPROVE IT?

• Zone 2 endurance training
• High-intensity interval training
• Strength training
• Body composition optimisation
• Sleep and recovery optimisation

Any questions? Please ask below 👇

13/02/2026

WHAT’S ON THE OP LIST TODAY

- A complex displaced clavicle fracture.
- A traumatic, full-thickness rotator cuff tear following a slip and fall.
- And an arthritic shoulder that has exhausted extensive conservative management.

As half term approaches and ski trips begin, we see a predictable pattern of injuries.

Clavicle fractures with significant displacement may require fixation to restore alignment, optimise union, and protect long-term function.

A traumatic cuff tear after a fall is distinct from degenerative wear. In the appropriate patient, timely repair can preserve strength and reduce the risk of irreversible muscle atrophy.

And then there is glenohumeral arthritis. Physiotherapy, activity modification, injections, and conservative treatment first. Surgery only when symptoms remain function-limiting despite appropriate non-operative care.

⛷️After a ski fall, seek assessment if you notice:
• Inability to actively lift the arm
• Marked weakness compared to the opposite side
• Visible deformity over the collarbone
• Persistent night pain
• Loss of function beyond a few days

Different pathologies. Different timelines.
The common thread is appropriate assessment and appropriate timing.

Shoulder surgery works best when it is precise, necessary, and part of a considered plan.

Any questions? Please ask below 👇

02/02/2026

WHAT A YEAR OF WEARABLE DATA TAUGHT ME - AND WHY INTERPRETATION MATTERS MORE THAN COLLECTION

January is as good a time as any to “audit” all aspects of our lives so I took some time to review data from my wearable. Here’s what I learned.

Wearables generate an enormous amount of physiological data. Beyond simple metrics like step count, making sense of it isn’t always straightforward.

Over the past year, my device tracked various metrics. Looked at in isolation, these numbers can be confusing — and sometimes misleading.

What changed things for me was using an AI-based analysis tool as a structured way to review patterns over time, rather than reacting to individual values.

By looking at multiple metrics together — and placing them in the context of age, training load, and recovery — the trends became clearer:

⬆️ rising heart rate
⬇️ falling HRV
⬆️ breathing rate
⬆️ temperature
↘️ sleep

Interpreted properly, this reflected accumulated training stress and recovery demand, not declining fitness or illness — particularly in the setting of HYROX training in my 50s.

The key lesson?

Wearables don’t provide diagnoses, and AI doesn’t replace clinical judgment.

But used thoughtfully, they can help organise complex data, highlight patterns, and support better decisions around training and recovery.

The value wasn’t in the technology itself — it was in understanding what the data was actually telling me.

Good data still needs good interpretation.

And for me, the key takeaway (which is surprisingly useful to help focus my training goals for this year) is to focus on recovery (especially sleep) as much as training.

Have you looked at your wearable data and if so what did it show you? Please share below 👇

30/01/2026

WHAT’S ON THE OP LOST TODAY?

On today’s list are procedures typically considered after appropriate conservative management has not worked effectively.

▫️ Manipulation under anaesthetic — used for refractory frozen shoulder to release capsular tightness, restore range of motion, and allow rehabilitation to progress.

▫️ Arthroscopic removal of loose bodies — addressing mechanical symptoms such as catching and locking caused by intra-articular fragments.

▫️ Humeral head debridement — smoothing unstable or damaged cartilage to improve joint mechanics, reduce pain, and support longer-term joint health.

These are not “quick fixes”, but carefully selected interventions aimed at restoring function, relieving pain, and optimising shoulder longevity.

Any questions? Please ask below 👇

03/10/2025

WHAT’S ON THE OP LIST TODAY - AWAKE SURGERY

One of today’s patients had had a bad experience with general anaesthetic so had her op “awake”.

This is where surgery is performed under local rather than general anaesthetic. We numb only the shoulder rather than giving a general anaesthetic so the patient isn’t put to sleep but can rather be awake throughout their surgery.

The patient has minimal post-op pain. The time in the recovery room is reduced to approximately 30mins with almost no post op nausea or vomiting.

These are big steps forward for patient confidence in operations where the fear of general anaesthesia traditionally caused almost as much anxiety as the operation itself.

The advantages of “awake surgery” are:

- no risk of a general anaesthetic
- minimal post-op pain
- no side effects from an anaesthetic (post-op nausea and vomiting, drowsiness, confusion)
- minimal, if any requirement for post-op opioids
- patients can start immediate post-op physio

Some patients don’t like the idea of being fully awake to watch their operation from start to finish and for these patients we offer sedation as an alternative.

Any questions? Please ask below 👇

20/09/2025

WHEN A SUBACROMIAL DECOMPRESSION REVEALS A SUBSCAP TEAR

Interesting op list today. I had three “subacromial decompressions” which is a type of surgery I don’t do very often. Nowadays we try to recover patients who would otherwise have needed a subacromial decompression with non-surgical measures. These patients had all had extensive conservative treatment and just weren’t recovering so opted for surgery.

As you can see from one of the examples, the patient had a subscap tear which was not evident on scanning but is evident when you internally and externally rotate the shoulder during arthroscopy. It wouldn’t have shown on MRI as it’s not a dynamic scan and not on ultrasound either as we press down on it to scan it and the tear is therefore masked.

This was an interesting list and all three patients should go on to a full recovery.

Any questions? Please ask below 👇

12/09/2025

WHAT’S ON THE OP LIST TODAY - BICEPS TENODESIS

Today’s op list included a biceps tenodesis. This patient had ruptured his long head of biceps last week. Timing is key in biceps ruptures so we managed to get him in for surgery this week.

Most people don’t need surgery after a long head of biceps rupture — in fact, many patients do really well without repair, but for this high-performing athlete, leaving it torn wasn’t an option he was comfortable with, so a biceps tenodesis was the right choice.

Sometimes, it’s not just about the tendon — it’s about listening to each patient’s goals and tailoring the plan to their lifestyle.

Any questions? Please ask below 👇

26/08/2025

Val is the most amazing person who is facing her biggest challenge yet. If you’ve learned from her, been treated by her or known her in any way you will know her spirit shines through in everything she does. Please donate what you can to get her home.

16/04/2025

WHEN SHOULD I WORRY ABOUT A LIPOMA?

This case is all about a lipoma. The video is of a lipoma I recently excised from a patient (shared with their permission). This appeared over the last couple of months and this patient rightly came along to get it checked out. We scanned it to assess what it was before discussing options and the patient opted to have this excised. It was of course sent off to pathology to get it checked post-op as we always do.

This condition is fairly common, affecting about 1% of the adult population. They are benign lumps of fat cells under the skin most commonly seen in adults between 40 and 60 years old. These lumps are usually soft and painless and if left are usually benign.

🚩 When to check them:

1️⃣ If they start hurting or limit movement.
2️⃣ If they grow rapidly.
3️⃣ If they’re very large (over 2 inches).
4️⃣ If new ones appear, especially after age 40.
5️⃣ If they’re deep within muscles or tissues.

While most lipomas are harmless, the signs above are worth a medical checkup.

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