Shoulder tendonitis

Shoulder Tendonitis: A Detailed Overview

Shoulder tendonitis is a common injury that can occur in sports or occupations involving repetitive overhead work, or overuse of the tendons. Tendons are tough bands of tissue that work with the muscles to fully support the shoulder joint, allowing for a wide range of movement.

What is shoulder tendonitis?

Shoulder tendonitis is a common condition characterised by inflammation or irritation of the tendons in the shoulder joint. When these tendons become inflamed or irritated, it can lead to pain and discomfort in the shoulder.

Improper techniques in sports such as netball, swimming, tennis and golf can overload the shoulder tendon, leading to tendonitis. It can also occur because of a sudden traumatic injury.

What is the difference between shoulder tendonitis and bursitis?

The difference between shoulder tendonitis and bursitis lies in the specific structures affected. Tendonitis involves inflammation of the tendons, while bursitis involves inflammation of the bursa, small sacs filled with fluid that cushion and lubricate the joint.

Both conditions can cause similar symptoms, including pain, swelling, and limited range of motion, but they affect different structures in the shoulder.

What are the different types of shoulder tendonitis?

There are several types of shoulder tendonitis, each affecting different tendons in the shoulder joint. One common type is rotator cuff tendonitis (shoulder impingement), which involves inflammation of the tendons of the rotator cuff muscles. This can occur due to overuse, repetitive movements, or trauma to the shoulder and usually for younger athletes in sports such as tennis or swimming.

Another type is biceps tendonitis, which affects the tendon that attaches the biceps muscle to the shoulder. This can result from overuse, degeneration, or shoulder instability. With this injury, there is pain in the front of the shoulder when lifting the arm over the head.

Supraspinatus tendonitis involves inflammation of the supraspinatus tendon, which can occur due to overuse or impingement of the tendon against the acromion.

Calcific tendonitis can occur when calcium deposits build up in the rotator cuff, resulting in extreme shoulder pain and reduced shoulder mobility. With this condition, if conservative treatments are unsuccessful (anti-inflammatories, physio and/or injections), then ultrasound-guided barbotage may be recommended, where the calcium is extracted with a syringe. After this, you may require surgical excision of the calcium deposits.

What are the symptoms of shoulder tendonitis?

Symptoms of shoulder tendonitis typically include pain, stiffness, swelling, and weakness in the shoulder. The pain is often felt deep within the joint and may worsen with movement, especially overhead activities or reaching behind the back. Stiffness and swelling may also be present, making it difficult to move the arm freely. In some cases, a clicking or popping sensation may be felt when moving the shoulder.

How is shoulder tendonitis diagnosed?

Diagnosing shoulder tendonitis usually involves a combination of medical history, physical examination, and imaging studies. Your London Shoulder Specialist will inquire about the onset, duration, and characteristics of the pain, as well as any precipitating factors or previous injuries.

Physical examination may include assessing shoulder range of motion, strength, and specific tests to evaluate for signs of tendonitis. Imaging studies such as X-rays, ultrasound or MRI are typically used for assessing signs of inflammation and for supporting a diagnosis.

What are the treatment options for shoulder tendonitis?

Treatment options for shoulder tendonitis aim to reduce pain and inflammation, improve shoulder function, and prevent recurrence. Conservative treatments are usually recommended as the first line of treatment and may include rest, activity modification, ice therapy, and physical therapy.

Resting the shoulder and avoiding activities that exacerbate pain can help reduce inflammation and promote healing. Ice therapy can also help alleviate pain and swelling, while physical therapy exercises can strengthen the shoulder muscles and improve range of motion.

In some cases, medications such as nonsteroidal anti-inflammatory drugs (NSAIDs) or steroid injections may be recommended to alleviate pain and inflammation.

When is surgery needed for shoulder tendonitis?

Surgery is usually reserved for cases that do not respond to conservative treatments or for severe tendon damage. Surgical options may include arthroscopic debridement, in which the damaged tissue is removed, or tendon repair, in which the torn tendon is reattached to the bone. Usually, after a full recovery from surgery, there is a full return to sports or activity.

What is recovery like after surgery for shoulder tendonitis?

Recovery after shoulder tendonitis varies depending on the severity of the condition and the effectiveness of treatment. With conservative treatments, most individuals can expect gradual improvement over several weeks to months.

Physical therapy is often a crucial component of recovery, focusing on strengthening the shoulder muscles, improving range of motion, and restoring function. However, it’s important to follow the recommended treatment plan and avoid overdoing activities too soon to prevent reinjury.

Can lifestyle changes help manage shoulder tendonitis?

Lifestyle changes can also help manage shoulder tendonitis and prevent recurrence. Strengthening exercises targeting the shoulder muscles and maintaining a healthy lifestyle with regular exercise and a balanced diet can also support shoulder health and reduce the risk of tendonitis.

By adopting these lifestyle changes and following a comprehensive treatment plan, individuals can effectively manage shoulder tendonitis and improve shoulder function over time.

If you suspect that you may have shoulder tendonitis, speak to your London Shoulder Specialist who can recommend an appropriate treatment plan and ways to effectively manage your condition.

Slap tear treatment

SLAP Tears: A Detailed Overview

A SLAP tear, short for Superior Labrum Anterior to Posterior tear, is a common shoulder injury that affects the labrum, a ring of cartilage that surrounds the shoulder socket. This type of tear can cause significant discomfort and impact shoulder function.

What is a SLAP tear?

A SLAP tear is a specific type of shoulder injury that occurs when the labrum, a rim of cartilage surrounding the shoulder socket, is damaged. The tear typically involves the top portion of the labrum, extending from the front to the back of the shoulder joint. SLAP tears can vary in severity, ranging from minor fraying to complete detachment of the labrum from the bone.

What causes a SLAP tear?

Several factors can contribute to the development of a SLAP tear, including:

  • Trauma: direct impact or trauma to the shoulder joint, such as a fall onto an outstretched arm or a sudden blow to the shoulder.
  • Repetitive overhead movements: athletes involved in sports that require repetitive overhead movements, such as tennis players, weightlifters, or cricket bowlers, are at increased risk of developing SLAP tears due to the repetitive stress placed on the shoulder joint.
  • Degenerative changes: wear and tear over time can lead to degenerative changes in the shoulder joint, weakening the labrum and making it more susceptible to tears.
  • Shoulder instability: individuals with shoulder instability, such as recurrent dislocations or laxity in the shoulder joint, are at higher risk of developing SLAP tears.

What are the symptoms of a SLAP tear?

The symptoms of a SLAP tear can vary depending on the severity of the injury and individual factors. Often, especially in younger athletes, there is a sensation of catching, popping, or grinding within the shoulder joint, typically during throwing movements which can extend into the back of the shoulder.

There can be persistent pain or discomfort in the shoulder, particularly deep within the joint or, when the biceps tendon is involved, at the front of the shoulder – which can be mistaken for rotator cuff tendonitis or shoulder arthritis

In older people, there may be a lack of painful symptoms, but they might have difficulty or experience some discomfort when reaching overhead or behind the back. There may be a feeling of instability or weakness in the shoulder, particularly during certain activities or when lifting objects.

How is a SLAP tear diagnosed?

A SLAP tear can be diagnosed by your London Shoulder Specialist, typically with a comprehensive physical examination, assessing the range of motion. They will talk through your symptoms and medical history including any precipitating factors or previous injuries.

An O’Brien test, or a Crank test, may be performed for detecting a SLAP tear. In some cases, an X-ray or ultrasound imaging may be used to visualise the shoulder joint, although these can be inaccurate for diagnosing a SLAP tear.

What are the treatment options for a SLAP tear?

Treatment for a SLAP tear depends on various factors, including the severity of the tear, symptoms, and individual lifestyle and activity level. In mild cases, the RICE protocol (rest, ice application and compression), along with anti-inflammatory medication can help alleviate pain and reduce swelling. After this, physical therapy is advised to strengthen the surrounding muscles and improve shoulder mechanics.

If conservative treatments do not relieve symptoms, your London Shoulder Specialist may recommend corticosteroid injections into the shoulder joint for alleviating pain and inflammation associated with a SLAP tear, providing temporary relief and enabling the progressions of physical therapy. Only when these measures have been unsuccessful after three to six months, surgery may be recommended.

Is surgery recommended for SLAP tears?

In cases where conservative measures fail to provide relief or for severe tears, surgical intervention may be recommended – especially for individuals with persistent pain, significant functional impairment, or large or complex tears, to restore shoulder stability and function. Surgical options include arthroscopic repair (keyhole surgery) of the labrum, called a ‘Slap Tear Repair’, where the torn tissue is reattached to the bone using sutures.

Sometimes, the long head of the biceps tendon is treated by cutting it off the labrum in a tenotomy, and then securing it to a different bone (tenodesis).

What is recovery like after a SLAP tear?

Recovery after a SLAP tear varies depending on the type and extent of the tear, the age and medical history of the patients, as well as the surgical approach used.

After surgery, the shoulder may be immobilised with a sling for four to six weeks to protect the repair and allow healing. Physical therapy is a crucial component of recovery, focusing on regaining shoulder strength, flexibility, and range of motion.

As healing progresses, individuals will gradually return to activities and sports, following a structured rehabilitation program. A full recovery can take between six and twelve months.

Can lifestyle changes help manage a SLAP tear?

Avoiding activities that exacerbate shoulder pain or put stress on the injured shoulder can help prevent further injury and promote healing.

Maintaining good posture and engaging in regular strength training exercises, particularly targeting the muscles around the shoulder joint, can help reduce strain, promote proper shoulder mechanics and improve shoulder stability.

A SLAP tear can be diagnosed by your London Shoulder Specialist who can recommend an appropriate treatment plan and ways to effectively manage your condition.

clavicle fracture

Clavicle Fractures: A Detailed Overview

A clavicle fracture, also known as a broken collarbone, is a common injury that can occur due to a blow to the shoulder or a fall onto the shoulder. It is more likely to occur when a fall occurs on a hard surface. This type of fracture can cause significant discomfort and hinder shoulder function.

What is a clavicle fracture?

This refers to a break or crack in the collarbone, which is the long bone located between the shoulder blade (scapula) and the breastbone (sternum). Clavicle fractures are one of the most commonly occurring fractures, typically resulting from trauma or direct impact to the shoulder area.

What causes a clavicle fracture?

They usually occur due to direct blows to the shoulder area, such as during falls, sports injuries, or motor vehicle accidents. Athletes participating in contact sports or activities with a high risk of falls, such as cycling, skiing or martial arts, are more susceptible to clavicle fractures.

Weakening of the bones due to osteoporosis can increase the risk of fractures, including fractures of the clavicle.

What are the symptoms?

The symptoms may include persistent pain, swelling and bruising at the fracture site, particularly when moving or raising the arm. Lifting objects overhead can be difficult and painful to perform.

A visible deformity or bump may be present at the site of the fracture, indicating displacement of the bone fragments. Occasionally, there may be numbness or tingling in the arm, when the fracture has compressed blood vessels and nerves.

How is it diagnosed?

Diagnosing a clavicle fracture typically involves a combination of medical history, a thorough physical examination, and imaging studies.

X-ray imaging or MRI scanning is the most commonly used diagnostic tool to confirm the presence of a clavicle fracture and determine the extent of the injury. Then, your London Shoulder Specialist can advise on either non-surgical or surgical treatments.

What are the treatment options?

Treatment depends on various factors, including the severity of the fracture, age, activity level, and overall health of the patient. The goal is to ensure that the broken bone has the best chance of healing, and that it heals in the proper position to restore full functioning of the arm.

For non-displaced or minimally displaced fractures, wearing a sling or arm brace for a couple of weeks may be sufficient to allow the bone to heal properly without the need for surgery. Also, over-the-counter pain relievers, such as ibuprofen, may be recommended to alleviate pain and inflammation. A fracture will usually take six to eight weeks to fully heal and normal function will return. However, if the ends of the fractured bone have shifted out of position, then surgery will be recommended.

When is surgery needed?

Surgery is not always necessary, especially for non-displaced or minimally displaced fractures that can be effectively managed with conservative treatments. However, it will be recommended in fractures with a large separation, compound or open fractures, when there is blood vessel or nerve damage, when healing hasn’t been successful after three to six months, or when there are overlapping broken ends of the bone (shortened clavicle).

Surgery involves a small incision on the top of the collarbone and the insertion of a metal plate and screws to maintain the proper position. Usually, these are left in the bone, but they can be removed later on after healing.

Are there any risks of clavicle fracture surgery?

Your individual suitability for clavicle fracture surgery along with any risks will be discussed with you in your consultation with your London Shoulder Specialist. There are some risks of clavicle fracture surgery which include difficulty in bone healing, lung injury and irritation caused by the plates, screws or pins required to hold the bones in the correct position.

A full recovery and return to activity/sport after clavicle fracture surgery will normally take up to 12 weeks. Your specialist will provide a strengthening exercise programme in this period.

A clavicle fracture is a common injury that can result from a trauma to the shoulder. By seeking prompt medical attention, and seeking guidance from a shoulder injury specialist, individuals can achieve successful healing and restore shoulder function.

If you suspect that you may have a clavicle fracture, speak to your London Shoulder Specialist who can recommend an appropriate treatment plan and ways to effectively manage your condition.

Subacromial Shoulder Pain

Subacromial Shoulder Pain: A Detailed Overview

Subacromial shoulder pain is a common condition that can significantly affect an individual’s quality of life. It is often associated with impingement of structures in the subacromial space of the shoulder joint.

What is subacromial shoulder pain?

Subacromial shoulder pain refers to discomfort or pain experienced in the space above the ball and socket joint (glenohumeral) and below the acromion process of the scapula (shoulder blade). It is often attributed to impingement of the tendons of the rotator cuff and the subacromial bursa against the acromion and coracoacromial ligament during shoulder movement.

What are the causes?

This shoulder condition can be caused by various factors, but most commonly is due to rotator cuff impingement or rotator cuff tendinopathy (shoulder impingement). This is usually due to repetitive overhead activities or shoulder movements that lead to compression and irritation of the rotator cuff tendons within the subacromial space.

Alternatively, it can be due to shoulder arthritis, calcific tendonitis or subacromial bursitis. Sometimes, bone spurs on the under surface of the acromion can narrow the subacromial space, leading to impingement and pain.

What are the symptoms?

This condition typically presents as persistent pain in the shoulder and upper arm that can spread further down the arm to the elbow and into the neck, especially during overhead activities or reaching behind the back. There is difficulty moving the shoulder, particularly when lifting the arm or rotating it outward and pain worsens at night, particularly when lying on the affected shoulder.

How is subacromial shoulder pain diagnosed?

Subacromial shoulder pain can be diagnosed by your London Shoulder Specialist, typically with a comprehensive physical examination, assessing the range of motion. They will talk through your symptoms and medical history including any precipitating factors or previous injuries.

X-rays are commonly used to visualise the structures within the shoulder joint, assessing any abnormalities or signs of impingement. In more complex cases, magnetic resonance imaging (MRI) scans may be performed. Then, they can advise on either non-surgical or surgical treatments.

What are the treatment options?

Treatment aims to alleviate pain, improve shoulder function, and address any underlying causes. In mild cases, the RICE protocol (rest, ice application and compression), along with anti-inflammatory medication can help alleviate pain and reduce swelling. After this, physical therapy is advised with an exercise plan for restoring strength, stability, and range of motion in the affected shoulder.

UK guidelines recommend ultrasound guided injection to manage pain by reducing pain and improving function, performed alongside physiotherapy. These injections should work within three to five days and should relieve pain for several weeks or months or permanently when combined with physiotherapy. The number of injections that can be done is limited. If there is a rotator cuff tear, then a rotator cuff tear surgery may be required.

Is surgery always necessary?

Surgery is not always necessary, especially in the early stages or when conservative treatments are effective. However, if symptoms persist despite treatment, surgical intervention may be considered. Common surgical procedures for subacromial shoulder pain include subacromial decompression and rotator cuff repair.

Can subacromial shoulder pain be prevented?

While it may not be entirely preventable, certain measures can help reduce the risk of developing subacromial shoulder pain:

Proper lifting techniques during activities can help minimise strain on the shoulder joint. Also, gradually increase the intensity and duration of activities to allow the shoulder joint to adapt and strengthen over time.

Also, maintaining good posture, including keeping the shoulders back and down, to reduce stress on the shoulder joint and prevent impingement.

Can lifestyle changes help?

Adopting certain lifestyle changes can help manage subacromial shoulder pain and improve shoulder health. Engaging in regular shoulder-strengthening exercises and flexibility routines can help to improve shoulder mechanics and reduce the risk of impingement.

Subacromial shoulder pain can be diagnosed by your London Shoulder Specialist who can recommend an appropriate treatment plan and ways to effectively manage your condition.

ACJ Separation

ACJ Separation: A Detailed Overview

Acromioclavicular (AC) joint separation is a common injury that affects the shoulder region, often resulting from trauma or direct impact to the shoulder. This condition, often mistaken for shoulder dislocation, can range from mild discomfort to severe pain and instability that hinders daily activities.

In this detailed overview, we will explore what ACJ separation is, its causes, symptoms, diagnosis, and various treatment options, including whether surgery is always necessary.

What is ACJ separation?

The acromioclavicular joint is located at the top of the shoulder, where the clavicle (collarbone) meets the acromion (a bony prominence of the shoulder blade). AC joint separation occurs when the ligaments supporting this joint are damaged or torn due to a sudden jolt or impact. This can lead to a noticeable gap or displacement between the clavicle and acromion, resulting in pain and instability.

What causes ACJ separation?

AC joint separation is commonly caused by a traumatic event, such as a fall onto an outstretched arm, or a direct blow to the area. Sports-related injuries, especially in sports such as football, cycling, snowboarding or skiing, increase the risk of ACJ separation. The tearing of ligaments responsible for stabilising the AC joint can vary in severity, leading to different grades of separation.

What are the symptoms of ACJ separation?

The symptoms of ACJ separation can range from mild to severe, depending on the extent of ligament damage. Common signs include:

  • Pain: Persistent pain around the AC joint, particularly during shoulder movement or when pressure is applied to the area.
  • Swelling: Swelling and tenderness over the AC joint due to inflammation caused by the injury.
  • Prominent collar bone: In more severe cases (Grade 3-5 injury), the ligaments that hold down the clavicle may rupture and a noticeable bump or deformity may be visible at the top of the shoulder.
  • Limited range of motion: Difficulty or pain while moving the shoulder, especially when reaching overhead or across the body.
  • Instability: A feeling of instability or weakness in the shoulder, making daily activities challenging.

How is ACJ separation diagnosed?

X-rays are commonly used to visualise the AC joint and surrounding structures, helping determine the severity of separation. In more complex cases, magnetic resonance imaging (MRI) scans may be performed to provide detailed images of ligament damage and joint displacement. Then, your Specialist can advise on either non-surgical or surgical treatments.

What are the treatment options for ACJ separation?

The treatment approach for ACJ separation depends on the severity of the injury. In mild cases, the RICE protocol (rest, ice application and compression), along with anti-inflammatory medication can help alleviate pain and reduce swelling. Immobilising the shoulder with a sling or brace may also be recommended for aiding the healing process.

Physical therapy with carefully prescribed rehabilitation exercises is crucial for restoring strength, stability, and range of motion in the affected shoulder.

If your London Shoulder Specialist diagnoses a more severe injury (Grade 3 or above), then surgery will be recommended, especially for those in heavy manual jobs or high-performance overhead athletes.

Is surgery always necessary for ACJ separation?

Surgery is not always necessary for ACJ separation, especially in mild to moderate cases. Conservative treatments, including rest, physiotherapy, and pain management, are often effective in promoting healing and restoring function. However, in severe cases with significant ligament damage or persistent instability, surgical intervention may be recommended to realign and stabilise the joint.

Usually, surgery will involve an incision on top of the shoulder, and the joint is put back into its correct position, sometimes using an implant to hold it together while the ligaments heal and any damage to the end of the collar bone may be tidied up. It will take around 12 – 16 weeks for a full recovery and return to activity/sports, with a plan of physical therapy during that time. If surgery is not chosen immediately, there may be an opportunity to have it at a later time.

Can ACJ separation be prevented?

While it may not be entirely preventable, certain measures can reduce the risk of ACJ separation. Athletes participating in contact sports should use appropriate protective gear, such as shoulder pads or braces, to minimise the impact on the shoulder.

Building and maintaining shoulder strength through targeted exercises can enhance joint stability and reduce the risk of injury. Also, ensuring proper technique during sports and activities can help avoid unnecessary stress on the shoulder joint.

Can lifestyle changes help manage ACJ separation?

Adopting preventive measures and lifestyle changes can further reduce the risk of ACJ separation and promote long-term shoulder health. Excess body weight can strain the shoulder joints, making them more susceptible to injuries. Maintaining a healthy weight reduces this risk as well as engaging in regular, low-impact exercises to strengthen the muscles surrounding the shoulder joint.

ACJ separation can be diagnosed by your London Shoulder Specialist who can recommend an appropriate treatment plan and ways to effectively manage your condition.

Guide to shoulder bursitis

Shoulder Bursitis: A Detailed Overview

Shoulder bursitis is a common shoulder condition that affects the small, fluid-filled sacs known as bursae, located near the shoulder joints. These bursae play a crucial role in reducing friction between bones, tendons, and muscles, facilitating smooth movement.

When these sacs become inflamed, it results in shoulder bursitis, causing pain and discomfort. In this detailed overview, we will explore the causes, symptoms, diagnosis, treatment options, prevention strategies, and the role of lifestyle changes in managing shoulder bursitis.

What is shoulder bursitis?

Shoulder bursitis, also referred to as subacromial bursitis, occurs when the bursae in the shoulder become irritated and inflamed. The shoulder has several bursae, but the subacromial bursa is the most commonly affected. This bursa is situated between the rotator cuff tendons and the acromion, the bone at the top of the shoulder.

What causes shoulder bursitis?

Several factors can contribute to the development of shoulder bursitis. Repetitive overhead movements, such as those seen in certain sports or occupations, can lead to irritation and inflammation. Trauma or injury to the shoulder, underlying conditions like rheumatoid arthritis, and bacterial infections are also potential causes. Additionally, age-related changes in the shoulder joint may increase the risk of bursitis.

What are the symptoms of shoulder bursitis?

The hallmark symptom of shoulder bursitis is pain, which is often felt on the outer side of the shoulder. This pain may intensify with specific movements, such as lifting the arm overhead. Swelling and tenderness around the affected area, as well as restricted range of motion, are also common symptoms. In some cases, individuals may experience aching or stiffness, making everyday activities challenging.

How is shoulder arthritis bursitis diagnosed?

Diagnosing shoulder bursitis typically involves a thorough examination by your London Shoulder Specialist. During your consultation they will discuss your symptoms, perform a physical examination, and order imaging tests such as X-rays or MRI scans to rule out other potential causes of shoulder pain. Fluid may also be extracted from the bursa for analysis to confirm the diagnosis.

What are the treatment options for shoulder bursitis?

Treatment for shoulder bursitis aims to reduce inflammation, alleviate pain, and improve shoulder function. Conservative approaches include rest, ice therapy, nonsteroidal anti-inflammatory drugs (NSAIDs), and physical therapy. Corticosteroid injections may be recommended for more severe cases to provide targeted relief. Modifying activities to prevent further irritation may be recommended.

Can shoulder bursitis be prevented?

While it may not be possible to prevent shoulder bursitis entirely, there are steps individuals can take to minimise their risk. Proper warm-up exercises before engaging in repetitive overhead activities, maintaining good posture, and incorporating shoulder-strengthening exercises into a regular fitness routine can help reduce the likelihood of developing bursitis.

Is surgery always necessary for shoulder bursitis?

Surgery is typically considered a last resort for shoulder bursitis and is reserved for cases that do not respond to conservative treatments. Surgical interventions may involve removing the inflamed bursa or addressing underlying issues such as bone spurs. Most individuals find relief with non-surgical methods, and surgery is only recommended when other options have been exhausted.

Understanding shoulder bursitis involves recognising its causes, symptoms, and available treatments. While surgery is not always necessary, conservative measures including lifestyle modifications can significantly contribute to managing and preventing shoulder bursitis.

Guide to shoulder labral tear

Shoulder Labral Tear: A Detailed Overview

Shoulder labral tears can be a painful and debilitating condition that affects the stability and functionality of the shoulder joint. Whether you’re an athlete, someone involved in repetitive overhead activities, or you have experienced a direct blow to the shoulder, understanding the causes, symptoms, diagnosis, and treatment options for a shoulder labral tear is crucial for managing and recovering from this injury.

What is a shoulder labral tear?

The shoulder labrum is a ring of cartilage that surrounds the socket of the shoulder joint. A shoulder labral tear occurs when this cartilage is damaged or torn, compromising the stability of the shoulder, and potentially leading to pain and limited range of motion.

What are the causes of a shoulder labral tear?

Several factors contribute to shoulder labral tears. Trauma, such as a dislocated shoulder or a fall onto an outstretched arm, can cause an acute tear. Chronic overuse, common in athletes involved in overhead sports like baseball or swimming, can lead to gradual wear and tear of the labrum. Additionally, repetitive motions, such as lifting heavy objects or participating in weightlifting, may contribute to the development of a labral tear over time.

What are the symptoms of a shoulder labral tear?

The symptoms of a shoulder labral tear can vary but often include:

  • Persistent shoulder pain, especially during specific movements
  • A feeling of instability in the shoulder
  • Clicking or popping sensations during shoulder movements
  • Limited range of motion
  • Weakness in the affected shoulder

How is a shoulder labral tear diagnosed?

To accurately diagnose a shoulder labral tear, your London Shoulder Specialist will typically conduct a thorough physical examination and may order imaging tests such as MRI or arthroscopy. These tests help visualise the extent of the tear and determine the most appropriate course of treatment.

What are my treatment options for a shoulder labral tear?

The treatment for a shoulder labral tear depends on the severity of the injury. Conservative approaches include rest, physical therapy, and anti-inflammatory medications to reduce pain and inflammation. In more severe cases, especially when conservative methods fail, surgical intervention may be recommended to repair or reconstruct the torn labrum.

Can a shoulder labral tear be prevented?

While not all shoulder labral tears are preventable, individuals can take steps to minimise their risk. Strengthening the shoulder muscles through targeted exercises, maintaining proper posture, and avoiding overuse or repetitive movements can contribute to shoulder joint health.

Is surgery always necessary?

Surgery is not always the first line of treatment for a shoulder labral tear. Many cases respond well to conservative measures such as physical therapy and rest. However, in cases where conservative methods fail to provide relief or in severe injuries, surgical intervention may be necessary to restore shoulder stability and function.

What is the downtime like after shoulder labral tear surgery?

Recovery time after shoulder labral tear surgery varies based on the severity of the tear and the specific surgical procedure performed. Rehabilitation, including physical therapy and a gradual return to normal activities, is crucial for a successful recovery. Full recovery may take several months, and adherence to the rehabilitation plan is essential.

When should I see a shoulder specialist?

If you experience persistent shoulder pain, instability, or limitations in shoulder movement, it is advisable to consult with a healthcare professional, preferably a shoulder specialist. Early diagnosis and intervention can prevent further damage and improve the chances of successful treatment.

Shoulder labral tears can significantly impact daily life and activities. Understanding the causes, symptoms, and treatment options is crucial for effectively managing and recovering from this condition. Whether through conservative measures or surgical intervention, seeking timely medical attention and adhering to a comprehensive rehabilitation plan can make a significant difference in restoring shoulder function and improving overall quality of life.

shoulder instability guide

Shoulder Instability: A Detailed Overview

Shoulder instability is when the structures around the shoulder joint fail to effectively keep the ball of the shoulder tightly in its socket. This can be a short-term or a chronic condition that can be caused by strenuous activities, such as in overhead sports, or following a shoulder injury. Some people can be more prone to shoulder instability because of their genetics. When left untreated, shoulder instability can lead to other conditions such as shoulder arthritis.

What is shoulder instability?

Shoulder instability can occur when the tissues around the shoulder, that may involve cartilage, ligaments, labrum or the capsule of the joint, are injured, torn or overstressed, causing the shoulder joint to become unstable. This results in the joint moving more than it should and can sometimes result in a labral tear or a total dislocation.

What causes shoulder instability?

There are different causes of shoulder instability, which fall into three broad categories. A traumatic dislocation, typically caused by a direct, forceful injury can tear the labrum around the shoulder socket. Usually, a sling is worn for a period of time and then physio undertaken, but the shoulder can remain unstable.

Anterior shoulder instability is the most common type, often affecting overhead athletes as a result of excessive abduction and rotation. Sometimes, joint laxity or hyperextension of the shoulder can cause multidirectional instability to occur, with very little force causing a shoulder dislocation. Posterior instability is less common, and can occur after athletic trauma. Non-traumatic dislocation can sometimes occur, affecting one or both shoulders, normally when performing a movement such as overhead lifting.

What are the symptoms of shoulder instability?

The symptoms of shoulder instability can vary by individual but can cause pain, or an ache that comes on during certain movements or after activity. Often there is a sensation that the shoulder may be about to shift out of place. Sometimes, there can be a loss of power or feeling of weakness during activity, such as overhead movement, or a clicking or popping sensation can be felt.

How is shoulder instability diagnosed?

Shoulder instability can be diagnosed by your London Shoulder Specialist based on your symptoms, medical history and any recent traumatic injury along with a physical examination and diagnostic tests. After a traumatic injury such as a hard fall or sports injury, if a fracture is suspected then X-rays can be organised to check the bones that make up the shoulder joint. MRI scans can be ordered to check damage to the surrounding ligaments and tendons as well as the surrounding labrum.

Can shoulder instability be treated without surgery?

There are several non-surgical treatment options for shoulder instability that will depend upon the severity of the condition as well as the age of the patient. For patients that have never had a shoulder dislocation, physical therapies can give the best results. Anti-inflammatory medications including steroid injections can help with addressing shoulder pain. However, if there is little improvement with non-surgical treatments, then surgery may be the only alternative option. As with any painful shoulder condition, the earlier a diagnosis can be performed, the easier it will be to manage and treat.

What surgical options are available for shoulder instability?

When all conservative methods of treating shoulder instability have been exhausted, then surgery may be recommended. Also, when the shoulder has become dislocated, or with repeated dislocations, surgical intervention may be required for treating the shoulder.

Depending on the underlying cause, an open or arthroscopic procedure may be recommended. Open surgery may be recommended for severe instability. For positional non-traumatic dislocations involving an abnormal muscle movement, thermal capsular shrinkage or plication may be recommended to help stabilise the shoulder and to prevent further dislocations.

What is the recovery time after shoulder instability surgery?

After surgery for shoulder instability, recovery time can depend on the severity of the condition and which procedure was performed. The hand, wrist and elbow range of motion can be restored as soon as the day following surgery. Activities such as writing and eating on the affected side may be resumed a week after surgery. A tailored physical therapy plan will usually start between one to four weeks after surgery to restore strength and range of movement. A full recovery is expected within three to six months.

Can shoulder instability recur after surgery?

With surgery, the risk of shoulder instability recurrence is low (between 5 and 10 per cent) and most people can return to their previous activities. However, with young patients, after a shoulder dislocation, it is more likely that they will have recurring issues of instability.

Can shoulder instability be prevented?

Shoulder instability can be successfully managed with shoulder strength exercises to build up the shoulder muscle. It is also recommended to limit excessive stretching and to maintain good core strength.

If you are experiencing shoulder pain, or are finding it harder to perform certain overhead activities or sports, seek a confirmed diagnosis and tailored treatment plan from your London Shoulder Specialist.

Shoulder arthritis guide

Shoulder Arthritis: A Detailed Overview

According to the Arthritis Foundation, it is estimated that nearly one third of adults aged over 60 have some degree of shoulder osteoarthritis. Usually, shoulder arthritis is a chronic, degenerative disease causing pain, discomfort and affecting quality of life. Although arthritis cannot be cured, with the right treatment plan it can be managed effectively.

What is shoulder arthritis?

Shoulder arthritis is a condition involving damage to the cartilage in the shoulder joint, resulting in inflammation, stiffness and reduced range of motion. Usually, shoulder arthritis occurs in the larger glenohumeral joint, affecting the cartilage covering the ball (the humeral head) and the socket (the glenoid). Sometimes, it can impact the acromioclavicular, more commonly known as the AC joint.

Osteoarthritis is the most common form of shoulder arthritis, but there are four other types of shoulder arthritis; rheumatoid arthritis, post-traumatic arthritis, rotator cuff tear arthropathy and avascular necrosis.

What causes shoulder arthritis?

There are different causes of shoulder arthritis, depending on the type.

  • Shoulder osteoarthritis – a degenerative disease caused by wear and tear of the joint with ageing.
  • Rheumatoid shoulder arthritis – an autoimmune disorder that affects the synovial membrane of the shoulder.
  • Post-traumatic arthritis – following an injury, usually a shoulder fracture or dislocation.
  • Rotator cuff tear arthropathy – after a significant and long-term rotator cuff tear.
  • Avascular necrosis – caused by disease or an injury/trauma that affects the blood supply to the shoulder joint.

What are the symptoms of shoulder arthritis?

The symptoms of shoulder arthritis can vary by person, and depend on the amount of cartilage loss. Common signs include shoulder pain, usually upon movement when lifting, carrying heavy objects, or exercising. Sometimes, there can be pain without movement.

Pain can radiate along the arm, and can be felt in the elbow and wrist. With arthritis of the AC joint, pain is centred at the top of the shoulder and can travel up the neck.

Shoulder stiffness with loss of range of movement is another common symptom, limiting what activities can be comfortably done. Sometimes, clicking, grinding or cracking can be felt in the affected joint, or it can ‘lock up’.

How is shoulder arthritis diagnosed?

Shoulder arthritis can be diagnosed by your London Shoulder Specialist, typically with a thorough physical examination and talking through your symptoms and medical history. They will evaluate the range of movement, strength, and stability of the shoulder. Imaging tests such as MRI or ultrasound may be needed to confirm a diagnosis.

What are the treatment options for shoulder arthritis?

Treatment options for shoulder arthritis to relieve symptoms will typically begin with non-surgical methods. This may start with a range of motion exercises and stretches to help with shoulder mobility. Pain relief treatment can be offered in the form of hot or cold therapies, anti-inflammatory medications or pain-relieving steroid injections.

For more severe tears, surgical intervention may be recommended.

Is surgery always necessary for shoulder arthritis?

With cartilage damage varying by individual with arthritis, treatment options will be offered on a case by case basis, and sometimes one or more treatments may be suitable. When non-surgical treatments are not effectively managing shoulder arthritis, surgery may be needed. Surgical treatment will depend on the type of arthritis, age and the degree of arthritis. It will also be focussed on the type of activity or sport being returned to. Surgery will focus on cleaning up the surface of the joint with debridement, but in more severe cases a shoulder replacement may be required.

What is shoulder joint replacement surgery?

In a total shoulder joint replacement surgery for treating severe cases of arthritis, the humeral head at the top of the arm is replaced with a metal ball and the shoulder blade is replaced with a plastic socket. These are both fixed into place with bone cement.

A reverse joint replacement is where the position of the ball and socket is reversed to compensate for a weakened rotator cuff.

What is the recovery time after shoulder joint replacement surgery?

Immediately after shoulder joint replacement surgery the focus is on pain relief and reducing any swelling. Physical therapy will begin within a few days of surgery, involving a gradual progression of exercises to restore strength and flexibility.

It will take at least six weeks before patients regain full function, and adherence to post-operative care instructions is critical for a successful recovery. Any vigorous exercises and contact sports should be avoided for a year after surgery.

Can shoulder arthritis be prevented?

While shoulder arthritis cannot be fully prevented, there are effective ways to manage the condition. However, with different shoulder conditions causing shoulder pain, it is always best to get a confirmed diagnosis first and for a tailored treatment plan. Specific exercises can be recommended by a physio to help build up muscle for shoulder strength, to keep the joint moving and to help avoid an injury.

Can lifestyle changes help manage shoulder arthritis?

There are several different non-surgical treatment options for reducing pain and improving movement with shoulder arthritis. Simple lifestyle changes such as adjusting diet and exercises for improving strength, flexibility and range of motion of the shoulder joint can go a long way to help manage the condition. If joint replacement surgery is recommended, then lifestyle changes will also ensure better results after the procedure.

Shoulder arthritis can be diagnosed by your London Shoulder Specialist who can recommend an appropriate treatment plan and ways to effectively manage your condition.

Guide to shoulder impingement

Shoulder Impingement: A Detailed Overview

Shoulder impingement is a common shoulder condition that occurs when the rotator cuff tendons are compressed and irritated, leading to pain and limited range of motion. In this comprehensive overview, we will explore the various aspects of shoulder impingement, including its causes, symptoms, diagnosis, treatment options, prevention, recovery, recurrence, and when to seek the expertise of a London Shoulder Specialist.

What is shoulder impingement?

Shoulder impingement occurs when the space between the acromion, a bony projection of the shoulder blade, and the rotator cuff tendons narrows, causing friction and irritation during the normal range of shoulder movement. This can lead to inflammation and pain in the affected area.

What causes shoulder impingement?

Several factors contribute to the development of shoulder impingement. Common causes include repetitive overhead activities, such as weightlifting or swimming, which may lead to gradual wear and tear on the rotator cuff tendons. Anatomical factors, such as the shape of the acromion or the presence of bone spurs, can also increase the risk of impingement.

What are the symptoms of shoulder impingement?

Individuals with shoulder impingement may experience symptoms such as pain, particularly when lifting the arm, reaching overhead, or during sleep. Weakness and a gradual loss of shoulder mobility are also common indicators of impingement.

How is shoulder impingement diagnosed?

Diagnosing shoulder impingement involves a thorough examination by a shoulder specialist. This may include a physical examination, imaging studies such as X-rays or MRI scans, and a review of your medical history. Identifying the specific cause and severity of impingement is critical for developing an effective treatment plan.

What are the treatment options for shoulder impingement?

Treatment for shoulder impingement varies based on the severity of the condition. Conservative measures often include rest, ice, anti-inflammatory medications, and physical therapy to strengthen the rotator cuff muscles and improve shoulder mechanics. In more severe cases, corticosteroid injections may be recommended to reduce inflammation and alleviate pain.

Is surgery always necessary for shoulder impingement?

Surgery is not always necessary for shoulder impingement and is typically considered when conservative treatments fail to provide relief. Arthroscopic procedures can be performed to address structural issues, remove bone spurs, or repair damaged tendons. However, the decision for surgery should be carefully evaluated and discussed with an experienced shoulder surgeon.

Can shoulder impingement be prevented?

Preventing shoulder impingement involves maintaining good shoulder health through regular exercise, proper technique during physical activities, and avoiding overuse of the shoulder joint. Strengthening the muscles surrounding the shoulder, particularly the rotator cuff, can provide added stability and reduce the risk of/ impingement.

How long does it take to recover from shoulder impingement?

The recovery time for shoulder impingement varies depending on the chosen treatment and the individual’s response. With conservative measures, many people experience improvement within a few weeks. Following surgery, rehabilitation is essential, and full recovery may take several months. It’s crucial to adhere to the prescribed rehabilitation plan to minimise the risk of recurrence.

When should I see a shoulder specialist for shoulder pain?

If you experience persistent shoulder pain, limited mobility, or if symptoms worsen despite conservative treatments, it is advisable to consult a shoulder specialist. Additionally, individuals involved in activities that repeatedly stress the shoulder joint should seek professional advice to prevent the development of shoulder impingement.

Shoulder impingement is a common yet manageable condition that can still significantly impact daily life. Understanding its causes, symptoms, and treatment options empowers individuals to make informed decisions about their shoulder health. Whether through conservative measures or surgical intervention, seeking timely medical attention is essential for effective management and long-term shoulder function.