Shoulder Tendinitis Treatment in Singapore: A Guide

Dr. Wang Lushun - LS Wang Orthopaedics Clinic

Dr Wang Lushun

Senior Consultant Orthopaedic Surgeon

MBBS (Singapore)

MRCS (Edin)

MMed (Ortho)

FRCS (Ortho) (Edin)

Shoulder pain that intensifies when reaching overhead or sleeping on your side is a common sign of shoulder impingement, a condition where the shoulder tendons become painfully compressed. This irritation often disrupts daily activities like dressing or lifting, affecting a wide range of individuals from office workers to active athletes in Singapore. This guide outlines the various treatment pathways available, from conservative physiotherapy to surgical intervention, to help you regain pain-free mobility.

Dr. Wang Lushun - LS Wang Orthopaedics Clinic
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What is Shoulder Impingement?

Shoulder impingement syndrome occurs when the rotator cuff tendons (tissues that connect muscle to bone) and the subacromial bursa (a fluid-filled sac that reduces friction between moving parts) become compressed between the bones of your shoulder. These soft tissues get pinched between the head of your upper arm bone (humerus) and the bony projection of your shoulder blade (acromion).

This compression happens repeatedly during shoulder movements, particularly when raising your arm. Over time, constant friction can cause inflammation (swelling and irritation), pain, and swelling. The rotator cuff tendons may become irritated and thickened. The bursa swells, creating a cycle of increasing impingement.

Shoulder impingement syndrome typically develops gradually rather than from a single injury. Contributing factors include:

  • Repetitive overhead motions (such as painting ceilings, swimming, or serving in tennis)
  • Poor posture
  • Muscle imbalances
  • Anatomical variations in bone shape

Some individuals have a naturally curved or hooked acromion that reduces the space available for soft tissues.

The condition is commonly seen among individuals in early to middle adulthood, with higher prevalence among those whose work or hobbies involve repetitive arm elevation. Swimmers, painters, construction workers, and tennis players face increased risk. Without intervention, shoulder impingement can progress to rotator cuff tears, making timely treatment important for supporting long-term shoulder health.

Individuals Who May Benefit

Shoulder impingement treatment may benefit individuals experiencing characteristic symptoms and meeting certain criteria:

  • Presence of typical symptoms: Pain when lifting the arm overhead, discomfort reaching behind the back, night pain when lying on the affected shoulder, and weakness during arm elevation
  • Confirmed diagnosis: Individuals whose physical examination and imaging studies (such as X-rays or ultrasound scans) suggest impingement rather than other shoulder conditions
  • Activity-related pain: Those whose symptoms worsen with specific movements, particularly overhead activities and internal rotation
  • Failed self-management: Patients who have tried rest and over-the-counter pain relief without adequate improvement
  • Motivation for rehabilitation: Individuals committed to following physiotherapy programmes and activity modifications
  • Good overall health: Patients without significant medical conditions that could affect treatment outcomes
  • Realistic expectations: Those who understand that recovery requires time and active participation in rehabilitation

Factors That May Affect Treatment Suitability

Certain factors may affect treatment suitability or require modified approaches:

  • Complete rotator cuff tears: Large tears (where the tendons that stabilise the shoulder are fully separated from the bone) may require surgical repair rather than impingement-focused treatment alone
  • Frozen shoulder (adhesive capsulitis): This distinct condition (characterised by severe stiffness and restricted movement) requires different management strategies
  • Shoulder instability: Underlying laxity (excessive looseness in the shoulder joint) may need to be addressed before or alongside impingement treatment
  • Cervical spine pathology: Neck problems can cause referred shoulder pain and require an accurate diagnosis first
  • Inflammatory arthritis: Conditions like rheumatoid arthritis (a disease where the immune system attacks the joints) affecting the shoulder need specialised rheumatological management
  • Active infection: Any shoulder infection must be treated before elective procedures
  • Uncontrolled diabetes: Poor glucose control can affect healing and may increase complication risks
  • Severe osteoporosis: Bone quality considerations (such as bone density, which measures bone strength and fracture risk) may influence surgical decision-making

A thorough assessment by a qualified healthcare professional can help determine an accurate diagnosis and appropriate treatment selection. Your doctor can evaluate your specific circumstances and risk factors to recommend a suitable treatment approach. Response times and outcomes vary depending on your specific condition and individual health factors.

Treatment Techniques & Approaches

Conservative (Non-Surgical) Treatment

Many shoulder impingement cases respond to conservative management. This remains the first-line approach for many patients.

  • Activity Modification: Identifying and temporarily avoiding aggravating movements allows inflammation to settle. This doesn’t mean complete rest. Rather, it involves intelligent modification of activities that cause impingement.
  • Physiotherapy: A structured rehabilitation programme forms the cornerstone of conservative treatment. Physiotherapy addresses muscle imbalances, improves posture, and strengthens the rotator cuff and scapular stabilisers. Exercises progress from gentle range-of-motion work to strengthening and functional training.
  • Anti-inflammatory Medications: Non-steroidal anti-inflammatory drugs (NSAIDs) can help reduce pain and inflammation during the acute phase. These medications work when combined with other treatment modalities.
  • Corticosteroid Injections: For significant inflammation, a subacromial corticosteroid injection can provide relief. This injection delivers anti-inflammatory medication directly to the affected area. It can reduce swelling and create a window for physiotherapy.
Surgical Treatment: Arthroscopic Subacromial Decompression

Conservative treatment may fail to provide adequate relief after several months. When this happens, your healthcare provider may discuss surgical intervention. Arthroscopic subacromial decompression is a commonly performed surgical approach for shoulder impingement in Singapore.

This minimally invasive procedure involves inserting a small camera (arthroscope) and specialised instruments through tiny incisions. The surgeon removes inflamed bursal tissue (the swollen cushioning sac between bones and tendons). They also shave away a small portion of the acromion bone to create more space for the rotator cuff tendons.

Arthroscopic surgery offers several features compared to traditional open procedures:

  • Smaller incisions
  • Less soft tissue disruption
  • Reduced post-operative pain
  • Faster recovery

The procedure also allows the surgeon to thoroughly inspect the shoulder joint. They can address any associated pathology, such as partial rotator cuff tears or biceps tendon problems.

Technology and Equipment Used

Shoulder impingement treatment utilises established diagnostic and therapeutic technologies:

Imaging:

  • MRI (magnetic resonance imaging) provides detailed views of soft tissues, identifying inflammation, tendon damage, and bursal thickening
  • Ultrasound offers dynamic imaging to assess impingement during movement
  • X-rays reveal bony abnormalities and acromion shape

Arthroscopic Equipment: High-definition cameras and specialised instruments allow precise surgical work through minimal incisions. Motorised shavers and radiofrequency devices enable tissue removal with controlled precision.

Injection Guidance: Ultrasound-guided injections can improve accuracy. This helps to direct medication to the intended target.

Wondering which approach may be suitable for you?

An orthopaedic surgeon can evaluate your specific needs and discuss suitable options.
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The Treatment Process

Pre-Treatment Preparation
  • Initial Consultation: Your orthopaedic surgeon (a doctor who specialises in bone and joint conditions) can take a detailed history of your symptoms. This includes onset, aggravating factors, and previous treatments. A comprehensive physical examination assesses the range of motion, strength, and specific impingement signs.
  • Diagnostic Imaging: Based on examination findings, imaging tests (such as X-rays or MRIs) can help confirm the diagnosis and rule out other conditions. X-rays assess bone structure. MRI evaluates soft tissue health. These investigations guide treatment planning.
  • Pre-operative Requirements (if surgery planned): Blood tests can help assess your medical fitness for surgery. You may need to stop certain medications, particularly blood thinners, before the procedure. Make arrangements for post-operative assistance in advance.
  • Day-of Preparation: For surgical patients, follow fasting instructions carefully. Wear comfortable, loose-fitting clothing that accommodates a shoulder sling. Arrive with a responsible adult who can accompany you home.
During the Procedure
  • Anaesthesia: Arthroscopic subacromial decompression (a keyhole procedure to create more space in the shoulder joint) typically uses general anaesthesia (you’re asleep throughout the procedure) combined with a regional nerve block (medication that numbs the shoulder area). The nerve block can provide post-operative pain control for a period.
  • Surgical Steps: The surgeon makes a few small incisions (portals) around the shoulder. The surgeon inserts the arthroscope (a small camera) and examines the joint. The camera then enters the subacromial space (the area under the top of the shoulder bone). Your surgeon removes the inflamed bursa (a fluid-filled cushioning sac). Your surgeon shaves a portion of the undersurface of the acromion (the bony prominence at the top of your shoulder) to create more space. Your surgeon can address any additional pathology identified, such as partial rotator cuff tears, simultaneously.
  • Duration: The procedure typically takes a period, depending on the extent of work required. You should not experience pain during surgery.
Immediate Post-Treatment
  • Recovery Room: You’ll spend a period in the recovery area as anaesthesia wears off. Nurses monitor your vital signs (such as heart rate, blood pressure, and oxygen levels) and comfort level. The nerve block keeps the shoulder numb initially.
  • Discharge: Many patients go home the same day. You’ll receive a sling for comfort and written instructions for wound care, medications, and initial exercises.
  • First Night: As the nerve block wears off, some discomfort is normal. Prescribed pain medications can help manage this. Sleep in a semi-reclined position, or prop yourself up with pillows for comfort.

Recovery & Aftercare

Recovery Period What to Expect:
First 24-48 Hours During the initial period, focus on rest and pain management. Apply ice packs wrapped in cloth to the shoulder for a period several times daily to reduce swelling. Keep surgical dressings clean and dry. Take prescribed medications as directed. Stay ahead of pain rather than waiting for it to become severe.

 

Begin gentle finger, wrist, and elbow movements to maintain circulation and prevent stiffness. Pendulum exercises (where you gently swing the arm using body movement rather than shoulder muscles) can start within the first day or two, as comfort allows.

Watch for warning signs that may indicate a need for immediate attention:

  • Excessive bleeding through dressings
  • Increasing redness or warmth around incisions
  • Fever
  • Numbness that doesn’t resolve
First Week You’ll transition from regular pain medication to as-needed use. Many patients find over-the-counter pain relievers sufficient within the first few days. Keep incisions dry until cleared by your surgeon. This typically occurs at the first follow-up appointment around one week post-surgery.

 

Physiotherapy usually begins within the first week. It focuses on maintainingthe range of motion and preventing stiffness. Passive exercises (where the therapist moves your arm) progress to active-assisted movements. You can perform daily activities using the non-operated arm while allowing the surgical shoulder to heal.

 

Sling use varies by surgeon preference but is typically for comfort rather than strict immobilisation. Many patients wean off the sling within a period as comfort improves.
Long-term Recovery
  • Weeks 2-6: Active range-of-motion exercises progress. Light strengthening exercises for the rotator cuff (the group of muscles and tendons that stabilise your shoulder) and scapular muscles (muscles around your shoulder blade) begin. Driving typically resumes within a period when you can control the vehicle safely.
  • Weeks 6-12: Strengthening intensifies progressively. Functional exercises mimic daily activities and work demands. Some patients return to desk jobs within a period and physical jobs within a period.
  • 3-6 Months: Recovery occurs for many patients. Return to sports and demanding physical activities occurs gradually. Progress is guided by strength and function rather than arbitrary timelines.

 

Ongoing maintenance exercises can help support the prevention of recurrence. Attention to posture, workplace ergonomics, and proper technique during sports activities supports long-term shoulder health.

An orthopaedic surgeon can provide post-procedure support to monitor your recovery progress.

Consult your surgeon to learn more about post-procedure support and what to expect during recovery.
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Potential Benefits of Shoulder Impingement Treatment

Many patients who complete appropriate treatment experience symptom improvement. Your healthcare provider can assess your individual progress. They can adjust treatment goals based on your specific condition and response to therapy. The extent and durability of improvement vary by individual anatomy, tissue quality, and adherence to rehabilitation protocols. Treatment for shoulder impingement can deliver meaningful improvements in function and quality of life:

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Pain Relief

Reduction or elimination of the aching and sharp pains associated with shoulder movement and rest

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Restored Function

Ability to reach overhead, behind the back, and across the body without discomfort

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Improved Sleep

Resolution of night pain can allow restful sleep without positioning restrictions

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Prevention of Progression

Early treatment can reduce the risk of rotator cuff tears (damage to the muscles and tendons that stabilise the shoulder) and chronic shoulder dysfunction

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Return to Activities

Resumption of sports, hobbies, and work duties that shoulder pain had limited

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Enhanced strength

Rehabilitation can help rebuild muscle function often weakened by pain and disuse

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Improved posture

Addressing contributing factors can improve overall upper body mechanics

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Increased independence

Performing daily activities like dressing, reaching shelves, and personal care without assistance.

Common Side Effects

All treatments carry some degree of temporary effects:

  • Post-operative discomfort: Surgical patients experience pain and swelling for the first few days. This can be managed with suitable medications, such as prescription pain relievers or anti-inflammatory drugs, and typically improves steadily.
  • Stiffness: Temporary limitation in movement is common after both surgery and during conservative treatment. Consistent physiotherapy, which involves guided exercises to restore strength and flexibility, can help prevent prolonged stiffness.
  • Bruising: Discolouration around the shoulder and upper arm may appear after surgery or injections. It resolves within a timeframe.
  • Injection-related effects: Corticosteroid injections, which are anti-inflammatory medications delivered directly to the affected area, may cause a temporary pain flare for a period before benefit occurs. Some patients experience facial flushing or mild blood sugar elevation.

Rare Complications

While uncommon, more significant complications can occur:

  • Infection: Surgical site infection affects some patients. Prompt treatment with antibiotics can usually resolve this.
  • Nerve injury: Temporary numbness around portals, which are small incision sites used during keyhole surgery, occasionally occurs. It typically resolves within weeks to months. Permanent nerve damage is very rare.
  • Continued symptoms: Some patients don’t achieve adequate improvement despite treatment. Further investigation may reveal previously unidentified pathology, such as underlying disease or structural problems.
  • Frozen shoulder: Post-operative stiffness occasionally progresses to adhesive capsulitis, a condition where the shoulder joint becomes severely stiff and painful, requiring additional treatment.
  • Tendon damage: Rarely, surgery may inadvertently affect rotator cuff tendons, which are the group of muscles and tendons that stabilise the shoulder, though this is minimised with careful technique.

Complication risks can be minimised through proper patient selection, meticulous surgical technique, and adherence to rehabilitation protocols. Choosing a qualified orthopaedic surgeon can help reduce the likelihood of adverse outcomes.

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Cost Considerations

Several factors influence the overall cost of shoulder impingement treatment in Singapore:

  • Treatment approach: Conservative management (non-surgical treatments such as physiotherapy and medication) costs differ significantly from surgical intervention.
  • Diagnostic investigations: MRI (detailed imaging using magnetic fields), ultrasound (imaging using sound waves), and other imaging contribute to evaluation costs.
  • Facility fees: Day surgery centre versus hospital setting affects charges.
  • Anaesthesia requirements: General anaesthesia (medication that makes you unconscious) with regional block (numbing injection for a specific area) has associated costs.
  • Surgeon’s fees: Based on complexity and time required.
  • Physiotherapy programme: Number and duration of sessions needed.
  • Medications: Pain relief and anti-inflammatory prescriptions.
  • Follow-up consultations: Post-treatment monitoring appointments.

Treatment packages typically include surgeon’s fees, facility charges, anaesthesia, standard medications, and initial follow-up visits. Physiotherapy is often quoted separately, as requirements vary among patients.

Management can help reduce long-term expenses associated with ongoing pain management, work absence, and potential complications from inadequate treatment.

A consultation with an orthopaedic surgeon (a doctor who specialises in bone, joint, and muscle conditions) provides a personalised assessment and detailed cost estimate based on your specific treatment needs.

Frequently Asked Questions

How long does shoulder impingement take to heal without surgery?
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Conservative treatment (such as physiotherapy and adjusting your activities) typically requires several weeks to a few months of consistent effort for meaningful improvement. The timeframe varies based on severity, how long symptoms have been present, and patient compliance with rehabilitation. Some patients experience relief within weeks. Others require months. Factors like age, overall health, and the presence of associated conditions like partial rotator cuff tears also influence recovery duration.

Can shoulder impingement return after surgery?
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Recurrence after subacromial decompression (a procedure where the surgeon creates more space for the rotator cuff tendons) is uncommon. The surgery increases the space available for the rotator cuff tendons. Maintaining good shoulder mechanics, posture, and rotator cuff strength through ongoing exercises can help support lasting results. New problems can develop over time, such as age-related rotator cuff changes. These represent different conditions rather than true recurrence of the original impingement.

Is shoulder impingement the same as a rotator cuff tear?
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No, these are distinct but related conditions. Shoulder impingement involves compression and inflammation of the rotator cuff tendons and bursa (the cushioning sac between bones and tendons). The tendons remain intact. A rotator cuff tear involves actual disruption of tendon fibres (where the tissue is partially or completely torn). Prolonged impingement can lead to rotator cuff tears over time. This is why treating impingement appropriately is important. Both conditions can exist simultaneously. Your surgeon can assess for both during evaluation.

Will I need physiotherapy after shoulder impingement surgery?
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Yes, physiotherapy (guided exercises and movement therapy) is essential for surgical outcomes. While surgery creates space for the tendons, rehabilitation can restore range of motion, rebuild strength, and retrain movement patterns. Many patients attend physiotherapy sessions multiple times weekly initially. They progress to independent exercises over several weeks to months. Skipping or inadequately completing physiotherapy can significantly affect results, even after technically successful surgery.

How soon can I return to swimming or tennis after treatment?
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Return to overhead sports depends on treatment type and individual progress. Your doctor or physiotherapist can set a timeline tailored to your specific recovery and risk factors. After conservative treatment, gradual return begins once you achieve a pain-free range of motion and adequate strength, typically after a period. Following surgery, overhead sports usually resume after a period. Start with gentle practice and progress based on comfort and function. Your physiotherapist can guide sport-specific rehabilitation. Rushing return risks re-injury or incomplete recovery.

Can I treat shoulder impingement with exercises alone?
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Many cases of shoulder impingement respond to exercise-based treatment, particularly when symptoms are mild to moderate and caught early. Specific exercises strengthen the rotator cuff and scapular muscles (the muscles that control shoulder blade movement) while improving posture and movement patterns. Exercises work as part of a comprehensive programme. This may include activity modification, anti-inflammatory measures, and professional guidance. Severe or long-standing cases may require additional interventions like injections or surgery.

What sleeping position may be suitable for shoulder impingement?
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Sleeping on your back with a small pillow or rolled towel under the affected arm provides comfort for many patients. If you prefer side-sleeping, lie on the unaffected side with a pillow supporting the painful arm in front of your body. Avoid sleeping directly on the affected shoulder, as this compresses the already irritated structures. Some patients find sleeping in a reclined position, such as in a recliner chair, helpful during acute flare-ups (periods when symptoms worsen suddenly).

How do I know if my shoulder impingement needs surgery?
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Surgery may be considered when conservative treatment (such as physiotherapy, activity changes, and anti-inflammatory medications) fails to provide adequate relief after several months of management. Signs that surgery may be considered include:

  • Persistent pain despite physiotherapy and injections
  • Inability to perform daily activities or work duties
  • Progressive weakness suggesting possible rotator cuff damage

Your orthopaedic surgeon can help determine the appropriate timing based on your symptoms, imaging findings, and response to non-surgical treatment. This decision can be personalised to your specific situation and health needs.

Conclusion

Shoulder impingement is a treatable condition. It need not limit your activities or quality of life indefinitely. Treatment options exist to address the underlying cause of your shoulder pain. These include conservative management with physiotherapy (structured exercises and techniques to improve movement and reduce pain) and targeted exercises. When necessary, surgical intervention provides another treatment option.

Early evaluation and appropriate treatment can relieve current symptoms. They can also help prevent progression to more serious conditions like rotator cuff tears (damage to the group of muscles and tendons that stabilise your shoulder). With appropriate care and commitment to rehabilitation, many patients can achieve improvement. They can return to the activities they enjoy.

Understanding your condition and treatment options empowers you to make informed decisions about your care. The information in this guide provides a foundation. Speak with a qualified healthcare professional for a personalised assessment. They can provide recommendations tailored to your specific circumstances and individual needs.

Ready to Take the Next Step?

If you're experiencing shoulder pain that suggests impingement, Dr Wang Lushun can help you understand your condition and explore appropriate treatment options.
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Dr. Wang Lushun - LS Wang Orthopaedics Clinic
Dr. Wang Lushun - LS Wang Orthopaedics Clinic

Dr Wang Lushun

Senior Consultant Orthopaedic Surgeon

MBBS (Singapore)

MRCS (Edin)

MMed (Ortho)

FRCS (Ortho) (Edin)

Internationally Recognised & Double Fellowship-Trained Surgeon With Over 18 Years of Experience

  • Bachelor of Medicine & Bachelor of Surgery (MBBS),
    National University of Singapore
  • Member of The Royal College of Surgeons (MRCS),
    Edinburgh, United Kingdom
  • Master of Medicine in Orthopaedic Surgery (MMed),
    National University of Singapore
  • Fellow of The Royal College of Surgeons in Orthopaedics and Traumatology (FRCS), Edinburgh, United Kingdom

As a Senior Consultant Orthopaedic Surgeon and former Head of the Hip and Knee Division in Ng Teng Fong Hospital, he has won awards for superior patient outcomes (value driven), service quality and enhanced recovery programmes. His patients include current and former national athletes and sporting professionals.

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Why Choose

Dr Wang Lushun?

Trusted orthopaedic surgeon

Trusted

Leadership on Orthopaedic Advisory Boards

Skilful orthopaedic surgeon

Skilful

Double Fellowships at Centres of Excellence

Experienced consultant with over 18 years in orthopaedics

Experienced

Senior Consultant with Over 18 Years of Experience

Patient-Centred Orthopaedic Care

We are dedicated to your recovery and well-being. Every patient deserves the freedom that comes with active living. Whether you're an athlete sidelined by an injury or a weekend hobbyist desperate to return to your passion, our mission is to help you regain your mobility and independence.

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Personalised Approach For Positive Outcomes

Our clinic prioritizes time dedicated to understanding each patient’s injuries and needs. Dr Wang strongly believes that personalised care & patient management will lead to better outcomes & positive experiences.

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Minimally Invasive Techniques For Faster Recovery

Dr Wang’s extensive experience with minimally invasive procedures allows for less scarring, lower risk of complications and faster recovery compared to traditional surgical methods.

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Aftercare Focused On Restoring Mobility & Well-Being

As an avid sportsperson, Dr Wang understands the time and patience required to regain mobility and return to active living. After your procedure is completed, Dr Wang will make sure your recovery is smooth and comfortable.

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We accept all patients, with or without insurance plans. Additionally, we are on the specialist panels of these Health Networks/Insurance Plans. Please contact us if you have any queries and we will be happy to assist you in checking with your insurance provider.

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