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 injuryAs 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.

Jan Oblak returns to Atletico Madrid after shoulder surgery

London Shoulder Specialist Mr Andrew Wallace was in Madrid at the weekend to watch Jan Oblak play his first game back as goalkeeper for Atletico Madrid only ten weeks after Mr Wallace performed shoulder surgery to repair Oblak’s labrum after a dislocation.

Sadly, they lost against Barcelona 2-1 but Oblak played the full game with no problems and it was fantastic to watch his superb one-handed save against a Messi free-kick, before stopping a goal-bound header from Gerard Piqué just before half-time.

Why your shoulder pain could be linked to an increased risk of heart disease

shoulder pain and heart diseaseA new study carried out by the Utah School of Medicine has established a link between shoulder pain and heart disease.
According to the study, those suffering with shoulder pain may be at an increased risk of heart disease. In particular, rotator cuff issues can indicate a much more serious problem and patients may need more than simple shoulder treatment to address their health.

Study intensifies heart-disease connection

Shoulder pain has already been suspected to be linked to heart disease and this latest study further strengthens the connection. It appears patients who have an increased risk of heart disease are also susceptible to musculoskeletal disorders such as tennis elbow and carpal tunnel syndrome.

Results of the study, published within the Journal of Occupational and Environmental Medicine, showed the more heart disease risks participants had, the more likely they were to suffer problems with the shoulder. This includes conditions such as high cholesterol, high blood pressure and diabetes.

A total of 36 participants experiencing the highest heart disease risk factors were shown to have a 4.6 times increased risk of developing shoulder pain. Interestingly, they were also six times more probable to suffer from a second shoulder problem known as rotator cuff tendinopathy.

Heart disease more likely than physical strain to cause shoulder issues

There are a lot of contributing factors which can lead to the development of shoulder pain. Most commonly reported is physical strain. However, the study included 1226 labourers and results showed a shoulder-straining job did not increase the risk of shoulder injuries in comparison to those with heart disease risk factors.

Of course, that isn’t to say straining jobs don’t accelerate rotator cuff injuries, but what it does show mean is they aren’t the primary cause. In patients who do present with shoulder pain, particularly rotator cuff injuries, cardiovascular health is more likely to play a role in its development.

The data collected by the study now needs to be properly analysed, which lead researcher, Dr Kurt Hegmann estimates will take around five years.

How can heart disease contribute towards shoulder pain?

Currently researchers don’t know for certainty why heart disease links to shoulder pain. However, there is a theory that it could be caused by a decreased blood supply to the shoulder, leading to weakened tendons. This would therefore increase the chances of injury.

Shoulder pain is also associated as a warning sign for a heart attack, most commonly if intense pain is felt suddenly down the left arm. This is caused by a blockage in the arteries, typically brought on by high cholesterol.

Overall, this new study is one of the most in-depth carried out to establish the link between heart disease and shoulder pain. It followed participants for a total of nine years and covered a wide range of risk factors. While it is important to note that it purely points out a link and not a cause and effect between heart disease and shoulder pain, it’s still a factor to be aware of when seeking treatment.

Chris Robshaw to miss Six Nations: Rugby and the shoulder injury

Chris Robshaw rugby shoulder injuriesEngland’s defence of their Six Nations title has got off to a shaky start against France and Wales; as head coach Eddie Jones described it, England have now used up all of their “get-out-of-jail-free cards”. The loss of Chris Robshaw due to a significant shoulder injury requiring surgery meant the England team entered the tournament with over half of the starting pack missing from action.

However, it’s more of a blow for Robshaw who has fought hard to make it into the starting team. He suffered the injury on New Year’s Day in the Aviva Premiership Harlequins’ 24-17 match.

This will be the first Six Nations he has missed for five years. Other players in the team have also been plagued with injury. Joe Marler is recovering from a calf injury, while James Haskell recently returned after a six-month absence caused by a toe injury, only to get knocked out within 35 seconds of being back.

Rugby is renowned for its high-injury risk and shoulder issues account for 20% of all injuries in the sport.

Understanding rugby-related shoulder injuries

Out of all sports, ruby is known to have the highest risk of injury both per player and per hour. Shoulder injuries make up 20% of all rugby-related injuries coming second to knee injuries.

Approximately 35% of rugby shoulder injuries are recurrent, meaning if a player does injure their shoulder they are more than likely to suffer another. These injuries most commonly occur during the tackle manoeuvre.

The risk of developing shoulder injuries in rugby can never be fully eliminated due to the high-contact and rough nature of the sport. However, players can reduce the risk by ensuring the surrounding musculature is well-built up.

The most common rugby-related shoulder injuries include:

  • Labral tears
  • Rotator cuff tears
  • AC joint sprain

Out of the above, labral tears are significantly more common than any other type of shoulder injury in the sport. Surprisingly, the number of full shoulder dislocations are rare in rugby. This is thought to be because of the additional support provided by the built-up muscles around the joint.

Treatment and prevention of rugby shoulder injuries

The majority of rugby shoulder injuries tend to occur at the beginning of each rugby season. This suggests that adequate pre-season training could help to reduce the risk. A proper training program should work on building up the shoulder gradually, intensifying in duration and strength as the season draws nearer.

It’s also important for players to ensure they are using proper technique, particularly when it comes to tackles and defensive skills. However, even with adequate preparation, it may not be possible to prevent injury completely.

Most players who develop what is commonly referred to as rugby shoulder, end up requiring surgery. They are also unable to return to their performance prior to the injury. This shows just how significant a shoulder injury can be to a player’s career.

The key is to seek treatment as soon as a shoulder injury is identified. Pain is typically the main symptom to watch out for. Early detection and treatment can make all of the difference to a player’s career.

Mr Andrew Wallace of Fortius Clinic operates on Atletico Madrid’s Jan Oblak

At the end of 2016, Mr Andrew Wallace of the London Shoulder Specialists successfully operated on Atletico Madrid goalkeeper Jan Oblak after he suffered a dislocation of the left shoulder while making a save during a game against Villarreal in December. Surgery to repair the labrum was successful but Oblak, who also plays for his national team of Slovenia, will now spend up to four months recovering.

Oblak suffered a Bankart tear to the shoulder

Twenty-three-year-old Oblak suffered a Bankart tear which is more common in younger patients. It is an injury to the labrum which occurs after a shoulder dislocation; to provide stability to the shoulder, particularly with its wide range of movement, the shoulder is supported by a cuff of cartilage called the labrum.

When the shoulder is dislocated, the shoulder pops out of its joint and the inferior glenohumeral ligament that composes part of the labrum can become torn. Oblak would have felt sensations of instability, catching and aching in the shoulder and would have likely experienced repeated dislocations in the future.

The club made the following statement after the surgery: “Jan Oblak has undergone a successful operation of the injury he suffered last Monday in the game against Villarreal. The player underwent arthroscopic surgery to the left shoulder to repair the labrum — with a positive result and stabilisation of the shoulder joint.”

Treatment was provided by Mr Andrew Wallace of the Fortius Clinic, a leading sports orthopaedic centre in London.

Balloon arthroplasty for rotator cuff repair

Recent studies have shown that balloon arthroplasty for rotator cuff repair could provide significant improvement in shoulder function.

Rotator cuff repairs can be notoriously painful and in more serious cases are considered irreparable. This leaves patients suffering with long-term functionality issues and often intense pain. In recent years, balloon arthroplasty has emerged as a possible solution for those diagnosed with severe, irreparable rotator cuff tears.

Understanding the balloon arthroplasty procedure

Inspace balloon arthroplastyBalloon arthroplasty is a relatively-new keyhole surgery technique which involves inserting a balloon into the shoulder to replace the irreparable rotator cuff tendon.

Prior to the introduction of this treatment, the only other option for irreparable tears was a procedure known as a reverse total shoulder replacement. This major operation involves completely repositioning the muscles so that the arm can move again, involving a long and painful recovery time. The balloon arthroplasty, on the other hand, is a much less invasive technique with reduced downtime.

Known as InSpace™, the procedure is largely beneficial for elderly patients who currently experience significant shoulder pain. The balloon comes in numerous sizes and is made from biodegradable polymer. The size used will depend upon the subacromial space available.

The balloon is inserted into the subacromial space via an arthroplasty procedure. It is then filled with a saline solution once it is in position. The surgeon then takes the joint through a range of different motions to ensure that the balloon is securely in place and isn’t likely to become dislodged.

As the procedure is performed via keyhole surgery, it can be carried out under local anaesthetic. This means patients can have the procedure and return home the same day.

What are the benefits of balloon arthroplasty?

Although balloon arthroplasty is a new procedure and isn’t yet approved by NICE, it has shown promising results in initial testing. The fact it is a fairly straightforward and non-invasive procedure compared to a reverse total shoulder replacement is a major benefit. It’s a low-risk option for patients who are reluctant to undergo major surgery.

It is worth noting that it isn’t necessarily a permanent solution. The balloon will naturally break down within six to twelve months. This means it can either be used as a temporary solution until the patient undergoes a reverse total shoulder replacement, or a new balloon can be inserted as and when it is required.

As far as scientific evidence goes, due to the infancy of the procedure, very little is known about its exact benefits and effectiveness. Some current scientific papers even suggest physiotherapy could be just as effective at helping to restore a good range of motion. However, that is based on rotator cuff tears which are reparable. It is therefore largely designed to treat irreparable injuries in older patients.

The recovery time is the most notable benefit, with patients requiring the use of a sling for around a week following the procedure. With reverse total shoulder replacement, the recovery takes an average six weeks.

Balloon arthroplasty has shown some promising early results for patients suffering with irreparable rotator cuff tears. However, further studies do need to be carried out to establish just how viable and effective the procedure is.