rotator cuff tear location

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

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

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

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

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

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

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.

WFH and shoulder pain

WFH Can Be a Pain, Arthritis Charity Study Finds

The coronavirus pandemic has forced more people than ever before to work from home. However, according to new research, the WFH practice can cause a number of health issues, including musculoskeletal pain.

A study led by the charity Versus Arthritis, found that four out of five people who have switched to WFH since the pandemic was first declared have developed some type of musculoskeletal pain. Employers are being urged to encourage their workers to be open about any pain they may be experiencing. So, why is WFH leading to chronic pain?

Poor WFH set-ups and lack of exercise to blame

According to the Versus Arthritis study, poor WFH set-ups and a lack of exercise are to blame for the increase in those suffering with musculoskeletal issues.

Participants were given a survey to complete. The results showed that 81% of respondents suffered with some type of neck, back or shoulder pain. Around 48% of respondents also claimed they were less active now than they were prior to the lockdown.

Nearly 23% of respondents reported feeling musculoskeletal pain most of the time. Worryingly, 46% also said they take painkillers more frequently now than they would like. While back and neck pain were the most common, 26% of respondents also suffered with shoulder pain.

A poor WFH set-up can cause unnecessary, repetitive strain on the shoulder. If left uncorrected, this could lead to more serious shoulder issues later down the line.

Workers reluctant to report pain to their employers

Despite being in pain, many employees are reluctant to report it to their employer. The study revealed that a staggering 81% of those experiencing pain hadn’t let their employer know. This is said to be down to a lack of understanding over their rights and they worry it could impact their employment.

The trouble is, if workers aren’t reporting pain and they aren’t getting it treated, it will simply worsen over time. Versus Arthritis are urging employers to do more to protect their workers. They recommend employers check in on their workers regularly to enquire about their musculoskeletal health. They may also need to fund equipment for their workers to ensure they can carry out their work comfortably.

There are also things workers can do to protect their musculoskeletal health at home. For example, there are preventative measures you can take to avoid developing shoulder issues.

How can you prevent shoulder pain when WFH?

If you have been working from home for the last year, you are at an increased risk of developing tendonitis, impingement and bursitis in the shoulder. This results from bad posture, such as being slouched over a laptop for hours on end.

Taking regular mini-breaks and avoiding staying sedentary for too long will really help. Ensure that your desk is also level with your elbows when you sit down. If you keep everything you need within easy reach, you’ll also avoid twisting and stretching the shoulder throughout the day.

Working from home does present several challenges in terms of our health. Incorrect posture and hours of inactivity can contribute towards painful shoulder conditions. If you are experiencing shoulder pain, seeking early treatment is important. Book a consultation with a shoulder specialist to address and treat the cause of your pain.


Some expert ergonomics tips to avoid shoulder strain when WFH

Shoulder replacements longevity

Study Finds Majority of Shoulder Replacements Last More Than 10 Years

A new study has revealed that most shoulder replacements last more than a decade. It was carried out by the National Institute for Health Research Applied Research Collaboration South West Peninsula, and the University of Exeter. Known to be the largest study of its kind, it provides reassurance to patients and surgeons alike.

Here, we’ll look at what the new study revealed and what it means for shoulder replacement patients.

Understanding the new shoulder replacements study

The new study is known to be the largest of its kind, analysing data from almost 18,000 people who had undergone a shoulder replacement. The results of the study were published in The Lancet Rheumatology.

It was discovered that 90% of shoulder replacements were still working well 10 years on. Patients still believed that the surgery had benefitted their lives. It is the first study to simply answer how long shoulder replacements last and will the surgery provide long-term benefits.

Other recent studies have highlighted the benefits of shoulder replacement surgery for younger patients. Due to how long the results of the procedure last, it can particularly be highly beneficial for young athletes.

What is a shoulder replacement?

A shoulder replacement aims to replace all, or part of the shoulder joint with artificial components. There are different types of shoulder replacement surgeries including reverse, total and partial replacements.

In a reverse replacement procedure, it switches the position of the ball and socket. A metal ball is secured to the shoulder blade in place of the previous socket. A new socket is then secured to the top of the arm where the ball used to be. They both feature a stem which is cemented to the bone.

A total shoulder replacement, a new ball and socket are also inserted. However, they are placed in the same position as the old ball and socket. This helps to maintain the original structure of the shoulder.

Finally, a partial replacement simply replaces the ball of the joint. This will move naturally within the socket.

The type of shoulder replacement you need will depend upon the severity of the degeneration of the joint. There are also risks and complications of each procedure that the surgeon will go through with you during the consultation.

Are there alternatives to surgery?

There are some alternatives to surgery. Shoulder replacements are typically considered as a last resort. In some cases, physiotherapy, steroid joint injections and non-steroid anti-inflammatory medications may be effective. Keyhole surgery is also another alternative that may be suitable to some patients.

So, patients do have several options when treating degeneration of the joint. However, in terms of long-term success, shoulder replacements do show excellent results. The findings of this new study reassure surgeons of its effectiveness when used in patient treatment plans.

shoulder stabilising surgery

Ancient Woodworking Technique Informs Shoulder Stabilising Surgery

A new technique for the treatment of shoulder instability has been identified, taking inspiration from ancient woodworking design. Known as the ‘Inlay Bristow’ technique, the arthroscopic procedure has shown a high success rate for patients experiencing recurrent shoulder instability.

Here, we will look at the new technique and what it could mean for patients. You will also discover more about shoulder instability and its symptoms.

What is the Inlay Bristow technique?

Currently, the Bristow-Latarjet procedure is one of the most commonly used techniques. This involves taking a small piece of bone from the scapula before fixing it to the glenoid bone. While it does have a great success rate in terms of providing long-term stability, it isn’t without its problems. If the graft doesn’t heal properly, it results in a non-union, potentially leading to bone deterioration or breakage of the screw.

The Inlay Bristow technique was inspired by an ancient woodworking technique which used mortise and tenon joints. In the procedure, a tenon is created by trimming the coracoid graft. It is then fixed into the mortise which has been created in the glenoid bone. The technique is said to optimise the accuracy of graft positioning.

A study was carried out to determine how effective this approach would be. Initial results proved promising and were published in The Journal of Bone & Joint Surgery.

Understanding the study

The study into the new technique was carried out by the Peking University Third Hospital. It included 51 patients who underwent the procedure for recurrent shoulder instability. After one year, in 96% of patients the coracoid bone graft had completely healed. CT scans were carried out at follow up appointments which showed little or no bone degeneration and good graft positioning.

The technique also showed to improve function. Significant improvements were recorded in shoulder stability as well as overall joint function. A staggering 87% of patients were also able to return to sport.

What is shoulder instability?

Shoulder instability occurs when the ligaments, labrum or the lining of the shoulder joint become torn, stretched or detached. This causes the ball of the joint to move partially, or completely, out of its socket.

It can be caused by repeated shoulder movements or trauma to the joint. The type of instability you have will determine the treatment you require. For example, a labral tear will be treated differently to a dislocation.

Most patients can be treated non-surgically, depending upon the type of shoulder instability they experience. However, a full consultation will be required to assess the extent of the issue. This will allow the specialist to determine the best course of treatment moving forward. The new tenon and mortise technique could prove a viable treatment options for patients in the future. However, further studies will need to be carried out to determine its suitability and safety.

frozen shoulder treatments

Study Finds Combined Corticosteroid and Exercise Successful at Treating Frozen Shoulder

New meta-analysis has revealed that combined corticosteroid and exercise are successful at treating frozen shoulder. The study, published within the JAMA Network Open journal, identified the combined treatment as being most effective in patients who had experienced frozen shoulder for one year or less.

Here, we’ll look at what the study found and the different treatments currently available for Frozen Shoulder.

Understanding the study

The new study involved carrying out meta-analysis and a systematic review of online databases in February 2020. It included studies which had been done to compare treatment modalities. There were 65 studies including 4097 patients involved in the analysis.

To ease pain in the short-term, it was discovered intra-articular (IA) corticosteroid was superior compared to other interventions. In the mid-term, adding a home exercise program alongside IA corticosteroid, physiotherapy and gentle stretches also provided added benefits.

The findings suggest that patients who undergo early IA corticosteroid and exercise programs can achieve better outcomes. Provided they have only experienced Frozen Shoulder for one year or less, this combined treatment could be most effective.

What is Frozen Shoulder?

Frozen shoulder is medically referred to as adhesive capsulitis. The condition presents pain and stiffness within the shoulder joint. The symptoms tend to worsen as time goes on, before resolving within one to three years.

The good news is, once a frozen shoulder has healed, it is uncommon for it to recur in the same shoulder. It may, however, occur in the other shoulder in some patients. It is unknown what causes the condition, though it is known to be associated with diabetes and long periods of immobilisation.

What current frozen shoulder treatments are available?

There are a number of frozen shoulder treatments currently available. The latest study could help specialists identify the best course of treatment for those experiencing the early stages of frozen shoulder. Other treatment options available include physiotherapy, medications, home care options and surgery.

With physiotherapy, the goal is to stretch out the shoulder joint in order to gain more motion. It can take up to nine months to see significant progress, depending upon the severity of the condition.

Surgery tends to only be carried out on patients with severe symptoms. If physiotherapy hasn’t worked, surgery may be the only option to help patients eliminate the pain and regain motion. However, there are risks to surgery which will need to be considered and discussed with your surgeon. To discuss the condition in more depth, call 203 195 2442 to arrange your consultation with one of our surgeons at our London shoulder clinic.