Patient
Information

Step 1 — Getting a Referral

To see Dr Cosic, you will need a referral from your GP or another specialist. Your GP can refer you directly if they suspect a shoulder, elbow, or wrist problem that warrants specialist assessment. A standard GP referral is valid for 12 months; a specialist referral for 3 months. When you visit your GP, it helps to describe your symptoms clearly — where the pain is, what makes it worse, and how it affects your daily life.

Your GP may arrange X-rays or an ultrasound before your appointment. This is helpful but not essential — Dr Cosic can arrange further imaging after your consultation if needed.

Step 2 — Your First Consultation

At your first appointment, Dr Cosic will take a detailed history of your symptoms, perform a physical examination, and review any imaging you have brought. He will explain your diagnosis in plain language and discuss all available treatment options — from physiotherapy and injections through to surgery. Nothing is decided without your full understanding and agreement.

Bring a list of your current medications, any previous X-rays or MRI scans, and if possible, someone you trust to help remember the information discussed.

Step 3 — Investigations and Imaging

Depending on your condition, Dr Cosic may request an MRI, CT scan, or further X-rays to fully assess the injury. MRI is particularly useful for soft tissue structures like the rotator cuff and ligaments. CT scans provide more detail about bone structure and are often used when assessing fractures or bone loss. You will receive clear instructions on where to go for your scans and what to expect.

Step 4 — Deciding on Treatment

Many conditions can be managed without surgery — at least initially. Dr Cosic takes an evidence-based approach, always exploring non-operative options first unless surgery is clearly the best course. When surgery is recommended, he will explain the procedure, the expected recovery timeline, and the realistic outcomes in detail. You will never feel pressured into a decision.

Step 5 — Surgery (if required)

If surgery is the agreed plan, the rooms will assist with booking at one of Dr Cosic's operating hospitals — Austin Hospital, Warringal Private, or Cabrini Malvern. You will receive pre-operative instructions covering fasting, medications to pause, and what to bring on the day. Most upper limb procedures are performed under general anaesthetic and many are done as day surgery or with a single overnight stay.

Step 6 — Recovery and Follow-up

Recovery varies by procedure. Dr Cosic will provide clear written instructions at discharge, including wound care, pain management, and sling use. He works closely with experienced physiotherapists using evidence-based rehabilitation protocols tailored to your surgery. Follow-up appointments are arranged at regular intervals to monitor your progress and address any concerns early.

What Is Shoulder Arthritis?

The shoulder is a ball-and-socket joint — the ball (humeral head) fits into the socket (glenoid) of the shoulder blade. Both surfaces are covered by a smooth, slippery material called cartilage, which allows pain-free movement. In arthritis, this cartilage gradually wears away. As it thins and eventually disappears, the underlying bone becomes exposed and the joint surfaces begin to rub against each other, causing pain, stiffness, and sometimes a grinding or clicking sensation.

The most common type is osteoarthritis — a degenerative process that develops over time, typically in people over 50. Less commonly, arthritis can develop following an old injury or infection (post-traumatic arthritis), as a consequence of rheumatoid arthritis, or after a rotator cuff tear that has been present for many years (rotator cuff tear arthropathy).

Symptoms

Shoulder arthritis typically develops slowly. Common symptoms include a deep ache in the shoulder, worse with activity and often at night; progressive stiffness that makes reaching overhead, behind your back, or across your body difficult; and a grinding, catching, or clicking sensation with movement. The pain often interferes with sleep, which can significantly affect quality of life.

Diagnosis

Dr Cosic will examine your shoulder and assess your range of motion. X-rays are the primary tool for diagnosing arthritis — they show the amount of joint space remaining, bone spurs, and the overall shape of the joint. An MRI or CT scan may be requested to assess the rotator cuff muscles and plan surgery if a replacement is being considered.

Treatment Options

Treatment is tailored to the severity of your symptoms and the degree of joint damage. Many people do very well with non-operative measures, particularly in the earlier stages. Options include:

• Activity modification and physiotherapy to improve strength and movement
• Anti-inflammatory medications (oral or topical) to reduce pain and swelling
• Corticosteroid (cortisone) injections for short-to-medium term relief
• Hyaluronic acid injections as an alternative to cortisone
• Total shoulder replacement — when cartilage loss is advanced, replacing the joint surfaces with a metal and plastic prosthesis can reliably relieve pain and restore function
• Reverse shoulder replacement — used when the rotator cuff is also severely damaged

What Keeps the Shoulder Stable?

The shoulder is the most mobile joint in the body, which means it relies heavily on soft tissue structures — rather than bony constraint — for stability. The key stabilisers include the labrum (a ring of fibrocartilage that deepens the socket), the glenohumeral ligaments (strong bands of tissue on the front of the joint), and the rotator cuff muscles. When the shoulder dislocates, one or more of these structures is typically torn or damaged.

What Happens After a Dislocation?

A first dislocation almost always tears the labrum at the front of the socket — this is called a Bankart lesion. In some cases, the ball of the shoulder also sustains a dent where it impacts the edge of the socket (Hill-Sachs lesion), or a chip of bone is broken off the front of the socket (bony Bankart). These injuries can make the shoulder prone to repeated dislocations, particularly in younger patients and those who play overhead or contact sports.

The risk of re-dislocation after a first episode is strongly influenced by age — in patients under 25, re-dislocation rates without surgery can exceed 80%. This is why early surgical assessment is recommended for young, active patients after a first dislocation.

Surgical Options

The two main surgical approaches depend on the degree of bone loss:

• Bankart repair — Arthroscopic reattachment of the torn labrum to the front of the socket. Highly effective when there is minimal bone loss. Day surgery procedure with return to contact sport typically at 6 months.
• Latarjet procedure — An open procedure where a small piece of bone (the coracoid) is transferred to the front of the socket to reconstruct the bone lost and provide additional stability. Recommended when significant bone loss is present. Dr Cosic has published research on this procedure and trained in it during his Paris fellowship.

What Is the Rotator Cuff?

The rotator cuff consists of four muscles — supraspinatus, infraspinatus, teres minor, and subscapularis — whose tendons blend together as they attach to the top of the humerus (upper arm bone). Together, they rotate and lift the arm, and keep the ball of the shoulder centred in the socket during movement.

Tears most commonly affect the supraspinatus tendon, which runs along the top of the shoulder. They are extremely common — present in around 25% of people over 60 and more than 50% of people over 80, often without causing any symptoms.

Types of Tears

Rotator cuff tears range from partial-thickness tears (where the tendon is thinned or frayed but not completely through) to full-thickness tears (where there is a complete hole in the tendon). Full-thickness tears are further classified by size — small (<1 cm), medium (1–3 cm), large (3–5 cm), and massive (>5 cm or involving multiple tendons). Size, age, activity level, and muscle quality all influence whether surgery is appropriate.

Symptoms

Rotator cuff tears typically cause pain on the outer aspect of the shoulder and upper arm, worse with overhead activities, and often worse at night. Weakness — particularly when lifting the arm to the side or rotating it outward — is common with larger tears. Not all tears are painful; some are discovered incidentally on imaging performed for another reason.

Non-Operative Treatment

Many rotator cuff tears, particularly smaller ones in older patients, are managed successfully without surgery. This involves physiotherapy to strengthen the surrounding muscles, activity modification, anti-inflammatory medications, and corticosteroid injections for pain relief. A significant proportion of patients achieve satisfactory function with this approach.

When Is Surgery Recommended?

Surgery is generally considered when: a full-thickness tear causes significant pain or weakness that hasn't improved with non-operative treatment after 3–6 months; the tear is large and occurred in a younger or more active patient; or weakness prevents meaningful daily function. Surgical repair is performed arthroscopically (keyhole) in most cases, reattaching the torn tendon to bone. Outcomes are generally excellent, with most patients regaining full strength and returning to their usual activities within 9–12 months.

The Elbow's Stabilising Structures

The elbow joint is held together primarily by two sets of ligaments — the medial ulnar collateral ligament (UCL) on the inner side, and the lateral ulnar collateral ligament (LUCL) on the outer side. The medial UCL is the primary stabiliser against valgus stress (the outward bending force generated by throwing), while the LUCL is critical for preventing the elbow from rotating outward (posterolateral rotatory instability, or PLRI).

Medial UCL Injury — The Throwing Athlete

Medial UCL tears are most common in overhead throwing athletes — baseball, cricket, and javelin throwers — where the repetitive valgus stress of throwing gradually stresses and eventually tears the ligament. Symptoms include medial elbow pain during or after throwing, reduced throwing velocity or distance, and sometimes tingling in the ring and little finger (due to proximity of the ulnar nerve).

UCL reconstruction (Tommy John surgery) replaces the damaged ligament with a tendon graft, typically from the patient's own forearm. The procedure has excellent outcomes, though full return to competitive throwing takes 12 months or more.

Lateral UCL Injury — After Dislocation

LUCL injury typically occurs when the elbow dislocates — either from a fall onto an outstretched hand or from a direct blow. The elbow is the second most commonly dislocated joint in adults. Most simple dislocations can be managed non-operatively after the elbow is relocated, but some patients develop persistent instability requiring surgical reconstruction.

Symptoms of chronic LUCL insufficiency include a feeling of giving way or clunking with certain arm positions — particularly with the arm raised and rotated outward. LUCL reconstruction restores stability reliably, with most patients returning to full activity within 6 months.

Why Recovery Takes Time

Surgery repairs damaged structures, but it is your body that heals them. Tendons and ligaments reattach to bone over weeks, not days. The healing tissue passes through predictable biological phases — inflammation (days 1–7), proliferation (weeks 2–6), and remodelling (weeks 6 onwards into months). Rehabilitation is designed around this biology. Doing too much too soon risks re-injury; doing too little risks stiffness and prolonged weakness.

The Role of Physiotherapy

Physiotherapy is not optional after orthopaedic surgery — it is an integral part of the procedure. Dr Cosic provides written rehabilitation protocols to your physiotherapist, tailored specifically to the surgery performed. Your physiotherapist will guide you through progressive phases of motion, strengthening, and functional training. Attending your physiotherapy appointments consistently is one of the most important things you can do to achieve a good outcome.

General Recovery Milestones

While every procedure and patient is different, some general patterns apply across most upper limb surgeries:

• Weeks 1–6 — protecting the repair, managing pain and swelling, maintaining mobility in the hand, wrist and elbow
• Weeks 6–12 — regaining active movement of the operated joint, beginning light strengthening
• Months 3–6 — progressive strengthening and return to daily activities, driving, light work
• Months 6–12 — sport-specific conditioning, return to overhead and throwing sports, heavy manual work

Sport-Specific Considerations

Different sports place different demands on the shoulder and elbow. Low-impact activities like swimming (freestyle and backstroke) and golf are typically reintroduced earlier — often at 3–4 months. Overhead and racquet sports (tennis, cricket, basketball) generally require 6–9 months. Contact sports and heavy resistance training are the last to return, often at 9–12 months after major shoulder surgery. These timelines reflect the time needed for tissue to mature and for neuromuscular control to be fully restored — not just pain levels.

Red Flags During Recovery

While some discomfort is normal during rehabilitation, certain symptoms should prompt you to contact Dr Cosic's rooms promptly: increasing redness, warmth, or swelling around the wound; fever above 38°C; a sudden pop or acute increase in pain; persistent numbness or tingling in the arm or hand; or complete loss of the strength or movement you had previously regained.

What Is Radiofrequency Ablation?

Radiofrequency ablation uses radio-wave energy, delivered through a fine probe, to gently heat and quieten the tiny sensory nerve branches that carry pain signals from the shoulder joint to the brain. By interrupting these pain pathways, RFA can substantially reduce shoulder pain. Importantly, it treats the pain rather than the underlying structural problem — it does not repair cartilage, tendons, or bone, but it can make the shoulder considerably more comfortable and easier to use.

What Makes “Cooled” RFA Different?

Standard radiofrequency can only treat a small area immediately around the probe tip. Cooled RFA circulates water through the tip to stop it from overheating, which allows the energy to spread further and create a larger, more rounded treatment zone. Around the shoulder, the sensory nerves vary in their exact position from person to person, so this larger zone improves the chance of reaching the target nerves and achieving more reliable, longer-lasting relief.

Which Nerves Are Treated?

The shoulder joint receives its pain sensation from the articular (sensory) branches of three nerves: the suprascapular nerve, the axillary nerve, and the lateral pectoral nerve. RFA targets these sensory branches while aiming to preserve the parts of the nerves that control muscle movement. Careful probe placement and nerve testing during the procedure help protect your shoulder’s strength and function.

Who Might Benefit?

RFA may be an option if you have ongoing shoulder pain that has not settled with other measures. It is often considered for:

• Chronic shoulder pain lasting more than three months despite physiotherapy, medication, or injections
• Shoulder osteoarthritis or rotator cuff arthropathy, particularly where pain is the main problem
• Patients who are not suitable for — or wish to delay or avoid — joint replacement surgery, for example because of other medical conditions
• Persistent pain following previous shoulder surgery

RFA is a pain-relieving treatment rather than a structural repair, so it is most useful when pain — rather than weakness or mechanical locking — is the dominant problem.

What Happens During the Procedure?

RFA is usually performed as a day procedure. In most cases a diagnostic nerve block is carried out first: a small amount of local anaesthetic is placed near the target nerves, and if this temporarily relieves your pain it confirms that these nerves are the source — and that you are likely to benefit from ablation.

On the day of the procedure itself, the skin is numbed with local anaesthetic and fine probes are positioned with the help of imaging (ultrasound and/or X-ray guidance). A brief test stimulation confirms the probes are correctly placed and helps protect the motor nerves. The probe tips are then heated for a short time at each target. The procedure usually takes only around 15 to 20 minutes and is performed under sedation or a general anaesthetic, so you remain comfortable throughout. You can usually go home the same day.

Recovery and What to Expect

Most people go home shortly after the procedure and do not need a sling. It is normal to have some soreness, mild bruising, or temporary tenderness around the treated areas for a few days, which usually settles with simple pain relief. You can generally return to light daily activities quickly. Pain relief is not always immediate — it often develops over the first one to three weeks as the treated nerves settle.

How Long Does the Relief Last?

Cooled RFA for shoulder pain typically provides meaningful pain relief and improved function for around twelve months or longer in many cases. Many people are also able to reduce their pain medication. Because the treated nerves gradually regenerate over time, the relief may eventually wear off — but if the treatment has helped, it can be safely repeated.

Risks and Considerations

RFA is generally well tolerated and considered low-risk. Possible side effects include temporary soreness, bruising, or an area of altered sensation or numbness over the shoulder, and — as with any procedure involving a skin puncture — small risks of bleeding or infection. Temporary weakness is uncommon, and steps are taken during the procedure to protect the motor nerves. Not everyone responds, and some people gain only partial or shorter-lived relief.