Dr Warren Kuo has been delivering experienced, expert, specialist care in shoulder and
knee surgery to the Nepean area for nearly 20 years. He holds specialist surgeon
appointments at both Nepean Hospital & Nepean Private Hospital as well as at St
Vincent’s Private Hospital and St Vincent’s Clinic.
He is a Clinical Senior Lecturer at The University of Sydney and is involved in the
training of Medical Students for the Nepean Clinical School. Dr Kuo also teaches and
trains Orthopaedic Registrars at Nepean Hospital as well as mentors Local and
International Fellows with interests in Shoulder Surgery.
Dr Kuo and his team of dedicated staff look forward to welcoming you into his rooms and
managing your Shoulder and Knee problems.
Dr Warren Kuo has been a VMO Consultant at the Nepean Public and Private Hospitals since 2003 after completing dual Fellowships at Mt Sinai Hospital New York and The Sports Medicine Centre in Calgary, Canada.
He was invited to join the Orthopaedic Department at St Vincent's Clinic and St Vincent's Private Hospital in 2009.
He is the current Secretary for the Nepean Hospital Orthopaedic Department and in 2012 completed his four year tenure on The Board of Surgical Education and Training Supervisors for Advanced Orthopaedic Training for The Royal Australasian College of Surgeons.
He is a Clinical Senior Lecturer at The University of Sydney and is involved in the training of Medical Students for the Nepean Clinical School. Dr Kuo continues to teach and train Orthopaedic Registrars at Nepean Hospital as well as mentor Local and International Fellows with interests in Shoulder and Orthopaedic Sports Medicine Surgery.
Royal Australasian College of Surgeons (Full Fellow) Australian Orthopaedic Association (Full Fellow) Australian Society of Orthopaedic Surgeons Shoulder Elbow Society of Australia American Academy of Orthopaedic Surgeons Australian Medical Association Australian Chinese Medical Association Nepean Medical Association
St Vincent's Sportsmed
Dr Warren Kuo has been delivering experienced, expert, specialist care in shoulder and knee surgery to the Nepean area for nearly 20 years. He holds specialist surgeon appointments at both Nepean Hospital & Nepean Private Hospital, Somerset Day Surgery as well as at St Vincent’s Private Hospital and St Vincent’s Clinic.
He is a Clinical Senior Lecturer at The University of Sydney and is involved in the training of Medical Students for the Nepean Clinical School. Dr Kuo also teaches and trains Orthopaedic Registrars at Nepean Hospital as well as mentors Local and International Fellows with interests in Shoulder and Orthopaedic Sports Medicine Surgery.
Dr Kuo and his team of dedicated staff look forward to welcoming you into his rooms and managing your Shoulder and Knee problems.
Shoulder stiffness is quite a common problem. Many patients improve with time and physiotherapy but those who do not may opt for a manipulation under a general anaesthetic, injection of cortisone and hydrodilatation.
This can be performed in recalcitrant cases of frozen shoulder. It is also frequently necessary to be performed during routine rotator cuff surgery as many patients will often have a degree of capsular restriction in conjunction with their tears.
Advances in technology over the past 5- 10 years has allowed surgeons to
perform many shoulder operations via arthroscopy or key hole surgery.
The procedure is performed via very small incisions using specialised
instruments. Impingement occurs due to a number of causes. There may be
inflammation of the tendon (tendinitis), bursa (bursitis) or some spurs.
These conditions can be treated successfully by cleaning up the inflamed
tendons, removing the inflamed bursa and trimming off any spurs. You
will be placed in a sling after surgery for comfort, but once your pain
levels start to settle, you will be encouraged to discard the sling and
start to use the shoulder as normally as possible.
The quicker you can regain your movement, the quicker the recovery.
Advances in technology over the past 5- 10 years has allowed surgeons to repair torn tendons via arthroscopy or key hole surgery. The procedure is performed via very small incisions using specialised instruments. We place anchors into the shoulder (humerus) with strong sutures/threads attached to them. These threads are passed through the torn edge of the tendon which are then tightened bringing the tendon back onto the bone. The larger the tear, the more anchors that will be required. You will then be placed in a sling after surgery to protect the repaired tendon for 6 weeks. Any associated problems inside the shoulder eg spurs can be visualised and treated at the same time.
If the long head of the biceps tendon has been partially torn off its attachment (SLAP lesion) or there is inflammation, fraying or damage to the main substance of the tendon itself then a biceps procedure may be required. It can be safely cut and left to retract. This is called a Biceps tenotomy. Although it sounds drastic to cut a tendon and not reattach it, the LONG head (as opposed to the SHORT head which is left untouched) contributes very little to strength and its main function is the contour and shape or look of the muscle. The overwhelming majority of patients who undergo a biceps tenotomy do not report any loss in strength and are pleased by the relief in pain. A small number of patients may report some spasm in the muscle with lifting in the initial stages but in most cases this will settle. Most patients are not concerned or even aware of any asymmetry. A Biceps Tenodesis is when the tendon is reattached in a position outside the shoulder joint. The recovery time is slower compared to a tenotomy alone but there contour is better preserved. It can often be performed in association with a Rotator cuff repair. If Dr Kuo is anticipating that a Biceps Procedure may be necessary for you, he will discuss these 2 options with you beforehand to allow you decide what is the best treatment for your individual circumstances.
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). If it is torn at the top it is called a SLAP lesion. The aim of surgery is to repair the labrum and put it back into its correct position. This is performed via arthroscopy/keyhole surgery in most cases. This is performed using specialised instruments, anchors and sutures/threads. On some occasions (depending upon the degree of damage), the procedure may need to be performed via a traditional cut. Your arm will be placed in a sling for up to 6 weeks after surgery.
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. The Type 1 only needs to be cleaned up/debrided. The Type 2 usually needs to be repaired. Type 3 sometimes only needs a clean up but may need to be repaired or the biceps itself may need to released +/- reattached. Type 4 lesions require a biceps release or reattachment.
Some patients develop pain from arthritis or damage to the AC joint. It is often related to heavy lifting. Spurs often develop and can also cause impingement to the shoulder as well as direct pain in the joint. In these cases, the spurs can be trimmed (co-planing) or a small portion of the end of the collar bone (which is worn out) can be removed or excised. This is usually performed arthroscopically. Some patients will sustain an injury when they fall on the point of their shoulder which results in the end of the collar bone coming out of joint. This is known as an AC joint dislocation and is different to a true shoulder dislocation. Depending upon the degree of dislocation, most of these injuries can be treated without surgery. However, significantly displaced cases may require surgical stabilisation. This is most often an open procedure requiring an incision to bring the end of the collar bone back into its correct position.
The most frequent reason for replacing a joint is for osteoarthritis. But it can be for rheumatoid and other inflammatory arthritis, avascular necrosis, post traumatic arthritis, fractures and more recently, has been beneficial for cuff tear arthropathy. The type of implant will be dependent upon the exact problem, age of the patient, functional demands, quality of the bone, and whether or not the rotator cuff is working normally. A total shoulder replacement (TSR) is most common. It involves replacing both sides of the joint (the ball and socket) with implants made of metal and high grade polyethylene. On some occasions, in younger patients or if there is not much damage to the socket, then only the ball needs to be replaced (hemiarthroplasty). When the rotator cuff tendons are completely torn for a long time and the patient cannot lift their arm or arthritis develops, a traditional TSR cannot be used as it depends upon the tendons to hold the implants in place. On these occasions, a Reverse TSR can be used (in older people only). It is called a Reverse TSR because the Ball is replaced by a Socket and the Socket replaced by a Ball. This design does away with the need for the rotator cuff tendons by changing the centre of rotation and using the deltoid muscle to aid in lifting the arm.
When you attend your first consultation you will require a GP or Specialist referral, your Medicare or DVA card and all imaging films (x-rays, CT, MRI etc.) with reports. PLEASE NOTE: If you do not bring your referral with you, you will not be able to claim a rebate from Medicare for your consultation.
Patients with private health insurance should bring their health fund details and if you are on an aged pension please bring this with you also.
It is preferred that you bring a completed New Patient Information Form however you are able to complete these when you arrive.
Patients under a Workers compensation or Third Party claim 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.
There is limited parking available on our premises behind the office. Alternate parking is available at the Nepean hospital multi level car park (for a fee) situated diagonally across the road.
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.
Please cancel at least 24 hours prior if possible so that your appointment time can be allocated to another patient who is seeking treatment.
