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Auckland Shoulder and Hand Clinic - Mr Shihab Faraj

Private Service, Orthopaedics

Today

Description

HOURS

Monday to Friday: 7:30am - 5:00pm

Mr Faraj is happy to see your patients with the following shoulder problems:

Rotator Cuff Tears • Shoulder Dislocation

 

Mr Faraj is happy to see your patients with the following hand problems:

• Carpal Tunnel Surgery & Release • De Quervain’s • Ganglions

• Trigger Finger Release • Wrist Arthroscopy • TFCC Repair

• Dupuytren’s Contracture • Ulnar Nerve Entrapment

 


Mr Faraj can see your patient within 5-7 working days at one of the clinics in the greater Auckland region.
Please send your referral to my office via health link akldhand or fax 09 6389 384 and my office will book your patient close to their home or work address.

I am a full time private consultant orthopaedic surgeon with subspecialty training in upper limb surgery. I have a particular interest in disorders of the hand, elbow and shoulder. I will also be happy to assist in the care of patients following accidents covered under ACC.

For North Shore City:

  1. Silverdale Medical Centre, 7 Polarity Rise, Silverdale. Fax: (09) 6389 384
  2. Westgate Medical Centre,  Westgate Shopping Centre -13E Maki Street, Westgate             Fax: (09) 6389 384

For West Auckland:

  1. New Lynn The Doctors, 19 Delta Ave, New Lynn. Fax: (09) 6389 384
  2. Westcare White Cross, 131 Lincoln Rd, Henderson. Fax: (09) 6389 384
  3. Westgate Medical Centre,  Westgate Shopping Centre - 13E Maki Street, Westgate Fax: (09) 6389 384

For Central Auckland:

  1. The Main Office, 92 Mountain Road, Epsom Fax: (09) 6389 384
  2. White Cross Ascot Hospital , 90 Greenlane Road, Remuera. Fax: (09) 6389 384

For South & East Auckland:

  1. Ormiston Hospital, Ground Floor, Radiology Dep, 125 Ormiston Road, Botany Junction. Fax (09) 638 9384 
  2. Manukau City Accident & Medical Centre16A Bakerfield Place, Manukau.                      Fax: (09) 6389 384
  3. Cavendish Specialist Centre, 175 Cavendish Road, Papatoetoe. Fax: (09) 638 9384
  4. Counties Medical Integrated Health Centre , 6-18 O'Shannessey Street, Papakura.            Fax (09) 6389 384

Staff

Wendy 

Jo

Consultants

Referral Expectations

Your GP will send us a letter explaining your condition and most likely they will suggest that you call us to make an appointment.

You need to bring with you:

1.       Any letters or reports from your doctor or other hospital.
2.       Any X-Rays, CT or MRI films and reports.
3.       All medicines you are taking including herbal and natural remedies.
4.       Your pharmaceutical entitlement card.
5.       Your ACC number or ACC45 document, if you have one.

Hours

Mon – Fri 7:30 AM – 5:00 PM

Procedures / Treatments

Shoulder Pain

Information sheet for Shoulder Pain Causes Shoulder Pain Causes (PDF, 27.7 KB)

Information sheet for Shoulder Pain Causes

Frozen Shoulder

Information sheet for Shoulder Pain - Frozen Shoulder Shoulder Pain - Frozen Shoulder (PDF, 132.2 KB)

Information sheet for Shoulder Pain - Frozen Shoulder

Rotator Cuff Tear

Information sheet for Shoulder Impingement and Rotator Cuff Problems Shoulder Impingement and Rotator Cuff Problems (PDF, 142.4 KB)

Rotator Cuff Surgery Patient Information Before Operation

Mr Faraj Orthopaedic and Hand Surgeon 92 Mountain Road, Epsom 09 6389 389 Notes for patients having rotator cuff repair surgery The rotator cuff is a group of four tendons and the related muscles that stabilize the shoulder joint and allow you to raise and rotate your arm. The shoulder is a ball-and-socket joint with three main bones: the upper arm bone (humerus), the collarbone (clavicle), and the shoulder blade (scapula). These bones are held together by muscles, tendons, ligaments, and the joint capsule. The rotator cuff helps keep the ball of the arm bone seated into the socket of the shoulder blade. Surgery to repair a torn rotator cuff tendon usually involves: · Removing loose fragments of tendon, bursa, and other debris from the space in the shoulder where the rotator cuff moves (debridement). · Making more room for the rotator cuff tendon so it is not pinched or irritated. If necessary, this includes shaving bone or removing bone spurs from the point of the shoulder blade (subacromial smoothing). · Sewing the torn edges of the supraspinatus tendon together and to the top of the upper arm bone (humerus). In open shoulder surgery, a surgeon makes an incision [2 in. (5 cm) to 3 in. (7.6 cm)] in the shoulder to open it and view the shoulder directly while repairing it. A smaller incision can be done with a mini-open procedure that allows the surgeon to reach the affected tendon by splitting the deltoid muscle. This method may reduce your chances of problems from a deltoid injury. Open-shoulder surgery often requires a short stay in the hospital. General anesthesia or a nerve block may be used for these types of surgical repair. Rotator cuff tears can sometimes be repaired with arthroscopic surgery. Mr Faraj does the surgery using open shoulder surgery method. What To Expect After Surgery Discomfort after surgery may decrease with taking pain medicines prescribed by your doctor. The arm will be protected in a sling for a defined period of time, especially when at risk of additional injury. Physical therapy after surgery is crucial to a successful recovery. A rehabilitation program may include the following: · As soon as you awake from anesthesia, you may start doing exercises that flex and extend the elbow, wrist, and hand. · The day after surgery, if your doctor allows, passive exercises that move your arm may be done about 3 times a day (a machine or physical therapist may help the joint through its range of motion). · Active exercise (you move your arm yourself) and stretches, with the assistance of a physical therapist, may start 6 to 8 weeks after surgery. This depends on how bad your tear was and how complex the surgical repair was. · Strengthening exercises, beginning with light weights and progressing to heavier weights, can start a few months after surgery. Why It Is Done Surgery to repair a rotator cuff is done when: · A rotator cuff tear is caused by a sudden injury. In these cases, it's best to do surgery soon after the injury.1 · A complete rotator cuff tear causes severe shoulder weakness. · The rotator cuff has failed to improve after conservative nonsurgical treatment alone (such as physical therapy). · You need full shoulder strength and function for your job or activities, or you are young. · You are in good enough physical condition to recover from surgery and will commit to completing a program of physical rehabilitation. How Well It Works Rotator cuff repair surgery for a tear from a sudden injury works best if it is done within a few weeks of the injury. But repairs of very large tears are not always successful.1 Rotator cuff surgery to repair frayed or thinned tendon tissue is less likely to work than surgery to repair an injury to a healthy tendon.2 Risks In addition to the risks of surgery in general, such as blood loss or problems related to anesthesia, complications of rotator cuff surgery may include: · Infection of the incision or of the shoulder joint. · Pain or stiffness that won't go away. · Damage to the deltoid tendon or muscle (if the deltoid is detached, additional surgery may be needed to repair it). · The need for repeated surgery because tendons do not heal properly or tear again. · Nerve or blood vessel damage (uncommon). · Reflex sympathetic dystrophy (rare). After the surgery Patient Education/Guidelines • The following exercises were designed to help you regain the use and movement of your shoulder following surgery. • These exercises may begin on day 2 or 3 after surgery. • You will be instructed on when to begin further postoperative physiotherapy protocols • Active motion means using your own muscle power to do the movement. • Passive motion means using your unaffected arm or an assistive device (i.e. pulley or stick) to move the extremity. • You should not attempt to raise your arm overhead or lift your arm away from your side under your own muscle power (active motion) for the first 2-6 weeks following surgery depending on the type of procedure you have undergone. • You may stretch your arm overhead with your unaffected arm (passive motion). • Your sling should be worn between exercises and at night for the first 2 weeks following surgery to help you remember not to reach up with your arm. • Sling use may be upwards of 4-6 weeks if you have undergone a tendon/ligament repair procedure. Home Exercise Program first 6 weeks after surgery • Perform the exercises slowly and within a pain-free range. • Use an ice pack for 20-30 minutes immediately following exercises as needed for discomfort. • A sling must be worn between exercises and at night to protect the repair and/or rest your shoulder as instructed. Warm Up Exercises • Remove your sling and perform this exercise every hour for five minutes. • Place the unaffected hand on the back of a chair for stability. • Bend forward at the waist with the affected arm dangling toward the floor. Move your body (not your arm) in a circular manner (clockwise). • Repeat in a counter-clockwise direction. • Do the same exercise only move your body forward and backward allowing the arm to swing like a pendulum. Patient Information after Surgery (DOCX, 145.5 KB)

Mr Faraj

Orthopaedic and Hand Surgeon

92 Mountain Road, Epsom

09 6389 389

 

Notes for patients having rotator cuff repair surgery

The rotator cuff is a group of four tendons and the related muscles that stabilize the shoulder joint and allow you to raise and rotate your arm. The shoulder is a ball-and-socket joint with three main bones: the upper arm bone (humerus), the collarbone (clavicle), and the shoulder blade (scapula). These bones are held together by muscles, tendons, ligaments, and the joint capsule. The rotator cuff helps keep the ball of the arm bone seated into the socket of the shoulder blade.

Surgery to repair a torn rotator cuff tendon usually involves:

·    Removing loose fragments of tendon, bursa, and other debris from the space in the shoulder where the rotator cuff moves (debridement).

·    Making more room for the rotator cuff tendon so it is not pinched or irritated. If necessary, this includes shaving bone or removing bone spurs from the point of the shoulder blade (subacromial smoothing).

·     Sewing the torn edges of the supraspinatus tendon together and to the top of the upper arm bone (humerus).

In open shoulder surgery, a surgeon makes an incision [2 in. (5 cm) to 3 in. (7.6 cm)] in the shoulder to open it and view the shoulder directly while repairing it. A smaller incision can be done with a mini-open procedure that allows the surgeon to reach the affected tendon by splitting the deltoid muscle. This method may reduce your chances of problems from a deltoid injury.

Open-shoulder surgery often requires a short stay in the hospital.

General anesthesia or a nerve block may be used for these types of surgical repair.

Rotator cuff tears can sometimes be repaired with arthroscopic surgery.

 Mr Faraj does the surgery using open shoulder surgery method.

 

What To Expect After Surgery

Discomfort after surgery may decrease with taking pain medicines prescribed by your doctor.

The arm will be protected in a sling for a defined period of time, especially when at risk of additional injury.

Physical therapy after surgery is crucial to a successful recovery. A rehabilitation program may include the following:

·        As soon as you awake from anesthesia, you may start doing exercises that flex and extend the elbow, wrist, and hand.

·        The day after surgery, if your doctor allows, passive exercises that move your arm may be done about 3 times a day (a machine or physical therapist may help the joint through its range of motion).

·        Active exercise (you move your arm yourself) and stretches, with the assistance of a physical therapist, may start 6 to 8 weeks after surgery. This depends on how bad your tear was and how complex the surgical repair was.

·        Strengthening exercises, beginning with light weights and progressing to heavier weights, can start a few months after surgery.

 

 

Why It Is Done

Surgery to repair a rotator cuff is done when:

·        A rotator cuff tear is caused by a sudden injury. In these cases, it's best to do surgery soon after the injury.1

·        A complete rotator cuff tear causes severe shoulder weakness.

·        The rotator cuff has failed to improve after  conservative nonsurgical treatment alone (such as physical therapy).

·        You need full shoulder strength and function for your job or activities, or you are young.

·        You are in good enough physical condition to recover from surgery and will commit to completing a program of physical rehabilitation.

How Well It Works

Rotator cuff repair surgery for a tear from a sudden injury works best if it is done within a few weeks of the injury. But repairs of very large tears are not always successful.1

Rotator cuff surgery to repair frayed or thinned tendon tissue is less likely to work than surgery to repair an injury to a healthy tendon.2

Risks

In addition to the risks of surgery in general, such as blood loss or problems related to anesthesia, complications of rotator cuff surgery may include:

·        Infection of the incision or of the shoulder joint.

·        Pain or stiffness that won't go away.

·        Damage to the deltoid tendon or muscle (if the deltoid is detached, additional surgery may be needed to repair it).

·        The need for repeated surgery because tendons do not heal properly or tear again.

·        Nerve or blood vessel damage (uncommon).

·        Reflex sympathetic dystrophy (rare).

 

After the surgery

Patient Education/Guidelines

• The following exercises were designed to help you regain the use and movement of

your shoulder following surgery.

 

• These exercises may begin on day 2 or 3 after surgery.

 

• You will be instructed on when to begin further postoperative physiotherapy protocols

 

• Active motion means using your own muscle power to do the movement.

 

• Passive motion means using your unaffected arm or an assistive device (i.e. pulley

or stick) to move the extremity.

 

• You should not attempt to raise your arm overhead or lift your arm away from your

side under your own muscle power (active motion) for the first 2-6 weeks following

surgery depending on the type of procedure you have undergone.

 

• You may stretch your arm overhead with your unaffected arm (passive motion).

 

• Your sling should be worn between exercises and at night for the first 2 weeks

following surgery to help you remember not to reach up with your arm.

 

• Sling use may be upwards of 4-6 weeks if you have undergone a tendon/ligament

repair procedure.

 

 

Home Exercise Program first 6 weeks after surgery

• Perform the exercises slowly and within a pain-free range.

• Use an ice pack for 20-30 minutes immediately following exercises as needed for discomfort.

• A sling must be worn between exercises and at night to protect the repair and/or rest your shoulder as instructed.

Warm Up Exercises                                                    

• Remove your sling and perform this exercise every hour for five minutes.                                • Place the unaffected hand on the back of a chair for stability.

• Bend forward at the waist with the affected arm dangling toward the floor. Move your body (not your arm) in a circular manner (clockwise).

• Repeat in a counter-clockwise direction.

• Do the same exercise only move your body forward and backward allowing the arm to swing like a

pendulum.               

Shoulder Instability

Information sheet on Shoulder Instability Shoulder Instability (PDF, 117 KB)

Information sheet on Shoulder Instability

Arthroscopy (keyhole surgery)

Over the last 30 years a large number of orthopaedic procedures on joints have been performed using an arthroscope, where a fiber optic telescope is used to look inside the joint. Through this type of keyhole surgery, fine instruments can be introduced through small incisions (portals) to allow surgery to be performed without the need for large cuts. This allows many procedures to be performed as a day stay and allows quicker return to normal function of the joint. Arthroscopic surgery is less painful than open surgery and decreases the risk of healing problems. Arthroscopy allows access to parts of the joints which can not be accessed by other types of surgery.

Over the last 30 years a large number of orthopaedic procedures on joints have been performed using an arthroscope, where a fiber optic telescope is used to look inside the joint. Through this type of keyhole surgery, fine instruments can be introduced through small incisions (portals) to allow surgery to be performed without the need for large cuts. This allows many procedures to be performed as a day stay and allows quicker return to normal function of the joint.
Arthroscopic surgery is less painful than open surgery and decreases the risk of healing problems.  Arthroscopy  allows access to parts of the joints which can not be accessed by other types of surgery.
Distal Radius Osteotomy
Fracture Management
Joint Replacement

For elderly patients joint replacement surgery is commonly required to treat damaged joints from wearing out, arthritis or other forms of joint disease including rheumatoid arthritis. In these procedures the damaged joint surface is removed and replaced with artificial surfaces normally made from metal (chromium cobalt alloy, titanium), plastic (high density polyethelene) or ceramic which act as alternate bearing surfaces for the damaged joint. These operations are major procedures which require the patient to be in hospital for several days and followed by a significant period of rehabilitation. The hospital has several ways of approaching the procedure for replacement and the specifics for the procedure will be covered at the time of assessment and booking of surgery. Occasionally blood transfusions are required; if you have some concerns raise this with your surgeon during consultation.

For elderly patients joint replacement surgery is commonly required to treat damaged joints from wearing out, arthritis or other forms of joint disease including rheumatoid arthritis. In these procedures the damaged joint surface is removed and replaced with artificial surfaces normally made from metal (chromium cobalt alloy, titanium), plastic (high density polyethelene) or ceramic which act as alternate bearing surfaces for the damaged joint.
These operations are major procedures which require the patient to be in hospital for several days and followed by a significant period of rehabilitation. The hospital has several ways of approaching the procedure for replacement and the specifics for the procedure will be covered at the time of assessment and booking of surgery.
 
Occasionally blood transfusions are required; if you have some concerns raise this with your surgeon during consultation.
Osteotomy

The division of a crooked or bent bone to improve alignment of the limb. These procedures normally involve some form of internal fixation, such as rods or plates, or external fixation which involves external wires and pins to hold the bone. The type of procedure for fixation will be explained when the surgery is planned.

The division of a crooked or bent bone to improve alignment of the limb.
 
These procedures normally involve some form of internal fixation, such as rods or plates, or external fixation which involves external wires and pins to hold the bone. The type of procedure for fixation will be explained when the surgery is planned.
Soft Tissue (muscles, tendons and ligaments)

In many cases tendons will be lengthened to improve the muscle balance around a joint or tendons will be transferred to give overall better joint function. This occurs in children with neuromuscular conditions but also applies to a number of other conditions. Most of these procedures involve some sort of splintage after the surgery followed by a period of rehabilitation, normally supervised by a physiotherapist.

In many cases tendons will be lengthened to improve the muscle balance around a joint or tendons will be transferred to give overall better joint function.
This occurs in children with neuromuscular conditions but also applies to a number of other conditions.
Most of these procedures involve some sort of splintage after the surgery followed by a period of rehabilitation, normally supervised by a physiotherapist.
Ligament Injuries Wrist/ Elbow
Tennis Elbow

www.southerncross.co.nz/sx_internet/index.cfm

Ulnar Nerve Entrapment, Cubital Tunnel Syndrome
Hand Surgery - Ganglion Cysts

Information sheet for Hand Surgery - Ganglion Cysts Hand Surgery - Ganglion Cysts (PDF, 6.9 KB)

Painful Wrist

http://www.assh.org/Public/HandConditions/Pages/WristSprains.aspx

Arthroscopy Wrist

Please click on the link below to the American Hand Surgery website http://www.assh.org/Public/HandConditions/Pages/Wristarthroscopy.aspx

Please click on the link below to the American Hand Surgery website

http://www.assh.org/Public/HandConditions/Pages/Wristarthroscopy.aspx

Carpal Tunnel Syndrome Open Release

www.southerncross.co.nz/index.cfm Information sheet for Hand Surgery - Endoscopic Carpal Tunnel Release Hand Surgery - Endoscopic Carpal Tunnel Release (PDF, 6.5 KB)

Carpal Tunnel Syndrome

Please click on the link below http://www.assh.org/Public/HandConditions/Pages/CarpalTunnelSyndrome.aspx#figure1

Revision Failed Carpal Tunnel Operation

Failed Carpal tunnel operation can be very frustrating. There are two possible presentations: Within the first three weeks this is likely due to inadequate decompression of the nerve Recurrence after 2-5 years this is due to the scarring process and the body's natural healing power. The treatment for the first cause is to redo the operation ASAP, the treatment for the second cause is to have interposition fat graft between the nerve and the skin. This often improves the symptoms to about 80%, provided the recurrence is documented with a follow up Nerve conduction study.

Failed Carpal tunnel operation can be very frustrating. There are two possible presentations:

  1. Within the first three weeks this is likely due to inadequate decompression of the nerve
  2. Recurrence after 2-5 years this is due to the scarring process and the body's natural healing power.

The treatment for the first cause is to redo the operation ASAP,  the treatment for the second cause is to have interposition fat graft between the nerve and the skin. This often improves the symptoms to about 80%, provided the recurrence is documented with a follow up Nerve conduction study.

Scaphoid Non Union

Scaphoid non union (PDF, 135.2 KB)

Scaphoid Fractures

Scaphoid Fractures (PDF, 248.8 KB)

Dupuytren's Contracture

http://www.southerncrosshealthcare.co.nz/index.cfm?04251518-A6B3-4FFD-9CDB-FE92472D33E2 Click on the following link for Dupuytren's Disease Patient Information Dupuytren's Disease Patient Information (PDF, 49.7 KB) Hand surgery - this document for patient education

Complex Regional Pain Syndrome

www.southerncross.co.nz/sx_internet/index.cfm

Hand Numbness
Arthritis of the Base of the Thumb

Patient information sheet for Hand Surgery - Arthritis of the Thumb Basal Joint Hand Surgery - Arthritis of the Thumb Basal Joint (PDF, 7.2 KB)

Tendon Transfer Surgery

Tendon Transfer Thumb Surgery (PDF, 46.4 KB)

Tendon Reconstruction

Tendon Reconstruction Surgery (PDF, 46.4 KB)

Thendon Sheath Giant Cell Tumour

emedicine.medscape.com/article/1253223-overview

Trigger Finger

Click on the following link for Hand Surgery - Trigger Finger Patient Information Hand Surgery - Trigger Finger Patient Information (PDF, 7.2 KB)

Contact Details

 

92 Mountain Road
Epsom
Auckland

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Street Address

92 Mountain Road
Epsom
Auckland

Postal Address

92 Mountain Road
Epsom
Auckland 1023

This page was last updated at 9:55AM on April 8, 2024. This information is reviewed and edited by Auckland Shoulder and Hand Clinic - Mr Shihab Faraj.