rugby shoulder injuries

Sidelined by a shoulder injury? Preventing and managing rugby shoulder injuries

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It is inevitable that in the high energy and high contact sport of rugby, the shoulder is prone to injuries. The forces transmitted to your shoulder in rugby can be tremendous, and injuries can be serious.

Although shoulder injuries are less common than head, neck or lower limb injuries in rugby, they tend to be among the more severe. One study found over half of rugby shoulder injuries are severe, often requiring surgery.

Here we look at common rugby shoulder injuries, ways to help prevent them occurring and managing shoulder injury on the sidelines for a confident return to the game.

Common rugby shoulder injuries

The shoulder joint is a unique and complex joint, containing many elements that control stability as well as mobility. The demands of rugby can affect many of these structures, with dislocations and instability causing the most serious injuries and time out of play.

Studies have shown that rugby tackles contribute to circa 70% of rugby injuries – affecting the tackler as well as the ‘tacklee’. The shoulder damage caused will depend on the position of the arm during the tackle. Tackling injuries can include labrum tears, as well as SLAP tears affecting the biceps tendon at the top of the shoulder, or sometimes dislocation.

One study involving English professional Rugby Football Union clubs, found that nearly a third of shoulder injuries are Acromioclavicular Joint Separations (or AC Joint sprains). This normally involves falling onto an outstretched arm, and ranges from mild to severe.

Can you prevent rugby shoulder injuries?

It’s not always possible to prevent a rugby injury. However, a rigorous strength and training programme can help protect the shoulder from avoidable injuries. Although collisions between rugby players will happen, a strong core, a stable trunk as well as neck and shoulder strength can all provide good resistance. It is also worthwhile enhancing your rugby skills and technique with the help of a coach.

It is important to recognise any shoulder weaknesses, possibly caused by previous injuries, as these can lead to future issues. Seeking advice as soon as you experience shoulder pain can help any injury from worsening. If you are not sure, consider a shoulder MOT with a shoulder specialist, to check everything is in working order.

Managing rugby shoulder injuries

Most rugby injuries, including AC Joint sprains will not require surgery, but usually involve rest, anti-inflammatory medication and physical therapy. This will normally be determined by a thorough physical examination by a shoulder specialist with the support of imaging to assess the severity of damage.

If other non-surgical treatments have been unsuccessful, surgery may be offered to repair labral tears, for example a SLAP tear repair. This is performed by keyhole surgery, after which a sling will be worn for up to six weeks. It can take up to 12 months involving physical therapy for a full recovery. For dislocations where there is continuing instability, shoulder surgery may be required to repair torn structures in the joint.

If you have a rugby-related shoulder concern that is preventing you from playing at your best, get in touch with The London Shoulder Specialists to arrange a consultation. To book an appointment, call +44 (0) 203 195 2442.

failed shoulder surgery

What are the Symptoms of a Failed Shoulder Surgery?

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When you undergo a shoulder surgery procedure, it is important to know the risks. By setting goals for what you expect to achieve from the surgery with the help of an experienced surgeon, together you can determine whether the surgery was a success or not.

If non-surgical treatments have not successfully treated your shoulder symptoms, then surgery may be required. Usually, this will be performed by open surgery or by shoulder arthroscopy (keyhole surgery). According to a review, these carry between a 5% and 30% failure rate.

So, what are the main symptoms of a failed shoulder surgery? What are the main causes? And, what happens next? Read on…

Symptoms of a failed shoulder surgery

Symptoms of a failed shoulder surgery will vary by the type of surgery, the individual as well as the surgeon and their technique. Certainly, some swelling and discomfort is to be expected following surgery. However, when symptoms linger on, or if the same symptoms experienced before surgery reappear after full recovery time, they can be an indication of a failed surgery.

Typical symptoms of a failed shoulder surgery can include:

  • Persistent pain in the joint that does not improve with medication
  • Swelling of the joint
  • Reduced mobility around the shoulder
  • Muscle weakness or atrophy
  • Popping, grinding or clicking sounds on moving the joint

Causes of failed shoulder surgery

Normally, the main goals set by a surgeon carrying out shoulder surgery will be to reduce pain and swelling, restore range of movement in the joint, improve strength, and restore function.

According to one study, more than 80% of surgical failures for shoulder instability are associated with bone loss. Also, soft tissue quality and soft tissue lesions can affect the surgery’s success. Additionally, dense scar tissue can cause symptoms, but also new injuries to the shoulder after surgery. Another factor is the experience of the surgeon, as there is always the risk of a technical error.

Revision surgeries carry a higher risk of failure and can lead to more functional complications. However, it can depend how much damage the joint has sustained. In some cases, there is no obvious cause and your surgeon may organise imaging to check the bones and tissues around the shoulder.

Treating failed shoulder surgeries

Procedures may be carried out on the rotator cuff, the labrum or the biceps tendon – that all carry different failure rates, with different treatment options. For example, a severe rotator cuff tear treated by arthroscopic repair requires commitment to a rehab plan that can take up to 12 months.

Failure of tendon healing is common, sometimes due to biological reasons, or inappropriate post-operative rehab. For patients limited by pain, a revision surgery, either keyhole or open surgery may be indicated. In a young person with a repairable lesion, this can lead to improved function of the shoulder. However, the risk of a retear may be high. Alternatively, conservative treatment options may be used to treat failed rotator cuff surgery – particularly when treating poor range of motion.

If you have questions about shoulder surgery, or if you’ve experienced a failed shoulder surgery, get in touch with the London Shoulder Specialists to arrange a consultation. They can carry out a physical assessment and can recommend treatment options tailored to you.

shoulder replacement risks

Higher Surgeon Volume Means Lower Risks for Patients After Shoulder Replacements

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A recent review published in the British Medical Journal indicates that choosing a surgeon for your shoulder replacement who carries out more than 10 surgeries a year can lead to better results.

Shoulder replacement patients treated by surgeons with higher yearly volumes reported lower risk of revision surgeries and serious complications, as well as shorter hospital stays.

Here we look at the research findings, why it comes at such a critical time and the risks associated with a shoulder replacement procedure.

Elective shoulder replacement surgery – the data

There are now over 8,000 shoulder replacements carried out every year in the UK. With an ageing population, this number is expected to rise significantly.

Researchers used data from the UK’s National Joint Registry and Hospital Episode Statistics for England. They reviewed 39,281 shoulder replacement procedures undertaken by 638 consultant surgeons between 2012 and 2020.

Specifically, the team explored the link between surgeon volume and a range of outcomes following shoulder replacement surgery. This included the effect on serious adverse events, reoperations, and prolonged hospital stays (more than three nights). With surgeons performing under 10.4 procedures yearly, patients faced a higher risk of revision surgery – in some cases twice the risk as those surgeons performing over this amount!

This new data, highlighting better outcomes with high volume surgeons, mimics findings from more extensive hip and knee replacements data.

How risky is shoulder replacement surgery?

Shoulder replacement surgery is usually required when there is severe osteoarthritis affecting the shoulder joint. After exploring non-surgical options, surgery is recommended to treat the symptoms of pain, stiffness and loss of mobility, to help improve a patient’s quality of life.

Generally, complications from shoulder surgery are quite rare and will depend on your individual circumstances, medical history and severity of the condition. Sometimes, a new shoulder injury may weaken the supporting muscles or loosen the implant causing pain and stiffness. However, revision surgery may be required when complications do arise.

Questions to ask your shoulder surgeon

As well as asking how many shoulder replacement procedures your surgeon has performed in the last year and their success and revision rates, it is important to ask what potential complications you can expect. It is also important to ask what the alternatives are to having a shoulder replacement and what happens if you don’t have surgery at this time.

To learn more about shoulder replacement surgery, please get in touch to arrange a consultation with the London Shoulder Specialists.

Shoulder bursitis vs arthritis

Shoulder Bursitis vs Arthritis: What’s the Difference?

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Shoulder bursitis and shoulder arthritis are both painful conditions affecting the shoulder joint. Although the symptoms of these conditions can be similar, they affect different structures of the shoulder and have different causes.

Treatments for these conditions depend on the origin, location and severity of symptoms. But as people can mistake the symptoms of bursitis for arthritis, it is important to get a confirmed diagnosis with a shoulder specialist to determine the most effective treatment plan.

Here we look at these two common shoulder conditions and the differences between them.

Shoulder bursitis

Shoulder bursitis is a common cause of shoulder pain, and the most common type of bursitis. It is caused by inflammation of the bursae, the fluid-filled sacs that surround the shoulder joint – normally affecting the subacromial bursae. These cushion the area between the rotator cuff tendons and the acromion, allowing structures like tendons and bones to glide without friction when you lift your arm.

Usually a chronic condition, shoulder bursitis is often accompanied by tendinopathy of the rotator cuff tendons. It is normally an overuse injury, but it can be caused by an accident, infection or pre-existing condition such as diabetes or rheumatoid arthritis.

Overhead activities become difficult to perform with this condition, and pain is typically worse at night. Other symptoms of shoulder bursitis are:

  • pain around the outside or tip of the shoulder
  • tenderness upon touching the shoulder
  • reduced range of movement in the shoulder joint
  • inflammation around the shoulder
  • shoulder pain when the arm is raised

Typical treatment for shoulder bursitis involves rest, icing, anti-inflammatories and physical therapy. Steroid injections into the inflamed bursae can also give some temporary pain relief. Full recovery from bursitis is normally achieved, but if symptoms worsen or don’t improve with treatment then surgery may be recommended to remove the damaged tissue.

How is bursitis different from shoulder arthritis?

Arthritis can occur anywhere in the body, but arthritis of the shoulder occurs at the Glenohumeral (large ball and socket joint) or the smaller acromioclavicular joint. Normally, this is osteoarthritis caused by wear and tear – typically affecting older patients. But there is also rheumatoid arthritis, which is a swelling of the synovium lining.

Shoulder arthritis affects the bones and cartilage but can cause some similar symptoms to shoulder bursitis. These include joint pain, inflammation and shoulder stiffness. Causes of shoulder arthritis differ to bursitis, with predetermining factors including age, excess weight, autoimmune diseases, and genes. However, it can also be caused by an injury or through repeated overhead activities.

The non-surgical treatment options for shoulder arthritis are similar to bursitis and can include ice or heat therapy, pain medication and physical therapy. For advanced osteoarthritis, surgery may be advised in the form of a total shoulder replacement.

To determine the cause of your shoulder pain, get in touch with the London Shoulder Specialists to arrange a consultation. They can carry out a physical assessment and organise imaging tests to identify the affected joint and can recommend treatment options tailored to you.

Menopause and frozen shoulder

The Menopause and Frozen Shoulder

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Frozen shoulder or adhesive capsulitis is a common shoulder condition that causes pain and stiffness in the shoulder joint. The condition mainly affects women over the age of 40, many of whom are experiencing menopause.

Although there is still no definite cause of frozen shoulder, strong links have been drawn with other health conditions. For example, diabetes can increase your risk twofold.

A team of orthopaedics researchers recently explored whether HRT played a role in managing painful shoulder conditions, including frozen shoulder. Read on to discover more about what the latest research revealed.

Link between frozen shoulder and HRT

Frozen shoulder occurs when the ligaments of the shoulder joint become swollen and stiff. There is already a well-established link with diabetes, thought to be because of high blood sugars and impaired circulation, causing tendons and ligaments to stiffen up. But the latest research suggests there could be a link with hormonal fluctuations.

A study in North America looked at the medical records of 2,000 women aged between 45 and 60. It found that 4% of women who had received HRT were diagnosed with frozen shoulder, compared with 8% of women who had not received HRT. However, further research is needed due to the small sample sizes.

Oestrogen contributes to the stimulation of bone growth, reduced inflammation as well as strengthening connective tissue. Women going through menopause experience a significant drop in oestrogen, causing most menopausal symptoms. It is believed that the higher levels of oestrogen in women receiving HRT could explain the lower likelihood of frozen shoulder.

Treating frozen shoulder

A frozen shoulder can improve, slowly, without treatment. Normally things improve within a year although this can take at least 24 months. Treatment is usually required to help minimise the shoulder pain and to free up movement in the shoulder joint.

Treatments for frozen shoulder can include:

  • Anti-inflammatory medication
  • Physical therapy
  • Steroid injections
  • Shoulder manipulation
  • Joint distension

Surgery, another option, will only be discussed after these other treatments have been unsuccessful. This would normally involve keyhole surgery to remove the scar tissue and, occasionally, part of the inflamed capsule from within the shoulder joint (arthroscopic capsular release). This would be followed by a period of physical therapy for the best possible results.

To learn more about frozen shoulder, get a confirmed diagnosis and discuss suitable treatment options, please get in touch to arrange a consultation with the London Shoulder Specialists.

5 types of shoulder arthritis

Understanding the 5 Types of Shoulder Arthritis

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Throughout your life, the shoulder joints are put through continuous wear and tear. Shoulder arthritis is known to be one of the most common conditions of the joint, causing significant pain and discomfort.

There are five different types of shoulder arthritis according to the American Academy of Orthopaedic Surgeons. Here, we look at the different types of arthritis and the symptoms to watch out for.

  1. Osteoarthritis

Caused by the breakdown of cartilage in the joint, shoulder osteoarthritis is one of the most preventative forms of arthritis. More prominent in those aged 50 and over, the condition can worsen if it is left untreated.

As the cartilage breaks down at the end of the bones where they join and form joints, the bone begins to rub together. This leads to pain and stiffness, as well as a loss of mobility. If you have this type of shoulder arthritis, you will notice the pain worsening when you carry out activity.

  1. Rheumatoid arthritis

Commonly affecting both sides of the body, Rheumatoid arthritis is an autoimmune condition. Causing the lining of the joints to swell, it could lead to erosion within the bones of the shoulder, and cause the joints to become deformed over time.

The main symptoms of Rheumatoid arthritis include a warm, tender feeling in the joints, stiffness, the development of Rheumatoid nodules, and fatigue.

  1. Post-traumatic arthritis

Post-traumatic arthritis usually develops after a dislocation or fracture of the shoulder. This typically resolves itself over time, but some patients may find it lasts more than six months. If the condition isn’t treated, eventually the bones could change shape, form bumps, and harden.

The symptoms experienced with post-traumatic arthritis are similar to those experienced with osteoarthritis. They include swelling, pain, stiffness, tenderness, and grinding.

  1. Rotator cuff tear arthropathy

Connecting the top of the arm and the shoulder blade, the rotator cuff consists of a collection of muscles and tendons. If you suffer a common rotator cuff injury, it could lead to a form of arthritis known as rotator cuff tear arthroplasty.

If the tear is large, or it is unable to heal, bone and cartilage damage can occur. If you don’t get it treated, the condition can cause severe pain and weakness within the arm. You will also find it difficult to raise your arm above your head.

  1. Avascular Necrosis

Although it typically occurs in the hip, avascular necrosis is another type of arthritis that can impact the shoulder. If the supply of blood to the bone is disrupted, the bone cells will start to die off. In time, the bone will eventually collapse, causing the surrounding cartilage to become damaged.

Caused by everything from steroid use to traumatic injury, this type of shoulder arthritis can eventually cause severe pain and bone damage.

If you are experiencing pain, stiffness, or weakness in the arm and shoulder, book a consultation with our London Shoulder Specialists today for an accurate diagnosis and treatment plan.

Shoulder decompression surgery

The Benefits of Shoulder Decompression Surgery

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New research has shown that shoulder decompression surgery may help to eliminate shoulder pain caused by shoulder impingement syndrome. Revealed at the American Orthopaedic Society for Sports Medicine annual meeting 2022, the findings suggest shoulder decompression could be beneficial in the treatment of rotator cuff tears.

Here, we look at the findings of the study, and delve into the benefits of shoulder decompression surgery.

Understanding the findings

The latest Canadian two-part study followed a total of 86 patients who were due to undergo a rotator cuff repair. They were split into two groups, with one undergoing the repair with shoulder decompression surgery, and the other without.

After 24 months, a follow up study was carried out, which included 57 of the initial 86 patients. This included 31 patients who didn’t undergo the shoulder decompression surgery, and 25 patients who did.

At the follow up, a clinical assessment, patient-reported outcomes, and the Western Ontario Rotator Cuff score was reviewed. The researchers discovered no real difference between the Western Ontario Rotator Cuff score in both groups. However, both did show a significant improvement compared to their pre-operative scores.

It was discovered that those who underwent shoulder decompression surgery were at a reduced risk of requiring revision surgery.

What is shoulder decompression surgery?

Shoulder decompression surgery is a procedure that aims to relieve shoulder pain caused by shoulder impingement syndrome. Also commonly referred to as Acromioplasty, or subacromial decompression, the surgery removes irritated, swollen soft tissue and bone spurs. This helps to widen the acromial space around the rotator cuff tendons.

The surgery is largely carried out using an arthroscopic method, and it helps to release the pressure from the inflamed rotator cuff. The procedure itself takes around an hour to complete, and it is typically carried out under general anaesthetic.

What are the benefits of shoulder decompression surgery?

As well as reducing the risk of revision surgery, shoulder decompression surgery provides excellent pain relief. Although the latest study reveals little difference between the pain relief experienced in those who do and don’t undergo the surgery, it is shown to be more effective when used.

As the procedure removes the inflamed ligament or bursa, it creates a lot more room within the acromial space. This allows the tendon of the rotator cuff to move around freely, helping to ease any swelling.

Like any keyhole surgery, the recovery for shoulder decompression surgery is faster and less problematic than open surgical methods. If your symptoms have not subsided after trying non-operative methods, shoulder decompression surgery will typically be recommended.

To find out if shoulder decompression surgery could help you to eliminate your shoulder pain, book a consultation with one of our leading shoulder experts today.

AC Joint Arthritis

What is AC Joint Arthritis?

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If you find it difficult to reach your arm across your body and there is pain or tenderness located in the top of the shoulder, it could be a sign of AC joint arthritis.

Shoulder problems can be caused by a wide range of factors and AC joint arthritis is one of them. So, what is it and how do you know if arthritis is the cause of your pain and tenderness? Read on to discover everything you need to know…

What is AC joint arthritis?

Acromioclavicular arthritis (AC joint arthritis) develops at the very top of the shoulder. The AC joint is located where the collar bone meets the top part of the scapula and, like other joints, it can be susceptible to wear and tear.

AC joint arthritis typically refers to progressive joint damage, typically affecting those aged 40 and over. As the cartilage wears away, it causes the ends of the bone to rub together. There is no cure, but there are ways to manage the condition.

What are the symptoms and causes of AC joint arthritis?

Identifying the symptoms of AC joint arthritis can help you to get the treatment you need quickly. However, it is worth pointing out that you may not experience any symptoms at all in the early stages of the condition.

The most common symptoms include:

  • Pain right at the top of the shoulder
  • Pain that worsens when you place your arm across the chest
  • Restricted movement, limiting your ability to carry out daily activities

You may also find that it affects your sleep with the pain worsening at night. So, what causes AC joint arthritis to occur?

In some cases, there is no clear cause. However, for most patients it develops due to overuse of the joint. This makes it a common concern for athletes. Other times, the condition can develop after a direct injury.

Whatever the cause, seeking treatment is important if you want to manage the condition and prevent it from impacting your daily life.

Treating AC joint arthritis

If you are diagnosed with AC joint arthritis, there are treatments that can ease the pain and make it more manageable to live with.

Pain medication can help to control any pain you feel, alongside heat or cold compressions. Physiotherapy is another common treatment option, helping to not only reduce the pain, but improve the patient’s range of motion.

Other treatment options include local anaesthetic and steroid injections, and keyhole surgery. In severe cases, surgery may be required to remove the AC joint. While this will help to stop the pain, it will not necessarily give you back your range of motion.

To find out if you are dealing with AC joint arthritis and the treatment that is best suited to you, call +44 (0) 203 195 2442 to book a consultation with one of our expert surgeons today.

shoulder surgery risks

Shoulder Surgery Risks Are Low but Some Patients Require Further Surgery, New Study Finds

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A new study carried out by the University of Oxford has revealed that shoulder surgery risks are low, but some patients do require additional surgery. Published in the British Medical Journal, the results provide reassurance to those who may be putting off going under the knife through fear of complications.

Here we will look at what the study revealed, and what patients can expect if they need to undergo shoulder surgery.

Just 1.2% of patients experience serious complications from shoulder surgery

The study, which assessed data from 288,250 arthroscopic shoulder procedures carried out from 2009-2017, showed risks of shoulder surgery are low. Just 1.2% of patients went on to develop serious complications such as pneumonia, a pulmonary embolism, heart attack, and death.

Approximately one in every 81 patients is at risk of developing one of these complications within 90 days. This does depend upon the type of procedure carried out, alongside other risk factors. However, it does show that complications are generally quite rare after undergoing shoulder surgery.

The most common complication that arose in the study, was Pneumonia, affecting one in every 303 patients. Pulmonary embolisms were the least common complication, affecting one in every 1428 patients.

One in 26 patients require additional shoulder surgery

The number of patients requiring additional surgery was also low, affecting one in 26 patients. An additional procedure was required either due to complications arising, or because the first operation didn’t work.

Repeat procedures caused by an infection were rare and occurred more frequently in rotator cuff repairs. They are also higher in frozen shoulder release surgery, likely down to its unpredictable nature and a lack of understanding about the condition.

The study didn’t reveal the exact cause of the increased complications. However, it does give surgeons and healthcare professionals a better idea of the risks and safety of shoulder surgery.

Understanding the risks of shoulder surgery

Any patient who requires shoulder surgery should go into the procedure understanding the risks. While they may be low, being aware of the complications gives patients the opportunity to make the most informed decision over their treatment.

Over the course of the study, the number of arthroscopic shoulder procedures increased. There is expected to be a continued rise in the number of procedures carried out each year. With more surgeries being conducted, being aware of the risks is crucial.

Generally speaking, the main risks of shoulder surgery include:

  • Pain
  • Stiffness
  • Bleeding
  • Infection
  • Nerve injury
  • Unsightly scarring

The risks and complications will vary depending upon your individual circumstances, as well as the severity of the condition.

If you are concerned about the risks of shoulder surgery, book a consultation with one of our friendly and knowledgeable surgeons. They will be able to address any fears you may have, and give you a better idea of your personalised risk factors.

younger rugby players at risk of shoulder injuries

Younger Rugby Players at Most Risk of Shoulder Injuries

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A new study carried out on young rugby players has revealed they have an increased risk of getting hurt in the sport. Those who play numbers 1-8 were shown to have a particularly increased risk of injury.

So, why are younger rugby players most at risk of shoulder injuries and what did the study reveal? Discover everything you need to know below.

What the latest study revealed

The latest study was carried out by researchers at the University of Limerick, assessing 15 Irish school boy teams. The results showed that young players were more at risk of shoulder injuries than professionals.

Nearly a quarter of injuries in younger players were sprains and dislocations, followed by head and neck injuries. Forward players were also discovered to be three times more susceptible to suffering a concussion than back players.

This isn’t the first study to highlight the risk of injury for younger rugby players. A previous study carried out by the University of South Africa, revealed that male rugby players aged 12-18 had an increased risk of labral injuries. Back players were found to have an increased risk of bony pathology. Interestingly, the study also showed forward players had a 21% increased risk of injury reoccurrence.

Common rugby shoulder injuries

Rugby is a high-contact sport, which means the risk of injury is quite high. There is a lot of direct physical force and tackles involved, making it incredibly easy to suffer a shoulder injury. So what injuries are most common in young players? Here’s a rundown of some of the most common shoulder injuries young rugby players are at risk of developing. 

Sprains and dislocations: The most common shoulder injuries in rugby are sprains and dislocations. Most sprains impact the acromioclavicular joint, while dislocations largely affected the glenohumeral joint. Players who suffer a fracture followed by a dislocation tend to experience more severe injury, while dislocations resulted in more days away from the sport.

Labral tears: Young rugby players are also susceptible to labral tears. These include Bankart tears, Superior Labrum Anterior to Posterior (SLAP) tears, and posterior shoulder instability. Bankart tears tend to occur in players who dislocate their shoulder, while SLAP tears occur at the top of the glenoid where the biceps tendon attaches.

These are some of the most common shoulder injuries young rugby players experience. The good news is a shoulder injury doesn’t need to end your career. With the right treatment, players can often return to the sport in a matter of months, depending upon the severity of their injury.

Treating shoulder injuries in young rugby players

There are various lines of treatment that can be used to treat shoulder injuries in young players. Most of the time, surgery will not be required. Instead, physical therapy, rest, and over the counter medications to control the pain will be all that is needed. However, in severe cases, surgery may be the only option.

To find out which type of treatment is right for you, book a consultation with one of our shoulder specialists today.