Frequently Asked Questions

You should seek specialist review if your shoulder pain has persisted for more than six weeks without improvement, is severe enough to affect sleep or daily activities, came on following an injury, or is accompanied by weakness in the arm. Shoulder pain that is getting worse over time — rather than settling — warrants an assessment regardless of how long it has been present. Early, accurate diagnosis consistently leads to faster and more complete recovery.

Certain features suggest a more significant problem that needs prompt assessment. These include: sudden severe pain following a fall or impact; marked weakness when lifting the arm; pain that radiates down the arm below the elbow; any sensation of the shoulder giving way or feeling unstable; or shoulder pain accompanied by fever, unexplained weight loss, or pain in both shoulders simultaneously. If in doubt, it is always better to seek an expert opinion early.

Yes. Pain originating from the cervical spine (neck) can radiate into the shoulder, upper arm, and even the hand. This is known as referred pain. One of the important tasks in a specialist shoulder assessment is distinguishing between pain that is arising from the shoulder joint itself and pain that is referred from the neck — since the treatment for each is very different. Professor Kochhar's clinical examination is designed to identify the source of your symptoms accurately.

No. You can book a private consultation with Professor Kochhar directly without a GP referral. However, if you have existing imaging (X-rays or MRI scans), relevant letters from your GP or physiotherapist, or a referral letter from another clinician, please bring these to your appointment as they will help inform the assessment.

Professor Kochhar sees both NHS and private patients. Please contact the practice directly to discuss the most appropriate pathway for your circumstances.

Your first consultation will typically last around 30 to 45 minutes. Professor Kochhar will take a detailed history of your symptoms — including when they started, what makes them better or worse, and how they are affecting your daily life. He will then carry out a thorough physical examination of the shoulder. Depending on his findings, he may arrange further imaging such as an ultrasound or MRI scan, or he may be in a position to discuss a diagnosis and management plan at the same appointment. You will always leave with a clear explanation of what has been found and what the next steps are.

Professor Kochhar sees patients at London Bridge Hospital and across a number of private hospitals in the West Kent area. Please contact the practice for details of current clinic locations and to find the most convenient option for you.

Calcific tendinitis is a condition in which calcium deposits form within one of the rotator cuff tendons of the shoulder — most commonly the supraspinatus tendon. These deposits can cause significant pain, particularly when the body begins to reabsorb them (the resorptive phase), which can produce a sudden and severe episode of shoulder pain. The condition affects men and women of all activity levels and is most common between the ages of 30 and 60.

The experience varies depending on the phase of the condition. During the formative phase, many patients have only mild discomfort or none at all. During the resorptive phase — when the calcium deposit breaks down — pain can become severe and come on very suddenly, often described as the worst shoulder pain the patient has ever experienced. The pain is typically felt deep in the shoulder and upper arm, is worse with overhead movement, and often disturbs sleep.

Calcific tendinitis is diagnosed through a combination of clinical examination and imaging. A plain X-ray can usually confirm the presence of a calcium deposit. Ultrasound is particularly useful as it allows the size, consistency, and exact location of the deposit to be assessed in real time, and also guides any subsequent injection or barbotage procedure. MRI may be used to evaluate the surrounding structures in more detail.

It can. Some deposits are reabsorbed by the body naturally over a period of months to years. However, the process is unpredictable, and many patients experience significant pain — particularly during the resorptive phase — that warrants specialist intervention rather than watchful waiting. An expert assessment allows a more informed conversation about whether active treatment is appropriate for your specific situation.

Barbotage is a minimally invasive, ultrasound-guided procedure used to treat calcific tendinitis. Under real-time ultrasound imaging, a fine needle is introduced precisely into the calcium deposit. A saline solution is injected to break up the calcium, which is then aspirated (drawn out) through the needle. The procedure is often combined with a small corticosteroid injection into the subacromial bursa to reduce post-procedural inflammation. Most patients experience significant improvement within four to six weeks, and many see their deposit reduce substantially or resolve entirely. It is performed as an outpatient procedure under local anaesthetic.

The area is numbed with local anaesthetic before the procedure, and most patients find it well tolerated. Some experience a brief increase in shoulder pain in the days following barbotage — this is a normal part of the healing response and typically settles within one to two weeks. Professor Kochhar will discuss what to expect in full before the procedure.

The majority of patients with calcific tendinitis do not require surgery. Most respond well to barbotage and physiotherapy. Surgical removal of the calcium deposit — performed arthroscopically (keyhole) — is reserved for the minority of patients in whom other treatments have not provided adequate or lasting relief. Professor Kochhar will only recommend surgery when it represents the best option for you individually.

Following barbotage, most patients notice significant improvement within four to six weeks, with continued progress over the following months as physiotherapy restores full movement and strength. Recovery following surgical removal typically takes three to four months for full return to activities.

The rotator cuff is a group of four muscles and their tendons that surround and stabilise the shoulder joint, allowing the arm to be lifted and rotated. A rotator cuff tear occurs when one or more of these tendons is partially or fully disrupted. Tears may result from an acute injury — such as a fall or sudden forceful movement — or may develop gradually due to age-related degeneration of the tendon tissue.

Common symptoms include pain in the shoulder and upper arm (often worse at night), weakness when lifting or carrying, difficulty reaching overhead or behind the back, and a catching or clicking sensation during movement. Some degenerative tears can be surprisingly painless initially, only becoming symptomatic after a minor incident. The severity of symptoms does not always reflect the size of the tear.

Diagnosis begins with a clinical examination in which Professor Kochhar assesses shoulder movement, strength, and specific tests for rotator cuff integrity. This is confirmed with imaging — typically an MRI scan, which provides detailed information about the size, location, and tissue quality of the tear, as well as the condition of surrounding structures. Ultrasound is also used in certain scenarios.

Full-thickness tears cannot heal spontaneously — once the tendon is completely disrupted, the gap will not close without surgical repair. However, many people with full-thickness tears live comfortably and function well without surgery, particularly if symptoms are manageable and the surrounding muscles compensate effectively. Partial tears may stabilise with physiotherapy and appropriate management. The decision about whether surgery is appropriate depends on tear size, your symptoms, your age, and your functional goals.

Professor Kochhar performs rotator cuff repair arthroscopically — using keyhole surgery. Small incisions are made around the shoulder, and a camera and fine instruments are introduced to reattach the torn tendon to the bone using small anchors. The arthroscopic approach causes significantly less trauma to surrounding tissue than open surgery, and is associated with lower complication rates, less post-operative pain, and faster recovery. The procedure is performed under general anaesthetic, usually as day surgery.

Recovery is staged. The shoulder is typically immobilised in a sling for four to six weeks to protect the repair. Gentle movement begins early under physiotherapy guidance. Progressive strengthening follows, and most patients return to desk-based work within a few weeks. Return to sport or heavy manual work generally takes between four and nine months depending on the size of the repair and individual factors. Professor Kochhar provides a personalised timeline at the point of surgical planning.

This depends on the type and size of the tear, and the individual. Some tears remain stable for many years with careful management. Others progress in size over time, and a larger tear is generally harder to repair successfully than a smaller one. This is one reason early specialist assessment is valuable — not because surgery is inevitable, but because understanding the tear allows an informed decision about whether timely intervention would preserve a better long-term outcome.

In experienced hands, arthroscopic repair achieves equivalent or better outcomes compared to open surgery for the vast majority of tears, with the significant additional benefits of less post-operative pain, a lower infection risk, and faster recovery. Professor Kochhar specialises in arthroscopic shoulder surgery and has extensive experience in both straightforward repairs and complex or revision cases.

Shoulder impingement — also called subacromial impingement — occurs when the soft tissue structures within the subacromial space (the gap between the top of the arm bone and the overlying acromion) are compressed or irritated during movement. The structures affected include the rotator cuff tendons and the subacromial bursa. It is one of the most common causes of shoulder pain in adults.

Impingement can result from a combination of structural and functional factors. These include the natural shape of the acromion (a curved or hooked acromion reduces the available space), inflammation and swelling of the subacromial bursa, weakness or imbalance of the rotator cuff muscles causing the humeral head to ride upward, and repetitive overhead activities. Poor posture — particularly rounded shoulders — can also contribute. In many patients, more than one factor is present.

The hallmark symptom is pain when lifting the arm — typically between about 60 and 120 degrees of elevation, producing what is known as a painful arc. Pain is usually felt in the shoulder and upper arm, is often worse at night (particularly when lying on the affected side), and may be accompanied by weakness or fatigue with sustained activity. Reaching overhead or behind the back is typically uncomfortable.

The first line of treatment is a structured physiotherapy programme focused on strengthening the rotator cuff and scapular stabilising muscles, correcting movement patterns, and addressing any postural contributions. Where pain is severe enough to limit engagement with physiotherapy, a precisely targeted subacromial corticosteroid injection — performed under ultrasound guidance — can provide effective relief and allow rehabilitation to proceed. For patients who do not respond adequately to conservative treatment, arthroscopic subacromial decompression is a well-established and effective surgical option.

Subacromial decompression is a keyhole surgical procedure performed under general anaesthetic, typically as day surgery. It involves removing the inflamed bursal tissue within the subacromial space and smoothing the undersurface of the acromion to increase the available space for the rotator cuff tendons. The procedure is well established and associated with good outcomes in appropriately selected patients. Recovery involves a period of physiotherapy, with most patients returning to full activity within three to four months.

No, though the two frequently coexist. Impingement refers to the mechanical compression and irritation of structures within the subacromial space. A rotator cuff tear is a structural disruption of the tendon itself. Chronic impingement can contribute to tendon degeneration and tearing over time — one reason why an accurate diagnosis and appropriate early management matters.

With appropriate physiotherapy, many patients see significant improvement within six to twelve weeks. Persistent cases — particularly where there is an underlying structural contribution such as a hooked acromion, or where a partial rotator cuff tear is also present — may take longer to respond or ultimately benefit from surgical intervention. The most important factor is an accurate diagnosis so that treatment is targeted at the right problem.

No — the majority of patients with shoulder impingement do not require surgery. Professor Kochhar's approach is to exhaust appropriate non-surgical options before considering any operative intervention. Surgery is considered when conservative treatment, properly implemented and given adequate time, has not achieved sufficient relief.

Corticosteroid injections are used selectively and in specific clinical contexts where the evidence supports their use — for example, as part of the management of subacromial bursitis or to facilitate engagement with physiotherapy. Professor Kochhar does not routinely administer steroid injections for conditions such as tennis elbow or golfer's elbow, where the long-term evidence for their benefit is poor and the risk of harm to the tendon is well established. All injection procedures are performed under ultrasound guidance to ensure precise placement.

Ultrasound-guided injection means the needle is placed under real-time imaging, allowing the clinician to see exactly where the medication is being delivered. This significantly increases accuracy compared to landmark-guided injection, improves outcomes, and reduces the risk of inadvertent injection into structures such as tendons where corticosteroid can be harmful. All injection procedures at Professor Kochhar's practice are performed under ultrasound guidance.

Open surgery involves a larger incision that allows direct access to the structures being treated. Keyhole (arthroscopic) surgery uses small incisions through which a camera and fine instruments are introduced, allowing the surgeon to work under magnified imaging on a screen. For shoulder surgery, the arthroscopic approach is associated with less trauma to surrounding tissue, lower complication rates, less post-operative pain, and faster recovery. Professor Kochhar specialises in arthroscopic techniques and performs the vast majority of shoulder procedures this way.

Physiotherapy is central to the management of almost every shoulder condition, whether or not surgery is involved. It is the cornerstone of non-surgical management for conditions such as impingement, partial rotator cuff tears, and frozen shoulder. Following surgical procedures, a structured, progressive rehabilitation programme is essential to restore movement, rebuild strength, and achieve the best possible outcome. Professor Kochhar works closely with specialist physiotherapists to ensure patients receive seamless care throughout their recovery.

Not necessarily. Professor Kochhar can often make a working diagnosis based on clinical examination alone, and will arrange any imaging he considers necessary following his assessment. However, if you have recently had relevant imaging — X-rays, an ultrasound, or an MRI — please bring this to your appointment or arrange for it to be sent in advance, as it can provide useful additional information and may avoid the need to repeat investigations.

Professor Tony Kochhar is a Consultant Orthopaedic Surgeon specialising in conditions of the shoulder, elbow, and upper limb. He holds the FRCS (Tr. & Orth) qualification, is a member of the British Orthopaedic Association, and is a Visiting Professor at the University of Greenwich. He sees patients privately at London Bridge Hospital and across the West Kent area, and is recognised by Doctify with their 2026 Outstanding Patient Experience award. He has been treating patients in both the NHS and private sectors for over two decades.

Professor Kochhar's practice covers the full range of shoulder and upper limb conditions, including rotator cuff tears and repair, calcific tendinitis, frozen shoulder, shoulder impingement, shoulder instability and dislocation, acromioclavicular joint injuries and arthritis, shoulder replacement, tennis elbow, golfer's elbow, elbow arthritis, wrist and hand conditions, and sports injuries of the upper limb. He also provides specialist medicolegal reports.

Professor Kochhar's founding principle is that most patients do not need surgery — but every patient deserves an accurate assessment by a highly skilled specialist and prompt, appropriate treatment. His approach is patient-centred: the right treatment for the individual, not a one-size-fits-all protocol. Where surgery is the best option, it is performed to the highest technical standard using the most appropriate minimally invasive techniques.

The practice aims to offer appointments promptly. Please contact the team directly on 020 7770 8185 to check current availability. For urgent presentations — such as acute severe shoulder pain — please mention this when you call and the team will do their best to accommodate you quickly.

Professor Kochhar works with most major private medical insurance providers, including BUPA, Vitality, and Aviva. Please contact the practice to confirm your specific insurer is accepted and to discuss the billing process. Self-pay patients are also welcome.