Your referral letter from your GP or other referrer. Medicare, DVA or aged pension card. Patients with private health insurance should bring their health fund details. Workers compensation or third party patients must ensure they have received written approval from their insurer prior to the appointment. Please bring this written approval with you. If you do not have this, please ring 02 4732 4557 prior to your appointment to discuss your situation. Investigations such as X-Rays, Ultrasounds, MRI and CT scans along with available reports. Please bring any old films as sometimes it can be useful as a comparison. A New Patient Registration, and a signed Privacy Information and Consent Form. (If you have not received these, they are available on the "Forms" page)

Typically after talking to and examining you, Dr Kuo will be able to provide you with a diagnosis of what is causing your symptoms.
He will recommend a treatment plan for you and correspond this information with your GP/referrer.

There are 4 main tendons around the shoulder to allow your arm to move in any direction (180 degrees of movement). These are called the Rotator cuff tendons. Each is called: Supraspinatus (on the top) Subscapularis (at the front) Infraspinatus (at the back) Teres Minor (at the back) Any one of these can be injured or torn whether it be by overuse and repetitive activity or a sudden event such as a fall. This can result in "Subacromial or Rotator cuff Disease". There are a spectrum of conditions starting with: Impingement syndrome: where the tendons (and associated bursa) become inflamed resulting in tendinitis and bursitis. Partial Rotator cuff tears (RCT) where a part of the tendon has pulled off the bone. Full thickness RCT where a complete segment of the tendon has pulled off the bone leaving a defect or hole. These tears can be small, moderate, large, massive and irreparable. Pain typically occurs with movements at or above shoulder height and even behind the back and often affects sleep and lying on the affected shoulder. The shoulder may also feel weaker and stiffer than normal. Initial treatment consists of avoiding aggravating activities, pain killers, anti-inflammatories, physiotherapy and even injections. If these measures don't help then surgery may be necessary.

Shoulder dislocations occur mostly in young active people. It is typically associated with a specific injury eg tackled in football, fall while snowboarding and can result in recurrent episodes. When the shoulder repeatedly pops out and affects a patient's ability to play sports or even function reliably on a day to day basis, then surgery may be required. The usual problem is a tear in the soft tissue ring around the shoulder socket. This tissue is called the labrum. It is most commonly torn at its lower front portion (Bankart lesion). This is referred to as anterior instability. If it is torn at the back it is called posterior instability (posterior Bankart lesion). The younger you are when you sustain your first dislocation (20years or younger) the more likely the shoulder will continue to be unstable. It is likely surgery will be required. Otherwise we would try to control your symptoms with physiotherapy and modification of sporting activities.

In this condition, the labrum (soft tissue ring around the shoulder socket) is torn at the top of the socket. It is where the long head of the biceps attaches to the bone. There are 4 main types: Type 1- fraying only of the labrum Type 2- detachment of the labrum Type 3-like a type 2 but with a "bucket handle" tear in addition to the detachment Type 4- when the tear extends into the biceps tendon itself The treatment will depend on the type of tear. Tears that do not respond to conservative measures may require surgery in the form of a SLAP repair or Biceps procedure.

Osteoarthritis refers to the wearing out of the joint. The smooth cartilage surfaces which are normally "frictionless" are damaged and become irregular and worn down to bone. The surfaces start to grate against each other which results in pain and stiffness. We try to control your symptoms with pain killers,anti-inflammatories, physiotherapy and injections, but if these are not successful, surgery can be considered. It is the most common reason for joint replacement of the shoulder.

Your GP will often organise X-rays and Ultrasounds prior to your consultation. In many cases this information is all that is needed. Sometimes further investigations are helpful and Dr Kuo will arrange for you to have an MRI, CT scan or other additional tests.

Many conditions do not need surgery. Aims of treatment are to resolve symptoms in the least invasive way possible with measures such as physiotherapy, painkillers, anti-inflammatories or activity modification.
Steroid injections are often helpful and can be performed personally by Dr Kuo when required.

If it has been advised that surgery is necessary our friendly and helpful staff will lead you through what can sometimes be an anxious time. They will be able to tell you what is required for your procedure and admission to hospital.

For instance, what to bring to hospital, when to stop taking blood thinning medications, when to fast and what time to come to hospital. In addition, you will be given information packs that will answer many of your questions and guide you through each step of the way.

If there are any further queries or you simply feel you would like further discussion please do not hesitate to make another formal appointment to have any questions or concerns addressed.

Arthroscopy of the shoulder and knee has revolutionised joint surgery. Although externally there are only small incisions (often barely visible once healed), the surgery that is performed deeper is in fact quite complex and extensive. Therefore, we expect there will be pain post-operatively.

Our anaesthetists will ensure you have medications to manage the pain after surgery while in hospital as well as on discharge to go home.

You will be given an instruction sheet on discharge which informs you as to what was performed at surgery and the "do's and dont's" in the immediate post operative period.

Your first post operative appointment will typically be after 1 week for knee and 2 weeks for shoulder surgery. Dr Kuo will review your wounds and explain in greater detail what was performed at surgery and what happens next.

In most cases yes.

Physiotherapy is an essential part of your treatment. All the good work performed during surgery can be undone by not doing your post operative exercises.

You will be given your physiotherapy protocol by Dr Kuo at your first post operative visit. If you don't have a regular physiotherapist, we can recommend one to you.

Every individual is unique in their recovery. However, we generally expect that for the various procedures performed, the most common recovery timeframes are as follows:

• Knee arthroscopy can take anywhere from 2-6 weeks to recover.
• ACL reconstructions will require 3-6 months for most activities but up to 8-9 months for unrestricted pivoting sports.
• Arthroscopic shoulder decompressions/acromioplasty typically take 1-2 months to return to most activities.
• Arthroscopic rotator cuff repairs and shoulder stabilisations and can take 3-6 months to recover depending upon your level of activity and your work demands. Return to contact sports may take 8-9 months.
• Shoulder replacement patients often feel significantly less pain compared to pre-operatively as early as a few weeks post-op however, full recovery can still take several more months.

Driving after shoulder surgery can be as soon as 2-3weeks if no repair is required. However if you have had a repair or reconstruction then you will be unable to drive for at least 6 weeks. Knee arthroscopies take around 1-2 weeks.

Return to work time frames will be dependent upon your occupation. If a shoulder repair is not performed then office duties can be as quick as 2-4 weeks but may still require 1-2months in many cases. Physical and labouring jobs and many sports can take 3 months. When a repair is performed it may take an additional 6-8weeks to the above time frames. Knee arthroscopies can take 1-2 weeks for office jobs and up to 4-6 weeks for more physical activity.

Consultation fees:
All consultations with Dr Kuo are to be paid in full on the day of service. For a list of fees please speak with our staff on 02 4732 4557. We accept cash, EFTPOS, Visa and MasterCard. Apologies for any inconvenience but we do not accept cheque, AMEX or Diners.

To cancel an appointment:
Please cancel at least 24 hours prior if possible so that your appointment time can be allocated to another patient who is seeking treatment.