Shoulder Pain

Shoulder Pain Indicated as Among Most Persistent in New Pain Mapping Study

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A new body-mapping study has revealed shoulder pain is one of the most persistent types of chronic pain. The study identified nine distinct types of chronic pain to aid in the diagnosis and treatment process for patients.

Here, we’ll look at what the new pain mapping study discovered, alongside common causes of shoulder pain.

What did the pain mapping study involve?

The new pain mapping study included a total of 21,500 people who had attended the severe pain management clinics at the University of Pittsburgh. A computer clustering analysis was carried out on patient body maps to determine patterns of pain distribution.

The results showed there were nine clear types of chronic pain a patient could experience. The researchers believe the identified patterns of pain distribution could help to predict pain impact, severity, physical function, and predicted outcomes.

So, what did it find in relation to those experiencing shoulder pain? Unfortunately, it wasn’t great news…

Patients with long-term shoulder pain saw the least improvement

More than 7,000 people involved in the study, went on to fill in a follow-up questionnaire. This was done three months after the body pain map.

Results showed that those who experienced abdominal pain went on to see the biggest improvement. However, those who experienced shoulder, neck, and lower back pain saw the least improvement.

Just 37% of those suffering from lower back, shoulder, and neck pain saw an improvement after three months. The researchers noticed that patients within this subgroup also had some of the same characteristics as those in the widespread pain groups. This could suggest that they are in the early stages of widespread, generalised, chronic pain.

A new long-term study into pain duration and stability within this group has now been recommended.

Common causes of shoulder pain

Shoulder pain is a very common problem that can vary greatly in severity. There are a lot of different causes of shoulder pain, with some proving to be more debilitating than others. Some of the most common causes of shoulder pain include:

  • Osteoarthritis
  • Rotator cuff tear
  • Bursitis
  • Tendinitis
  • Frozen shoulder

Osteoarthritis is a leading cause of ongoing shoulder pain. It causes the cartilage within the joint to break down over time. This in turn leads to a lot of pain and stiffness within the shoulder.

Rotator cuff tears are also common, and they can also develop over time. As the tendon within the shoulder wears down gradually, the pain will start to develop. You can experience partial or full tears, and they tend to be most common in those aged over 50.

Each different cause of shoulder pain will require a different treatment plan. Therefore, if you are suffering from chronic shoulder pain, it is important to seek a diagnosis. Once the cause has been established, an effective treatment plan can be created.

rotator cuff disorders diagnosis

Rotator Cuff Disorders: Tendonitis or Tear?

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Shoulder pain is something most of us experience at some point in our lives. However, if the pain doesn’t go away, it could be a sign of a more serious injury.

There are lots of shoulder injuries you can develop, and rotator cuff disorders are particularly common. Here, you’ll learn about the different rotator cuff disorders and how to spot the differences between them.

What is rotator cuff tendonitis?

Rotator cuff tendonitis is inflammation or irritation of the rotator cuff muscles. The condition can range in severity, and in extreme cases cause the rotator cuff to become trapped below the acromion. This causes extreme pain, requiring immediate treatment.

Tendonitis occurs over time and can be caused by several factors. You can develop it due to playing overhead sports, or simply by sleeping in an awkward position on the shoulder.

What is a rotator cuff tear?

A rotator cuff tear develops when the attachment from the tendon at the head of the humerus rips. The supraspinatus is the main tendon affected, though a tear could also develop in the other surrounding tendons.

A lot of the time, they occur over time, starting with the fraying of the tendon’s fibres. If the shoulder is used despite continuing pain, the tendon could go on to tear. You can either experience a partial, or full-thickness tear.

Symptoms to watch out for

While both tendonitis and a rotator cuff tear can cause significant pain, there are some differences in their symptoms.

With tendonitis, you’ll find that symptoms often start out mild and worsen in severity over time. They include:

  • A clicking sound when using the shoulder
  • Pain when lifting or reaching for something
  • Stiffness
  • Pain even when the shoulder is still

When the condition starts to worsen, you may also have difficulty reaching around your back, and experience more pain at night when trying to sleep.

With a rotator cuff tear, symptoms will depend upon the type of tear you experience. However, some general symptoms to look out for include:

  • Pain when trying to sleep
  • A weakness in the shoulder and arm
  • Pain when you aren’t using the shoulder
  • A popping or cracking sound when using the shoulder

If you suffered an acute tear, the pain will usually be more severe, and loss of strength will occur immediately. If it is a degenerative tear, it will cause some pain, but not as intense as an acute tear. Without treatment, a rotator cuff tear will advance until pain medication no longer has any effect.

Whether you are suffering with a rotator cuff tear, or tendonitis, there are some effective treatment options available. Non-surgical options include rest, physiotherapy, non-steroidal anti-inflammatory medications, or steroid injections. Alternatively, surgery may be required for more severe injuries.

If you are experiencing pain or weakness within the shoulder, it could be a rotator cuff disorder. Book a consultation with a shoulder specialist now to diagnose and begin treatment for the injury.

recurrent anterior instability study

London Shoulder Specialist Study Recently Published in the American Journal of Sports Medicine

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A recently published study carried out by a team including London Shoulder Specialist Mr Ali Narvani has assessed the different treatment options for recurrent anterior instability. Up until now, there has been little research carried out into the effectiveness of existing treatments.

Here, we will look at what the recent study revealed and what it means for patients.

Understanding the recent study

Published in the American Journal of Sports Medicine, this recent study pooled data from 2018, across seven cohort studies. It compared Latarjet and Bankart treatments for anterior shoulder instability. Both continuous data and dichotomous data were pooled from a total of 3,275 patients.

Results showed that the Bankart technique had an increased risk of recurrence and re-dislocation. However, it had a decreased risk of infection compared to the Latarjet technique. Both had a similar Rowe score, revision, and haematoma formation rates.

What is the Bankart technique?

During the Bankart procedure, the overstretched or torn labrum and capsule are repaired deeper within the shoulder joint. The surgery is usually performed arthroscopically, but an open procedure can also be used. The method chosen for your repair will be discussed with you during your consultation.

In most cases, the surgeon uses a nerve block during the surgery. This helps to completely numb the area for up to a few hours. Painkillers will be provided to ease the pain after the procedure to make the recovery more comfortable.

What is the Latarjet technique?

The Latarjet technique focuses on relocating a piece of bone, complete with an attached tendon, to the joint of the shoulder. It is commonly performed on patients with recurrent instability that is brought on by a Bankart lesion. This procedure is often recommended for patients where a labrum repair doesn’t fix the damage within the joint.

Understanding shoulder instability

Instability in the shoulder arises when the upper arm bone is pushed out of its socket. It can happen due to an injury or from overuse. Shoulders are susceptible to repeated dislocations after they have been dislocated once. If it keeps happening, it is referred to as chronic instability.

Shoulder instability may be directional, or multidirectional. With directional instability, it can affect the anterior or posterior of the joint. With multidirectional instability, both the front and the back of the joint are affected. Anterior instability tends to be the most common form patients experience. This is likely since the capsule of the joint is weaker in the front of the joint.

Treatment for shoulder instability will depend upon the location and cause of the issue. As the new study suggests, the Latarjet procedure is more effective at reducing the likelihood of recurrence. However, for some patients the Bankart procedure may be the better option.

Call +44 (0) 203 195 2442 to book a consultation to discover the best course of treatment for your shoulder instability today.

treating tennis shoulder

Treating Tennis Shoulder: the Management of Shoulder Impingement

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Tennis shoulder is a common injury, typically experienced by athletes. Also known as shoulder impingement syndrome, it can develop suddenly, or gradually. Patients may experience significant pain when lifting their arm, causing difficulty when playing sport or carrying out daily activities.

As Wimbledon makes its post-COVID comeback this month, now is the perfect time to learn more about treating tennis shoulder.

What is tennis shoulder?

Tennis shoulder, or shoulder impingement, is caused when a tendon within the shoulder rubs against nearby bone or tissue when the arm is lifted. It occurs within the rotator cuff at the top of the arm. Most of the time, the condition will improve by itself. However, there are times when it is reoccurring.

Swimmers, baseball players, and tennis players whose arms are frequently used overhead are especially vulnerable. Also at risk are people who carry out repetitive lifting or overhead activities with the arm, such as painting, and building. Minor injuries can also result in impingement.

Tennis shoulder symptoms to watch out for

Local swelling and tenderness of the shoulder are common symptoms of rotator cuff problems. Lifting your arm may cause pain and stiffness. Additionally, pain may be felt when an elevated arm is lowered.

There may be mild symptoms at the beginning, causing patients to delay seeking treatment. Typically, shoulder instability can produce the following symptoms:

  • Pain on the outer and top part of the arm
  • Pain that worsens when the arm is lifted, particularly above your head
  • Weakness within the arm
  • Aching or pain which worsens at night, causing difficulty with sleep

Stiffness is not usually a symptom of shoulder impingement. If you are experiencing any stiffness, it could be an indicator of frozen shoulder, rather than impingement.

What treatment options are available?

There are several options available for treating tennis shoulder, including physiotherapy, steroid injections, and surgery.

Most patients with shoulder impingement find physiotherapy exercises are enough to correct the issue. The goal of physio exercises is to strengthen the muscles within the joint and correct shoulder posture.

Steroid injections are used to eliminate the pain associated with the condition. The effects last a few weeks, and they are ideal for those suffering with more intense shoulder impingement pain. The only trouble with this form of treatment is that it is only recommended to be given to each patient twice. This is due to a risk of tendon damage if they are used in the long-term.

Surgery is typically used as a last resort for more severe cases of shoulder impingement. A subacromial decompression may be helpful.

In the procedure, the space surrounding the tendon of the rotator cuff is widened, ensuring it doesn’t rub or catch against anything.

Most cases of shoulder impingement can be corrected without surgery. However, it is a good idea to undergo a consultation with a shoulder specialist. This will help you to discover the best form of treatment for your shoulder impingement. To book an appointment with the London Shoulder Specialists call +44 (0) 203 195 2442.

rotator cuff tear location

Location of Your Rotator Cuff Tear Does Not Affect Your Surgical Outcome, New Study Finds

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Rotator cuff tears are a common, painful condition. Typically treated through surgical repair, there has been a lot of debate over the factors which contribute towards a favourable outcome. These include older age, the size of the tear, smoking, and location.

Now, a new study has shown that the location of the tear does not impact the surgical outcome. Here, we will look at what the study revealed and what patients need to know about the different rotator cuff injuries.

What the latest study revealed

The latest study, published within the May 2021 issue of the Arthroscopy Journal, was carried out to compare functional outcomes based upon location of the rotator cuff tear. They retrospectively analysed 104 patients with symptomatic partial thickness rotator cuff tears from 2010 to 2015.

The researchers collected data on range of motion, pain score measurements, and outcome scores. Data was compared before surgery, as well as one year after, and finally two years after the procedure. Each of the patients had suffered a supraspinatus tendon tear up to 2cm and their average age was in the mid-fifties.

All patients showed a significant improvement in function and pain relief two years after the surgery. It was discovered that there wasn’t any difference between where the tear was located and the outcome of the procedure.

Understanding Articular-Sided and Bursal-Sided tears

Most rotator cuff tears occur within the supraspinatus tendon. However, they can develop as articular-sided or bursal-sided tears.

Articular-sided tears tend to be the most common and they are common in athletes who participate in overhead sports. They run into the rotator cuff from the articular side, typically resulting from trauma.

Bursal-sided tears are less common, and they mostly result from subacromial impingement. They run into the rotator cuff from the bursal side and tend to occur in older age. The reason these tears are less common is because the bursal side is a lot stronger than the articular side. It contains greater tensile strength which makes it more difficult to tear.

What factors can affect the surgical outcome?

The new study shows that the location of the tear does not impact the outcome of surgery. However, there are some factors which can affect how well the tear heals. These include:

  • The size of the tear
  • Diabetes
  • Patient age
  • Lifestyle factors such as smoking
  • The severity of the tear

These are some of the main factors which could determine how well the shoulder heals after surgical repair. Your London Shoulder Specialist surgeon will be able to discuss the risks with you prior to the procedure.

diabetes and frozen shoulder

UK Study Finds Diabetes Likely Cause of Frozen Shoulder

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A new UK study has revealed that Diabetes Type 1 can lead to musculoskeletal issues such as frozen shoulder. The research was presented at the 2021 Diabetes UK Professional Conference.

Here, we will look at what the study found and the link between diabetes and frozen shoulder.

Understanding the study

Researchers from the University of Exeter, analysed health and genetic data from the UK Biobank and FinnGen. They were looking to see if patients with Diabetes Type 1 were more likely to develop other conditions. When a link between diabetes and frozen shoulder was found, the team used the Mendelian randomisation technique to establish whether it was a casual or serious link.

It was revealed that Diabetes Type 1 can directly increase the risk of four conditions. These include frozen shoulder, carpal tunnel syndrome, Dupuytren’s Contracture, and trigger finger. Each of these musculoskeletal conditions are characterised by reduced mobility in the hand, shoulder, fingers, or wrist. They also cause a lot of pain to patients.

It is thought that prolonged high blood pressure caused by Diabetes Type 1 is to blame for the increased risk of musculoskeletal issues. The hope is that now healthcare professionals can recognise these four conditions as chronic complications of Diabetes. This will ultimately help to diagnose and treat the conditions quickly, improving patient outcomes.

What is frozen shoulder?

Frozen shoulder is a condition which causes the shoulder to become painful and stiff. It can last for months, or even years in some cases. It is typically a self-limiting condition which means that it resolves on its own and should have no long-term harmful effect on a person’s health. However, there are treatments available which can help ease the pain and improve mobility.

Frozen shoulder occurs when the tissues around the joint of the shoulder become inflamed. Due to the inflammation, the tissue starts to tighten and shrink, leading to pain and discomfort.

Most people develop a frozen shoulder due to a surgery or injury which prevents the arm from moving normally. As the new study confirms, diabetes can also be a factor.

How is frozen shoulder treated?

While a frozen shoulder does tend to clear up by itself, there are treatment options available which are aimed at controlling pain and increasing mobility of the shoulder joint. Pain relief medication, steroid injections, and physiotherapy are all effective treatment options.

Many patients find a combination of pain relief and physiotherapy works best. The treatment you receive will depend upon how stiff and painful the shoulder is. The goal of physiotherapy is to improve the motion in the shoulder. It will also help to build up strength in the area, helping to reduce the pain. If non-operative measures fail to improve the symptoms, then arthroscopic release of the shoulder capsule and manipulation of the shoulder joint, performed under a general anaesthetic, could be advised.

If you are concerned you might be suffering from a frozen shoulder, call 0203 195 2442 to book a consultation today. There are many potential causes of shoulder pain and stiffness. Therefore, the exact cause will need to be diagnosed before treatment can begin.

Returning to work after rotator cuff repair

Returning to Work and Play After Rotator Cuff Repair

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After undergoing a rotator cuff repair, it is important to give the body plenty of time to heal.

Returning to work and sporting or leisure activities should only be considered once the body has fully repaired. The length of time this will take depends upon multiple factors. A recent study has also revealed some patients do not return to their previous work levels.

Here, you will discover everything you need to know about returning to work and play after rotator cuff repair.

Will you be able to return to previous work levels?

The majority of patients who undergo a rotator cuff repair go on to return to previous work levels within six months to a year. However, a recent study has estimated that over 35% of workers who experience a rotator cuff tear, might never return to previous work levels after surgery.

A systematic review was carried out by the Rush University Medical Center in the USA to look into return to work outcomes. They followed 1,224 rotator cuff repair patients with a mean age of 52.2. The researchers discovered that 62.3% of patients were able to return to previous levels of work. The average time it took to fully recover was 8.15 months. A total of 37.7% of patients didn’t return to previous work levels.

Despite some not being able to return to previous work levels, all patients experienced significant improvement in pain reduction and final outcome. There were also no links discovered between arthroscopic and open procedures.

Those who were returning to light work also had the highest likelihood of returning to previous levels. An impressive 97% were able to fully return to what is considered light work.

How quickly can I return to sport after rotator cuff repair?

Those looking to return to sport after rotator cuff surgery can expect the same recovery time as getting back to work. It takes an average of eight months to recover from the procedure, though this will vary between patients.

Numerous studies have shown that the majority of recreational athletes manage to get back to the same level of play as before the surgery. However, only half of professional athletes will regain the same level of play.

Factors that impact recovery after rotator cuff repair

Whether or not you will be able to return to previous work and play levels after rotator cuff repair surgery, depends upon numerous factors. The size of the tear, the sport you play, and your overall fitness will each play a key role in your recovery.

There is also evidence to suggest that patient resilience can play a part in recovery. A study published in the Shoulder & Elbow journal sought to assess the connection between the patient’s ‘resilience’ pre-procedure and post-operative shoulder pain and function and also wider physical and mental health. The study found that resilience was more of an indicator of mental and physical health than of early recovery from shoulder surgery.

So, the majority of patients who undergo rotator cuff repair surgery do manage to return to the same level of work and play. However, your London shoulder surgeon will give you a better idea of whether or not you will be able to get back to work and sport during your consultation.

Steroid injections for releasing a frozen shoulder

Releasing a Frozen Shoulder

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Frozen shoulder is a common condition that can cause significant pain within the shoulder. It tends to clear up by itself over a period of time, though it may take up to a year for it to fully recover.

To speed up recovery and ease the symptoms caused by the condition, there are several things you can do. Below, we will look at what frozen shoulder is and how it can be treated.

What is frozen shoulder?

Frozen shoulder is a condition that causes a gradual loss of movement within the shoulder joint. It is mostly caused by inflammation of the tissues of the joint. When inflammation occurs, scarring begins to develop, referred to as adhesions. These adhesions can cause issues with movement of the joint.

The exact cause of frozen shoulder isn’t known. However, it can occur after the shoulder has been immobilised for long periods of time, or due to conditions such as Bursitis.

There are a lot of shoulder conditions a patient can suffer with. Therefore, you should always seek a diagnosis to ensure you are dealing with frozen shoulder and nothing more serious.

Steroid injections prove most effective in recent study

The recent study, published by JAMA Network Open in December 2020, analysed 65 studies. Over 4,000 participants were assessed to see which treatments proved the most effective. It was revealed that steroid injections were the most effective at reducing inflammation.

The treatment was shown to lead to the fastest recovery, and it helped to eliminate or significantly reduce pain. Steroid injections are often used in the treatment of frozen shoulder, but researchers suggest they should now be used as a first line of therapy. They also state that the injections should be provided alongside an at-home exercise program.

Physical therapy for releasing frozen shoulder

Physical therapy is an essential part of frozen shoulder recovery. Through specialist exercises, you will start to regain the strength and movement back within the shoulder.

First, the current movement of the shoulder will be assessed. Then, you will be provided with a range of exercises to help improve the range of movement. These include strength and stretching exercises. You will also be given posture and pain relief advice.

The number of treatments you need will depend upon a variety of factors. Your physiotherapist will tell you how long the therapy will need to continue.

Anti-inflammatory medications to treat frozen shoulder

Alongside steroid injections, anti-inflammatory medications can also be provided. These include Ibuprofen and Aspirin. Your London Shoulder Specialist may also prescribe pain medication to help with sleep and pain reduction.

Frozen shoulder can be a very painful and limiting condition. However, it will tend to clear up by itself within a year. In the meantime, treatments such as steroid injections can help in releasing frozen shoulder, reducing pain and improving movement within the joint.

Shoulder surgery timing

Signs You Might Need Shoulder Surgery

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When you suffer a shoulder injury, it will not always need to be treated with surgery. In fact, most shoulder injuries will heal without surgical intervention. However, in cases where surgery is required, the procedure should be carried out as early as possible.

If you want to ensure you get the right type of treatment quickly, it is important to understand the signs that you might need surgery. Here, we will look at some of the most common signs to watch out for which could mean you require shoulder surgery.

#1 Your injury hasn’t improved after six months of treatment

With most types of shoulder injury, non-surgical treatment will first be provided for a period of up to six months. These include rotator cuff disorders and frozen shoulder. In some cases, non-operative treatment is provided for three months before surgery is considered.

If there is no improvement in the pain or mobility of the shoulder and it shows no signs of healing, surgery will be the best option.

#2 Ongoing pain that impacts your ability to carry out daily tasks

Shoulder injuries can be extremely painful. However, if you suffer with ongoing pain that is impacting your ability to perform basic daily tasks, surgery may be required. When you are living in constant pain, it can greatly reduce your quality of life. Nobody should live in consistent pain, so if your shoulder isn’t healing, surgery is a good option to ease the discomfort.

#3 Complete tears within the shoulder

Rotator cuff tears within the shoulder are common and they will require surgery if they are severe. Partial tears can often heal without surgery, but complete tears often require surgical intervention.

Complete tears are most commonly experienced within the rotator cuff. These can be extremely painful and will require a long recovery process.

#4 The shoulder is unstable and pops out of place

You may find that your shoulder dislocates frequently, or it is unstable. This can lead to a number of issues, especially when trying to carry out daily tasks. For patients under the age of 30, surgery is often the best way to build up stability and prevent further dislocations.

There have been several studies carried out recently which have shown surgery on younger patients to treat shoulder instability can prove beneficial for over a decade.

Knowing when to seek help for a shoulder injury

With shoulder pain, patients are often reluctant to seek help. They mistakenly believe that shoulder pain is a common and normal symptom that will heal on its own. While in some cases this may be true, if the pain is constant and it affects your ability to do things, you should seek professional help.

Booking a consultation with a specialist will help you to determine whether or not your shoulder requires surgery to treat it. The surgeon will be able to explain the pros and cons of surgery, alongside the potential risks.

While shoulder injuries do not always need surgery, it is important to seek a diagnosis and treatment plan as soon as you can.

Shoulder fractures

Common Types of Shoulder Fractures and Your Treatment Options

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Shoulder fractures are common, and they often require a long recovery period. However, actual recovery time and treatment options are determined by the type of fracture that has occurred.

There are different types of fractures a patient can experience. Here, we will look at the common types of shoulder fractures and the treatment options available.

What are the common types of shoulder fractures?

The shoulder has three main bones which can suffer a fracture. These include the clavicle (collarbone), scapula (shoulder blade), and the humerus (upper arm bone). While fractures to each of these bones produces the same type of symptoms, there are some differences between them.

Clavicle fractures mostly tend to occur after a fall, accident or direct hit. The severity of the fracture is measured in Groups I, II, and III. Patients will usually have some trouble lifting the arm with this type of fracture.

Scapula fractures are the least common type and they mostly occur in men aged 25 to 45. They are mostly caused by a direct hit to the area either through playing sports or after suffering a car accident. Patients with this type of fracture will typically also have suffered additional damage such as rib fractures or nerve injuries.

Fractures which affect the humerus bone are commonly referred to as proximal humerus fractures. They affect the top of the bone and can develop at any age. However, older people and those suffering from osteoporosis are at an increased risk. There are other types of fractures that can affect the humerus bone, but they don’t tend to affect the shoulder as much as a proximal humerus fracture.

These are the three different types of fractures patients can develop. The question is, if you do suffer with a shoulder fracture, what treatment options do you have?

Understanding your shoulder fracture treatment options

The type of treatment required to correct a fracture will depend upon several factors. The type and severity of the fracture will ultimately determine the best course of treatment.

With a clavicle fracture, most do tend to heal without the need for surgery. However, if the fracture is fragmented or severely displaced, surgery may be required. Non-surgical treatment of this kind of fracture includes painkillers, a polysling, and physiotherapy.

Proximal humerus fractures may or may not require surgery. If they don’t, a cuff sling and collar will need to be worn for up to six weeks. Strength in the arm will gradually return after three months. There is also the possibility that compared to the uninjured shoulder, it will always feel stiffer. If surgery is required, there are a couple of techniques that may be used. Your surgeon will talk through your options with you during the consultation.

If you suspect you have a fractured shoulder, seeking treatment as quickly as possible is recommended. Living with a fracture can be painful and limit your daily activities. Call 0203 195 2442 to book a consultation now to diagnose and identify the best course of treatment for your fracture.