shoulder steroid injections

Steroid injections and your shoulder

Before undergoing shoulder surgery, many patients are recommended steroid injections in a bid to prevent the need for surgery. While they can prove to be effective at resolving mild injuries, sometimes surgery is required to fix more severe shoulder issues.

Here, we’ll look at why timing is everything when undergoing steroid injections and everything you need to know to lower the risks.

What are shoulder steroid injections?

Steroid injections, or cortisone shots, are given to patients in an attempt to reduce inflammation and minimise pain. They tend to include a local anaesthetic, along with corticosteroid medication.

While they can be very effective, they do pose some risks and complications. Joint infections (1 in 10,000), a temporary flare-up of inflammation and pain within the joint (1:20), and nerve damage (very rare) are all potential side effects of these injections. For this reason, the number of injections patients can have within one year are usually restricted. Additionally, numerous injections are thought to potentially weaken the tendon.

Are steroid injections harmful before shoulder surgery?

There has been a number of negative news stories in the media recently, highlighting the dangers of having steroid injections prior to shoulder surgery. However, it is important patients realise the truth behind the news coverage as it isn’t always 100% accurate.

In light of the case of a patient who went to the doctor complaining of shoulder pain, only to be given steroid injections which made the problem worse, there are a few important factors to point out. The first was the patient received the steroid injection by their GP, not a shoulder specialist. If the patient were to have visited a shoulder specialist, investigations would have been provided to determine the cause of the pain and to establish the best course of treatment.

Shoulder specialists have a lot more extensive training into both diagnosing shoulder injuries and recognising the indications for steroid injections. So, the risks of anything going wrong are dramatically reduced. They are also able to determine the best form of treatment, eliminating unnecessary injections.

If steroid injections are required before surgery, there is a set period of time you should wait before having the surgery once the injection has been administered.

How long should you wait before undergoing shoulder surgery?

In order to reduce the risks, patients are advised to wait at least one month after having a steroid injection, before undergoing surgery. However, this varies dependent on the nature of the surgery. In the case of a shoulder replacement, this would be three months, whilst for arthroscopic procedures, this is usually four weeks but intervention dependent.

A recent study carried out by the Rush University Medical Centre in Chicago, revealed that previous steroid injections do not increase the risks of shoulder surgery provided the injection was administered more than a month beforehand.

If you are concerned about having shoulder surgery after a steroid injection, it’s a good idea to talk to a shoulder specialist. They will be able to help you identify whether a steroid injection is needed, or whether another alternative treatment would be most effective. It is also really important to ensure you’re choosing an experienced specialist when having steroid injections administered.

future of shoulder surgery

The Future of Shoulder Surgery 

Shoulder surgery is usually considered as a last resort for most conditions, though in some circumstances it is unavoidable.  The recovery process after some interventions can be long. However, advancements have been made within the industry to make surgical repairs faster, more accurate and less invasive.

Technological advancements have led to much better surgical options. While the sector has already improved dramatically, it is still undergoing development to boost the future of shoulder surgery. Here, we’ll look at how the sector has already improved and what the future holds in terms of shoulder surgery options.

More technological options available to patients than ever before 

There have already been major developments within shoulder surgery over the past decade. The techniques used have helped to minimise recovery times and provide more accurate repairs.

As well as the surgical methods themselves, other advancements have been made with anaesthesia. While not always suitable, regional anaesthesia can sometimes be used instead of local or general anaesthetic. Often regional anaesthesia is combined with general anaesthesia, as it provides good pain relief following the operation. This results in patients being able to leave the hospital the same day as the surgery. However, regional anaesthesia isn’t appropriate for all patients: it largely depends upon the nature of the injury and the type of surgery required.

More recent developments in the field of shoulder surgery, include virtual simulation. Pre-operative planning tools and software are being developed which help surgeons to look at the patient’s shoulder anatomy in clear detail before planning the best course of treatment. It has proven especially effective at aiding with glenoid placement accuracy in shoulder replacements. This drastically reduces the risks of complications and improves the survival rate of implants.

These are just a couple of advancements that have been made. However, developments still continue, with impressive technology currently being developed to aid in the future of shoulder surgery.

What does the future hold for shoulder surgery?

There are a few advancements being made within the industry, such as huge investment into rotator cuff tear technology.

Stryker have recently completed an acquisition of OrthoSpace, a private Israeli company. This has given them ownership of InSpace, which includes the use of a balloon system in order to disable bone friction, enabling faster recovery and reduced pain.

The InSpace technology is currently being studied in the US, though it has so far been used in more than 30 countries, on a total of 20,000 patients. Now that Stryker has taken control of the technology, it plans to invest $220m to get it fully onto the market.

In the UK, a national trial is underway to assess its effectiveness.

This isn’t the only exciting development currently planned in the shoulder surgery sector. Tendon healing is also being focused on, with specialists looking into developing an advanced biological device. Bone marrow stem cell studies are being carried out in order to see whether a biological device would be feasible.

The future of shoulder surgery is certainly looking promising given the current study and development into shoulder surgery technology. In the meantime, patients experiencing shoulder pain have numerous treatment options available to them. Book a consultation with an experienced shoulder specialist in London today to find out whether surgery is the right option for you.

surgery for rotator cuff injury

When is surgery absolutely essential for rotator cuff injury? 

When it comes to treating shoulder injuries, patients are usually presented with non-surgical options first. This is because surgery on the shoulder can be quite complex; meaning a lengthy recovery time and potential risks and complications. However, in some cases, surgery cannot be avoided.

Rotator cuff injuries can be particularly tricky to repair. Therefore, depending upon their severity, surgery may be the only treatment option available. Here, we’ll look at when surgery is normally recommended for rotator cuff injuries.

Understanding the severity of the injury

One of the major factors which determine whether shoulder surgery is required for rotator cuff injuries is the severity of the injury itself. If the patient is suffering from a partial tear or a small full thickness tear, this may be monitored and treated non-surgically, through physiotherapy or non-invasive treatment options. The age of the patient is a factor in decision making, as it is known that the natural history of tendon tears is that they progress in size.

If the problem is a full tear, and particularly if the patient is considered to be young, surgery is generally the best treatment option. It is highly unusual for rotator cuff tears to heal themselves. So, the surgeon will always look at the severity of the tear before deciding whether or not surgery is the best way forward.

Extreme pain and loss of motion

Another factor to consider is how much pain and loss of motion the patient is experiencing. Pain levels can be hard to monitor in patients, as each individual has a differing pain threshold. However, if it is causing significant pain, obviously it is within the patient’s best interest to treat it as quickly as possible. High levels of pain can also make alternative treatment options more difficult, such as physiotherapy.

Similarly, if there is a loss of motion which cannot be improved via physiotherapy or minimally invasive treatments, surgery would be required. Leaving the injury untreated when it’s causing a loss of motion, could lead to further degeneration of the shoulder, such as muscle loss.

Lifestyle considerations

Lifestyle considerations also need to be taken into account when coming up with the best treatment plan. If the rotator cuff tear is moderate to severe and it’s causing issues for patients not being able to carry out daily tasks, surgery may be essential.

For those with fairly inactive lifestyles, provided the pain isn’t too unbearable, they may be able to benefit from a non-surgical approach. However, for those with an active lifestyle, particularly athletes, getting back into the sport they love is essential, so surgery could be the best treatment choice for those who require full shoulder fitness in everyday life.

To find out what your best treatment options are, it is important to undergo a consultation with an experienced shoulder specialist. The sooner patients seek treatment for rotator cuff injuries, the more likely it is they will be able to benefit from non-surgical treatment, depending upon the severity of the injury.

treatment of rotator cuff tears

Study into stem cell formation provides insight into challenge of rotator cuff tears

A new study published within the Journal of Bone & Joint Surgery has provided an insight into the challenge inherent in the treatment of rotator cuff tears. It was discovered that stem cells within the rotator cuff more frequently turn into fat cells, rather than muscle cells in the event of a tear.

Here, we’ll analyse the findings and what it means for the future treatment of rotator cuff tears.

Understanding the research into rotator cuff tears

The research was carried out on mice, with numerous experiments performed to identify the characteristics of a group of stem cells known as satellite cells. Found between muscle fibres, satellite cells are crucial in the repair of muscle injuries.

Rotator cuff tears are known to be one of the most difficult to repair due to extensive fat accumulation. Chronic tears are especially susceptible to excess fatty build-up and the researchers wanted to determine whether there was a genetic basis which would explain why this particular area is prone to excess fatty deposits.

The researchers carried out DNA-level studies. These managed to identify hundreds of differing gene activations in comparison to the stem cells in calf muscles. It was discovered that the stem cells within the shoulder were programmed to develop into fat cells more easily than those in the calf muscles. It was also discovered that rotator cuff stem cells were 23% less likely to develop into muscle cells.

Why does it matter?

This study is the first of its kind to assess the DNA modification of rotator cuff disease. At present, rotator cuff tears can be notoriously difficult to treat. This is largely down to the fact that there is excess fatty build-up surrounding the muscles. Therefore, researching into why this occurs is crucial for the development of more effective treatments.

The researchers claim this study has opened the doors for a lot of additional studies. It shows that through further studies, newer, more effective clinical and therapeutic treatments could be developed. This would prove revolutionary for patients suffering from rotator cuff tears in the future.

How future research could improve clinical and therapeutic treatment of rotator cuff tears

In terms of therapeutic treatments, with the research discovered, it could be possible to take muscle stem cells from a patient’s body, then insert them into the rotator cuff muscle for improved repair. This could help to decrease the amount of fatty build-up and increase muscle repair within the area.

The researchers are already undertaking additional research into the nature of the fat accumulation in patients with rotator cuff tears. They are also trying to identify how immune and stem cells are working together to alter the muscle after surgery.

So, this new research is promising that newer, more effective treatments can be developed to treat rotator cuff tears in the future. While the tears can currently be successfully repaired via surgery, the fatty build-up can prove problematic for effective healing.

If you suspect you are suffering from a rotator cuff tear, it’s important to seek a correct diagnosis. Book a consultation with a shoulder specialist to determine the cause and most effective treatment option available.

shoulder labral tear

Is surgery necessary to repair a shoulder labral tear?

A shoulder labral tear is a common shoulder injury, particularly for athletes that participate in sports that involve overhead motion, such as netball, swimming or weightlifting. They most commonly occur due to wear and tear, though they can also occur due to trauma or injury.

If a shoulder labral tear is diagnosed, there are non-surgical treatment options which can help you resume normal day-to-day activities with full mobility and reduced discomfort. However, to return to competing at your previous level in your chosen sport then a surgical repair of the labrum may be required.

What is a labral tear?

The labrum in the shoulder is basically a cartilage disc which is attached to the shoulder socket. It plays a crucial role in ensuring the ball of the shoulder is kept securely in place. It also helps to ensure stability and movement within the shoulder.

Like any part of the shoulder, the labrum is susceptible to injury. Repetitive movements are the most common cause of labral tears, meaning they are especially common in athletes. As the labrum is exposed to repetitive strenuous movements, it will start to fray over time, becoming prone to tears.

There is also the possibility trauma, or an injury could lead to a labral tear. These types of sudden tears tend to be more severe, with some resulting in a total dislocation of the shoulder.

What symptoms does a shoulder labral tear present?

Many shoulder injuries present similar symptoms. If suffering from a shoulder labral tear you will typically feel either an aching or pain within the shoulder, and the joint may be weak or unstable. You may also experience a popping sensation, along with pain when you carry out certain overhead movements, such as throwing a ball. A shoulder specialist will be able to diagnose the problem correctly and recommend the best treatment option for you.

Is shoulder surgery the best option?

Surgery is typically the main course of treatment offered for labral tears. However, it will depend upon your lifestyle and how severe the tear is.

If you live a more inactive lifestyle and the tear isn’t too serious, you may choose not to opt for a surgical repair. Non-surgical treatment options include taking a break from activities that are causing pain and using anti-inflammatory medications to decrease pain and swelling in the shoulder. Once pain and swelling have decreased, then physical therapy can help to strengthen the shoulder muscles, improving function and mobility.

However, if you’re a keen sports player and you want to get back to playing as soon as possible, surgery will be the best option. This is because the labrum isn’t able to fully repair itself, so while the tear may improve, without surgery it’s unlikely to ever fully heal. This means there could still be some level of pain and weakness experienced if you do choose to avoid surgery.

If you suspect you are suffering from a shoulder labral tear, book a consultation with the London Shoulder Specialists today. You will be assessed to establish whether or not a labral tear is responsible for your shoulder pain and from there you will discover the best treatment options moving forward. To book an appointment, call +44 (0) 203 195 2442.

anterior shoulder pain

Determining the Cause of Anterior Shoulder Pain

The shoulder is one of the most complex and largest joints within the body. Therefore, there are a lot of ways you can injure it on a day-to-day basis.

Most commonly, shoulder pain occurs in the posterior (back) of the shoulder. However, there are a few types of injuries which can lead to pain in the anterior (front) of the shoulder. If you’re experiencing anterior shoulder pain, determining the root cause is crucial before treatment can be recommended. Here, you’ll discover some of the most common causes of anterior shoulder pain and the types of treatments available.

Anterior shoulder pain and rotator cuff injuries

Rotator cuff injuries are one of the most common injuries to result in pain throughout the shoulder. If it becomes inflamed or injured, it can lead to anterior shoulder pain. The type of pain experienced can range from more of a dull aching, to sharp, intense pain and even potentially immobility.

Most commonly, an injury to the tendons of the rotator cuff is caused by repetitive injury. However, you can also damage the rotator cuff through a sudden injury. These types of injuries tend to lead to other symptoms too such as shoulder weakness, popping of the shoulder and with severe tears, you may struggle to actually use the shoulder and arm.

Anterior shoulder pain and fractures, breakages and injured tendons

The most common causes of anterior shoulder pain are fractures, breakages and injured tendons. If you place a lot of repetitive strain onto the shoulders, through heavy lifting for example, or through playing sports, it can lead to a repetitive injury.

If you’re suffering from a fracture, you’ll typically notice severe pain, along with bruising and swelling. They tend to result from a fall onto the arm or shoulder. There’s also the possibility that you may have dislocated the shoulder. If the arm looks out of place, or if there is pain, numbness, weakness and swelling, it’s likely a dislocation injury.

Anterior shoulder pain and Adhesive Capsulitis

Also referred to as frozen shoulder, Adhesive Capsulitis typically develops if the shoulder hasn’t been used properly. It can occur through biceps tendinopathy, rotator cuff tendinopathy or trauma to the shoulder.

If this is the cause of your shoulder troubles, you’ll experience pain, as well as a decrease in the motion of the arm. Your shoulder joint may also feel stiff.

Anterior shoulder pain and shoulder osteoarthritis

Finally, osteoarthritis can also cause anterior shoulder pain. Also referred to as wear and tear arthritis, it’s caused when the bones rub against one another, wearing away the cartilage between them. Common symptoms of osteoarthritis in the shoulder include pain, stiffness and swelling of the joint.

Different types of shoulder injuries will require different types of treatment and delaying seeking diagnosis and treatment, typically means the problem will worsen rather than resolve itself. For an appointment with the London Shoulder Specialists, call 0203 195 2442.

physio for shoulder pain

Physio for Shoulder Pain Works Better When You Actually Believe It Will Help

A new observational study has revealed that physio for shoulder pain works better when patients believe that it will help. Carried out by researchers from the University of Hertfordshire and the University of East Anglia, the results of the study highlight just how powerful the mind can be at helping the body to heal.

Here, we’ll look at the findings of the study and how self-belief and positivity can potentially help to ease shoulder pain.

Understanding the study

In the first study of its kind, researchers followed over 1000 patients who were undergoing physiotherapy for shoulder pain. All of the patients were receiving physiotherapy at 11 NHS trusts, along with social enterprises throughout East England.

The team analysed 71 different patient characteristics and clinical findings before and during their first physiotherapy session. Then, they assessed follow up information provided by 811 patients six months after. It was discovered through the follow up information provided, that the majority of patients experienced improvement through physiotherapy.

The results revealed that those who experienced a higher level of pain and disability at the start, also experienced higher levels within six months than those who had a lower level of pain. However, the most surprising finding was that those who believed physiotherapy would work, experienced more significant improvements.

The more positive you are, the better you’ll heal

The study found that the more positive patients are about the effectiveness of physiotherapy, the better they healed within six months. For example, those who thought they would fully recover after physiotherapy, healed better than those who thought they would see the pain much improve.

[external link: https://theconversation.com/physiotherapy-works-better-when-you-believe-it-will-help-you-new-study-110469]

They also discovered that although those with a higher level of pain and disability at the start had higher levels six months on, those who had the confidence to do things despite their pain generally experienced better results. In fact, through self-belief, some patients with a higher baseline of disability and pain experienced better results than those with low baselines levels.

The study follows on from previous research which has revealed that a patient’s expectation of recovery could predict the outcome of physiotherapy for neck and back pain, as well as orthopaedic surgery.

Could the findings help patients avoid surgery?

So, if self-belief can significantly improve shoulder pain and enhance the effectiveness of physiotherapy, does this mean that patients could avoid surgery? It would largely depend upon the type of injury sustained. Significant injuries are still likely to require surgery is physiotherapy isn’t working.

Physiotherapy does tend to be the first treatment option for shoulder pain and for patients that do not respond to conservative approaches, shoulder surgery is often the best option to reduce pain and increase mobility.

If you are concerned about your shoulder pain, it’s best to seek treatment as soon as possible. There are lots of different causes of shoulder pain so getting a proper diagnosis is key. Book a consultation with a shoulder specialist today to determine the cause and best course of treatment for your shoulder pain.

Mr Andrew Wallace attends Sydney Shoulder Symposium

Mr Andrew Wallace attends Sydney Shoulder Symposium

London Shoulder Specialist Mr Andrew Wallace recently attended the 13th Royal North Shore Shoulder Symposium: Advanced Shoulder Technologies held at Royal North Shore Hospital, Sydney as invited guest speaker.

Mr Wallace gave several lectures at the Symposium, two of which have been published in this month’s issue of the Shoulder and Elbow Journal.

Mr Andrew Wallace published in Shoulder and Elbow JournalThe first article focused on the shoulder condition that Winston Churchill suffered from and which was to affect him from his younger years and through into his later political career. Entitled ‘Faithful but unfortunate’, the article reviews the historical record of Churchill’s shoulder instability and looks at one of Churchill’s contemporaries, ASB Bankart, who was to propose the surgical approach to management of the unstable shoulder that has become the ‘gold standard’ of treatment.

The second article reviewed arthroscopic Bankart repair with remplissage for non-engaging Hill-Sachs lesion in a group of 20 professional collision athletes and concluded that this combined approach was able to demonstrate good outcomes with lower recurrence rates.

To arrange a consultation with Mr Wallace at the London Shoulder Specialists, call 0203 195 2333 or email wallace@fortiusclinic.com.

article on shoulder surgery

Mr Steven Corbett publishes arthroscopy article in The Bone & Joint Journal

London Shoulder Specialist Mr Steven Corbett and colleagues have recently published an article in The Bone & Joint Journal. Entitled ‘The assault on arthroscopy: is there a middle ground?’, the article evaluates the role of shoulder surgery in light of the economic analysis of the CSAW (Can Shoulder Arthroplasty Work) trial that is also published in this issue of the journal.

The CSAW trial focused on the use – or overuse – of shoulder arthroscopy and subacromial decompression procedures.

They also reference the evidence of clinical trials investigating the role of arthroscopy in the treatment of orthopaedic conditions.

Mr Corbett and his fellow authors believe the CSAW trial is an important project and its results should be carefully considered but had some concerns with the scope of the study.

They highlight the limitations of the project, whilst welcoming further studies to help the management of patients.

The CSAW trial was supported by the British Shoulder and Elbow Society who are reviewing the current guidelines it provides to orthopaedic surgeons in the light of its findings.

The article concluded that “as a surgical community, we welcome any and all studies that explore the efficacy of operations and the surgical pathway, and will continue to engage with them.

“While there is no doubt that the overuse of arthroscopic procedures needs to be rationalized, it is still important not to withhold surgery from those who need it.”

Mr Ali Narvani on irreparable rotator cuff tears

London Shoulder Specialist Mr Ali Narvani’s article on irreparable rotator cuff tears

An article on Superior Capsule Reconstruction was recently published in The Archives of Bone and Joint Surgery by London Shoulder Specialist Mr Ali Narvani. Alongside colleagues based at Rowley Bristow Unit, Ashford and St Peter’s NHS Trust, Chertsey, Mr Narvani’s article focused on the management of irreparable rotator cuff tears, a shoulder condition that remains challenging.

Superior Capsule Reconstruction (SCR) was first introduced in 2012 by Dr Teruhisa Mihata, a Japanese orthopaedic surgeon, and since then has grown in popularity as an option to treat severe irreparable rotator cuff tears.

Mr Narvani and colleagues reviewed the available literature on the procedure and their conclusion was that short-term clinical results show it is a promising treatment option but further long-term trials, which compare SCR to other treatment options are required. Clarification on the importance of the choice of graft type and thickness is also needed.