Living with shoulder instability: management and treatment

shoulder instability treatmentYour shoulder provides a much wider range of motion than any other joint in your body. However, this also makes it much more likely to suffer from instability. The cause of this painful condition varies between old and younger patients.

Whatever the cause, successful treatment often relies upon early detection. Here, we’ll look at how shoulder instability is typically managed and treated.

Shoulder instability treatment

There are several treatment options which can be used to treat shoulder instability. Patients who have never suffered a dislocation of the shoulder joint, will typically find physical therapy offers the best course of treatment.

  • Regular physical therapy sessions will focus on strengthening up the girdle; providing stability to the joint. In addition, electrical and ultrasound stimulation, along with massage can also be used to minimise the pain.
  • Placing ice over the affected area twice daily will also help to reduce pain and limit inflammation. In severe cases, the patient may also be given corticosteroid injections to manage the pain and inflammation.
  • If the shoulder has become dislocated, physical therapy alone will not always be enough to repair the problem. Just one dislocation could be treated without the need for surgery, but if multiple dislocations are identified, an arthroscopy may be needed.
  • The arthroscopy can usually be done as an outpatient procedure. It’s minimally invasive and has shown great success in the treatment of shoulder instability.

It’s worth pointing out, treatment can vary depending upon the age of the patient. Below you’ll discover more about age-related treatment options.

Shoulder instability treatment for older patients

The majority of older patients who present with shoulder instability, have developed the condition after a fall or traumatic incident.

If a patient is over the age of 40, treatment will usually be done non-operatively. A sling will need to be worn, ensuring the joint is immobilised for a set time period. This gives it plenty of time to heal. Once it has been rested, usually within a couple of weeks, physiotherapy will be used to help the patient regain motion and strengthen the shoulder joint to prevent future injury.

Interestingly, the re-occurrence rate of shoulder instability in older patients is very low. A full recovery is also expected within three to six months.

Shoulder instability treatment for younger patients

Younger patients are generally more prone to shoulder instability issues; particularly young athletes. In sports which require frequent overarm movements such as tennis, there’s an especially high chance of shoulder instability.

If the shoulder is dislocated, it is likely to end with future instability in the joint. It’s estimated that 80% of young patients who experience a dislocation, go on to experience recurring instability issues.

Treatment will very much depend upon the severity of the instability. If the shoulder has been dislocated fully, it will need to be reset. However, it’s worth noting that this doesn’t treat the actual instability issue.

The instability is most commonly treated with physiotherapy to start. To address the pain, anti-inflammatory medications may also be prescribed. If very little improvement is seen after physiotherapy, surgery may be the only other option.

Overall, shoulder instability can be treated, though the method and recovery period will depend upon several factors, including the age of the patient. As with any shoulder injury, the earlier instability is detected and managed, the easier it will be to treat.

All strenuous physical activities should be stopped until the shoulder is strengthened and the pain is gone.

London Shoulder Specialist Ms Susan Alexander of the Fortius Clinic reiterated in a recent presentation on shoulder instability “the importance of a close working relationship, with good, open and regular communication between surgeon, physiotherapist and general practitioner to optimise the treatment of this complex condition.

Tuning your tennis shoulder

The temperatures have plummeted and rain is predicted so we must be nearing one of the highlights of the British summer: Wimbledon. As the oldest and most prestigious of the Grand Slams looms, it’s that time of year when even amateur tennis enthusiasts dust off their rackets and a great opportunity to highlight one of the most common injuries suffered in the sport and how you can prevent it.

Treating tennis shoulder

Tennis shoulder is a common, painful injury, which largely occurs due to repetitive overuse of the shoulder. Just like cricket, tennis players use a lot of overhead arm movements; causing the joint and underlying muscles to eventually loosen, tear or – in more severe cases – come away from the socket completely.

Understanding tennis shoulder

The shoulder is by far the most flexible joint within the body. It’s designed to allow a wide range of different movements, while maintaining good stability. However, if you push the joint too far in any direction, it has the possibility to irritate any of the surrounding muscles and tendons.

Out of the entire structure of the shoulder, the rotator cuff tends to be the most susceptible to injury. Some experts argue this is because the rotator cuff isn’t able to adapt quickly enough to any sudden changes. So, with this theory, if you’re just starting out in the world of tennis, you’re at a higher risk of developing shoulder-related injuries.

Even seasoned tennis players are at a high risk of injury. Many take time off during the winter months then, as the weather warms up, returns to their favourite sport. As the shoulder hasn’t been used for months, it’s simply unprepared for the pressure that it’s about to be placed under and injury becomes a high possibility.

Is tennis shoulder preventable?

If you’re looking to return to tennis or take it up for the first time, one of the best pieces of advice is to make sure you’re properly warmed up. This doesn’t just mean doing a series of stretches before playing, it means starting to prepare for the game before the season actually commences.

Proper training will help you expose the shoulder to the movements required within a tennis game, over a gradual period. This alone will make a massive difference to your tennis shoulder risk level. The longer you can prepare the shoulder before you start playing properly, the lower your risk will be.

Right before you play, a proper warm-up will also help. This should ultimately include some of the movements you’ll be performing, such as an overhead serve. You’ll also want to focus on flexibility training of the legs, spine, arms and shoulders.
Similarly, a cool down is just as important as the warm-up. This will also greatly reduce the amount of aching you experience the day after.

Building up your back and shoulder muscles will also help to lower your risk of injury. The more stable and strong you can make the shoulder, the less prone it will be to injury.

Overall, due to how repetitive tennis shoulder movements can be, it’s impossible to completely prevent the risk of injury. However, the above advice will help you minimise your chances of developing tennis shoulder. If you do experience any pain in the shoulder, it’s imperative you get it looked at right away. The earlier you get the problem treated, the easier it will be to rectify.

Age is not a factor in shoulder replacement success

shoulder replacement successA recent study has shown that age may not necessarily be a factor in determining shoulder replacement success. This result has surprised researchers, as up until now, age has always been associated with a decreased chance of success.

What’s more, older patients tend to experience far less complications and gain an increased level of shoulder function after the procedure compared to younger patients.

Understanding the study

The recent study was conducted by the Henry Ford Hospital in Detroit and it followed two different aged patient groups. The first included 262 patients under the age of 65, while the second followed 103 patients who were over 75. Each patient had undergone surgery due to osteoarthritis.

The older group were found to have less function in the shoulder than the younger group before they had surgery. However, once the replacement surgery had been performed, the older group experienced more improvement than the younger group.

While the study determined there was no real link between age and the outcome of shoulder replacement surgery, it was quite a small study. Therefore, more in-depth research would need to be done in order to determine just how factual these results are.

What causes a patient to require shoulder replacement?

Shoulder replacement surgery may not be performed as much as knee and hip replacement surgery, but it’s still surprisingly common. There are numerous things that can lead to a patient requiring this type of surgery including:

Osteoarthritis and rheumatoid arthritisArthritis in the shoulder joint is by far one of the most common causes of shoulder pain; particularly osteoarthritis. This occurs over time and largely affects patients aged 50 or over. The pain results from the cartilage being worn away and the bones then begin to rub against each other. Eventually the joint becomes painful and stiff.

Rotator cuff tear arthropathy – If you have a large rotator cuff tear that’s been there a while, it can lead to rotator cuff arthropathy. Because of the tear, changes can start to appear within the joint, which in turn can lead to damage to the cartilage and arthritis.

Serious fractures – If the bone in the upper arm becomes shattered, it could prove very difficult to have them placed back together. Therefore, a shoulder replacement may be recommended.

Understanding shoulder replacement surgery

Shoulder replacement surgery has proven really successful at eliminating shoulder joint pain. It’s one of the few surgical procedures that has been carried out since the 1950s. However, the techniques and equipment used have certainly improved over time.

While it is an effective treatment option, surgery is only ever considered as a last resort. The first thing patients are usually given to ease the pain is medication and recommended changes in activity. If these initial treatments don’t work, that’s when surgery could be more effective.

The procedure involves removing any damaged sections of the shoulder joint and replacing them with artificial components. The head of the joint alone could simply be removed, or the ball and socket may need to be replaced depending upon the severity of the problem.

Overall, shoulder replacement surgery is common and it does have a high success rate. In the past, patients have been put off due to their age, but this new study proves surgery could actually be more effective in older patients.

London Shoulder Specialist to speak at Sport and Exercise Medicine Symposium

London Shoulder Specialist Ms Susan Alexander is to speak at this month’s One Day International Sport and Exercise Medicine Symposium held in London. Entitled ‘From Pain to Performance’, the conference is widely recognised as one of the leading sport and exercise medicine conferences in the UK and is facilitated by the Society of Sports Therapists.

The Society of Sports Therapists was established in 1990 by Professor Graham Smith to address the increasing demands made on everyone involved in the management and treatment of sports injuries. For the symposium, Professor Smith brings together internationally renowned speakers who work at the cutting edge of musculoskeletal and orthopaedic medicine.

sports and exercise medicine

Alongside colleagues discussing topics such as the management of groin injuries in professional sport to the effects of cryotherapy on muscle reaction time in ankle sprains, Ms Alexander will be speaking on ‘The Problem Shoulder – Referral or Rehab?’.

Could stem cells be used to regrow rotator cuff tendons in the future?

tem cell rotator cuff repairA new discovery made by Uconn Health researchers, could revolutionise the way rotator cuff tears are treated forever. Using stem cells, the researchers found that they could regenerate the tendons, completely repairing the tear without surgery. This exciting discovery provides hope, particularly for athletes, that this common shoulder issue could be treated quickly and almost painlessly.

How would stem cell rotator cuff repair work?

In order to regenerate the tendons, it requires a nano-textured fabric seed complete with stem cells. It is the introduction of the nano-textured fabric along with the stem cells that’s important in the effectiveness of the stem cell rotator cuff repair treatment. Surgeons have already used stem cells occasionally in the past, injecting them in the tear of the rotator cuff. However, on their own, they haven’t proven to be very successful.

The nano-textured fabric seed appears to significantly increase the success of the treatment. With the seeds help, the stem cells found it much easier to attach to the bone. This resulted in regrown tendons that weren’t just repaired, but they were stronger afterwards too. The cell structure appeared to look just like undamaged and natural tissue. This contrasts to current surgical treatment which often leaves an unorganised cell structure, causing the tendons to grow back weaker.

It’s worth noting that this stem cell rotator cuff repair treatment has only been tested on animals. So, human trials would need to be conducted in order to establish whether it presents the same benefits.

Understanding rotator cuff tears

Rotator cuff tears are extremely common, and they’re typically caused by repetitive micro-trauma. That means, they develop over time, whether it be weeks or even years. Once the tendon becomes torn, it causes the shoulder to weaken, which ultimately leads to pain when you try to carry out normal, everyday activities such as brushing your hair.

A lot of the time, torn tendons actually start out by fraying. Then, often after lifting a heavy object, and after a period of time where the damage becomes worse, the tendon finally tears.

Rotator cuff tears are categorised as partial and full-thickness tears. With the partial tear, the tendon becomes damaged, but it doesn’t completely tear. A full-thickness tear on the other hand, occurs when the tendon comes completely away from the bone.

These tears often result in extreme pain, even when the patient is resting, or lying in bed at night. So, the fact these common tears could soon be repaired by stem cells is definitely welcome news for patients. However, until these stem cells can be used as a mainstream treatment, what options do patients have in the meantime?

Current rotator cuff treatment options

There are numerous treatment options available right now, including injections, surgery and physical therapy. The treatment that’s right for you will depend upon the severity of the tear. Surgery tends to be used for the most severe, painful rotator cuff tears, and there’s many different methods that can be used.

If you suspect you have a rotator cuff tear, it’s best to get it diagnosed as soon as possible. The earlier it is detected, the less invasive the treatment will be. For example, a minor tear could repair itself with physiotherapy. So, if you want to avoid surgery, always get your shoulder pain checked out as quickly as possible.

London Shoulder Specialist to speak at ‘The Future of Football Medicine’ conference in Barcelona

Future of Football MedicineThis week, London Shoulder Specialist Mr Andrew Wallace will be attending one of the big events in the international sports medicine calendar. This year’s International Conference on Sports Rehabilitation and Traumatology will focus on ‘The Future of Football Medicine’ and will take place between 13 and 15 May at Camp Nou, the home of FC Barcelona.

With over 2,500 attendees from 90 countries expected, Mr Wallace has been invited to give a lecture on shoulder injuries in footballers. On Sunday, he will be joining other leading sport medicine specialists on a panel focusing on the ‘Future of Sport Surgery: Sparing the Scalpel?’ and reviewing conservative versus surgical options for footballers’ shoulders.

It’s not game over: study finds that majority of shoulder replacement patients return to sports

Shoulder replacement surgery is often considered as a last resort for severe shoulder injuries. However, a new study has shown that the majority of shoulder replacement patients under the age of 55, find they can return to sports, often in as little as seven months.

This proves promising for recreational athletes who worry they’ll never be able to play sports again after the surgery. So, what does shoulder replacement involve and which sports will patients still be able to partake in after the surgery?

Understanding shoulder replacements

A lot like hip and knee replacements, a shoulder replacement involves replacing the damaged components with artificial ones, or more commonly referred to as a prosthesis.

Younger athletes can develop early osteoarthritis due to the repetitive motions performed in various sports. Once the joint develops arthritis, a total shoulder replacement is often required. This involves removing the joint surfaces, and then replacing them with a metal ball which has been highly-polished, that is then attached via a stem, along with a plastic socket.

Once healed, the prosthesis should allow the patient to move the shoulder freely and painlessly; allowing them to get back to the tasks they were unable to perform prior to the surgery. Of course, the results and success of the replacement vary between patients.

However, the study which was published in the World Journal of Orthopaedics, showed in patients under the age of 55, return to sport after shoulder replacement wasn’t only possible, but probable.

Which sports can shoulder replacement patients go back to?

One thing that is worth noting, is that there are limits as to which sports a shoulder replacement patient can go back to. The study questioned 61 patients, and found over 90% were able to return to a high demand sport.

return to sport after shoulder replacementThe exact sports patients returned to included:

  • Fitness sports – 97.2% of patients went back to fitness-related sports
  • Golf – 93.3% of patients went back to playing golf
  • Tennis and swimming – One of the more surprising statistics presented by the study, 87.5% of patients could return to both singles tennis and swimming
  • Basketball – 75% of patients found they could return to basketball
  • Flag football – 66.7% of patients returned to flag football

You’ll notice none of the above sports are contact sports. You may find you cannot return to sports such as rugby, for example, once you’ve undergone a total shoulder replacement.

Why are the results of the study important?

The reason why this study is important to shoulder specialists and young athletes is because it shows a shoulder replacement could be a viable choice for young patients suffering from early osteoarthritis.

It proves the treatment doesn’t eliminate the chances of a return to sport after shoulder replacement. Overall, as with any type of shoulder injury, it is important to seek treatment if you’re experiencing any pain as early as possible. This reduces the risk of the problem getting worse and provides a much more optimistic outcome.

Shouldering the pain: shoulder injuries in professional cricketers

Specsavers-County-Championship cricket shoulder injury preventionShoulder injuries are most commonly associated with contact sports such as rugby. However, they’re also extremely common in non-contact sports such as cricket and, as the clocks go forward and temperatures get warmer, we see the attention of sporting fans turn to the start of the domestic cricket season.

Due to the repetitive actions used in batting and bowling, professional cricketers often suffer cricket shoulder injury. In fact, it’s so common, the term ‘Thrower’s shoulder’ is often used to describe shoulder pain experienced by bowlers.

So, what type of shoulder injuries do cricketers need to worry about? Here we’ll look at the different cricket shoulder injury that can occur and whether they can be prevented.

Different types of shoulder injuries experienced by cricketers

There are a wide range of shoulder conditions which can affect professional cricketers. Below we’ll provide a general overview of the different injuries and how they typically present themselves.

  1. Overstretched or torn tendons – One of the milder injuries which occurs in cricketers is an overstretched tendon, caused by repeatedly overusing the shoulder muscles. Bruising, swelling, pain and inflammation are all characteristics of this type of injury. In more severe cases, the tendon can tear, causing more of a burning pain and the inability to use the arm.
  2. Joint sprain – More specifically a glenohumeral joint sprain, this occurs when the ligament starts to come away from the bone. Like an overstretched tendon, it presents itself in bruising, pain and swelling. If the ligament has torn, however, players would experience a snapping sound, along with the inability to control the arm.
  3. Impingement syndrome – A more serious injury which can occur if the inflammation of milder injuries such as overstretched tendons aren’t treated. The tendon can become trapped within the subacromial space, causing significant pain and discomfort. If left untreated, it can lead to issues with the rotator cuff.
  4. Rotator cuff tears – The type of rotator cuff injuries experienced by cricketers are slightly different to those experienced by contact sport athletes. Degenerative tears are the most common types experienced, which are caused by a gradual breakdown of the tendon. Again, this is caused by the repetitive motions used during the sport. They can start out as partial tears, but if left untreated can lead to a full thickness tear which would require surgery to fix.

Can cricketers prevent shoulder pain?

As much of cricket, particularly the fielding process, relies upon repetitive movements, does this mean shoulder injuries cannot be prevented? While it is impossible to completely eliminate the risks involved, there are things you can do to reduce your chances of developing a cricket-related shoulder injury.

First and foremost, it’s important to ensure you are using the correct bowling and batting techniques. It’s also helpful to build up the stability of the shoulder, through specially targeted strengthening exercises.

Finally, increasing your endurance gradually is also a good idea. This will help to specifically limit the chances of developing rotator cuff injuries.

Following the advice above can help to reduce your chances of developing shoulder injuries. However, equally as important is knowing when to seek treatment. The majority of cricketers simply play on, without seeking help for shoulder pain. This not only affects your performance, but it can also lead to more serious injuries which could have a significant, long-term impact on your career.

If you suspect you or your player is suffering a cricket shoulder injury, an orthopaedic surgeon that specialises in the shoulder can provide speedy diagnosis and effective treatment.

Swimmers found to be more vulnerable to developing shoulder pain

Swimmer's ShoulderSwimmers are more vulnerable to developing shoulder pain than athletes who aren’t involved in overhead sports, according to a new study published in The American Journal of Sports Medicine.

Researchers studied a cohort of competitive swimmers over the course of an intensive 12-week training season and found that swimmers experience a 15% increase in forward shoulder posture compared to an approximately 1% increase in those that participate in non-overhead sports. There was also a substantial decrease in subacromial space distance in comparison.

“Swimmers have a lot of pain during training season and this [study] validates some of where that pain is coming from,” Elizabeth E. Hibberd, assistant professor at the University of Alabama and the Director of Athletic Training Research Laboratory, explains. “Over the course of the training season, they are getting these adaptions in their physical characteristics, predisposing them to injury.”

Swimmer’s shoulder is a common injury experienced by professional swimmers, affecting both men and women alike. Here we’ll look at why swimmers are more vulnerable to developing shoulder pain and the types of injuries which can occur.

Why are swimmers more vulnerable?

Unlike other sports, swimmers require a high endurance level of the upper extremity. The upper body is responsible for approximately 90% of the propulsive force involved in swimming, with the shoulders absorbing the majority of the pressure.

Shoulder pain and injury typically develops due to a combination of the overuse of the shoulders and leaving little rest time for the muscles to recover. It’s thought that competitive swimmers can swim six to eight miles each day, sometimes up to seven days a week. The constant movement of the muscles and joint, along with the mechanical characteristics involved in swimming, put an enormous amount of pressure onto the shoulders.

The shoulder joint is also particularly prone to instability and it isn’t difficult to see why shoulder injuries are the most common orthopaedic injury reported by competitive swimmers. In a recent review of published literature on musculoskeletal injuries in swimmers, the prevalence of shoulder injuries runs from between 40% and a staggering 91%.

Injuries can occur due to one or a combination of the following:

  • Over training
  • Hypermobility
  • Tightness of the joint
  • Poor technique
  • Fatigue
  • Weakness
  • The use of hand paddles
  • Previous shoulder injury

Professional swimmers therefore, are much more likely to develop shoulder injuries due to the amount of time they spend training.

Majority of swimmers believe mild to moderate shoulder pain is normal

Due to the amount of time swimmers spend in the water, most believe mild to moderate shoulder pain is normal. However, this mindset can prevent the swimmer from seeking help quickly enough when they’ve suffered an injury.

As they don’t recognise that they do have a shoulder injury, many swimmers also try to treat the pain themselves using pain medication. The trouble with this is, as the injury is left untreated, it will become worse the longer it is left undiagnosed. This leads to more time out of the pool and can seriously damage a professional swimmer’s career.

Can swimmer’s shoulder be prevented?

Further research is required to establish which intervention methods would be most effective for swimmers. While you can never completely eliminate the risk of shoulder injury, there are ways you can reduce the risk. These include:

  • Building up the muscles of the shoulder to make the joint more stable and less prone to injury.
  • Always use the correct stroke technique.
  • Ensure you seek a diagnosis quickly if you experience any form of shoulder pain.

What is known is that it is really important to have the injury diagnosed as soon as possible. If you wait before seeking help, it’s likely inflammation will have developed and the pain will be more widespread, making it difficult to make a precise diagnosis. Inflammation masks the symptoms, making it more difficult to pinpoint the exact injury. That’s when a broad ‘swimmer’s shoulder’ diagnosis is made.

Overall, swimmers shoulder is a common injury which plagues professional swimmers. It is vital that proper techniques and training are undertaken to prevent the risk and a fast diagnosis is made if injury does occur.

Snowboarding and the shoulder

Snowboarding shoulder injuriesAs avid snowboarders around the globe gear up for the Snowboarding World Championships later this month, competitors will be balancing injury prevention with maximising performance.

Snowboarding shoulder injuries are a common risk for professional snowboarders due to the way the body is positioned. In skiing, the majority of pressure is placed onto the lower body, as the knees twist and help manoeuvre the skier around the mountain. With snowboarding however, the feet are strapped onto the board, and it’s the upper body that’s largely responsible for manoeuvring around the course. Not only that, but if the snowboarder loses their balance and falls, it’s the upper body that’s going to take the full force of the fall.

Here we’ll look at the most common shoulder injuries in snowboarding and what, if anything, can be done to prevent them.

How common are shoulder related injuries in snowboarding?

It’s estimated that shoulder injuries account for between 8% to 16% of all snowboarding injuries. However, these figures are taken from the ski medical clinic so the actual rate of injury could be much higher as most snowboarders visit their local physician to report any issues. It’s also likely these figures will increase over coming years, as snowboarding is witnessing a boom in popularity, with more people taking up the sport each year.

It’s also interesting to note that beginners have a higher injury risk than the more advanced snowboarders who tend to use much riskier and more difficult manoeuvres. Approximately a quarter of injuries occur during a person’s first experience of snowboarding and that’s because of the increased risk of falls.

What shoulder injuries are most commonly experienced by snowboarders?

So, as a snowboarder which shoulder injuries are you most at risk of developing? The most common include:

Rotator cuff injuries: The rotator cuff is made up of several tendons and muscles surrounding the joint of the shoulder. Helping to keep the shoulder in place, this large group of muscles and tendons is typically the most vulnerable to injury during a snowboarding fall. Rotator cuff injuries vary significantly in severity, with most presenting as a dull ache or severe pain in the affected area.

Gleno-humeral dislocations: While dislocations aren’t as common as rotator cuff injuries, they can occur after a nasty fall. The patient may be unable to move the arm away from its current position and significant pain will usually be felt.

Clavicle fractures: This is a very common shoulder injury, involving the collarbone – one of the main bones within the shoulder. Treatment for this type of injury is usually straightforward, with the arm requiring a sling while the fracture heals. However, in some cases surgery may be required.

Acromioclavicular separations: If you fall directly onto the shoulder, there’s a risk of acromioclavicular separation. This is where the clavicle separates away from the scapula. The majority of the time this type of injury can be treated without surgery, though it depends upon its severity.

So, can these injuries be prevented? Unfortunately, due to the high risk of falls in snowboarding, it’s impossible to completely prevent shoulder injury. However, making sure you use the latest equipment and you use the proper techniques while out on the slopes, will help to reduce your chances of injury.

Overall, most importantly is that you seek help from a shoulder specialist if you suspect you’re developed a snowboarding related shoulder injury. The earlier you get it looked at, the easier it will be to treat.