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.

frozen shoulder

Frozen Shoulder is in the Top 3 of Most Painful Conditions, According to NHS

Frozen shoulder has been listed as one of the top 3 most painful conditions by the NHS. The organisation has highlighted the conditions which cause the worst pain and the largest disruption to daily life. While cluster headaches got the number one spot, frozen shoulder wasn’t far behind at spot number three.

According to the NHS, in patients with frozen shoulder, the joint can become so stiff and tight, that it is almost impossible to carry out normal movements. Here, we will look at what frozen shoulder is, and how it can be treated.

What is frozen shoulder?

Frozen shoulder is diagnosed when you have pain and stiffness within the shoulder joint. Also known as adhesive capsulitis, it can be a really painful condition that can last anywhere from one to five years. It occurs when damage has been caused to the shoulder joint lining, known as the shoulder capsule.

How is frozen shoulder treated?

The majority of the time, a frozen shoulder is treated non-surgically. The three main non-surgical treatments include pain relief medication, steroid injections and physiotherapy. Steroid injections aren’t frequently used, but they can provide relief from excess swelling.

Often, a mixture of treatments is used depending upon how painful or swollen the shoulder is. Due to the side effects it can cause, strong painkiller medication prescribed by doctors can only be used for short periods of time.

In order to help you regain movement within the shoulder, physiotherapy is highly effective. They will teach you stretching exercises and provide you with pain relief and good posture advice.

When might surgery for frozen shoulder be required?

Although the majority of patients are treated non-surgically, in some surgery may be the best solution. The procedure carried out to treat frozen shoulder is known as arthroscopic capsular release.

In the procedure, a tiny camera is inserted into the joint of the shoulder. Small incisions are made so the surgeon can strategically insert instruments, using the camera to help see what they are doing. In order to help the patient achieve better mobility, the shoulder capsule is cut to give the joint a lot more freedom.

There are other surgical techniques used, but the arthroscopic procedure tends to be the most common. The trouble is, after the surgery, it isn’t uncommon for patients to experience a lot more pain. This can lead them to avoid certain movements. For this reason, physical therapy is started almost immediately after the procedure has been performed.

While frozen shoulder is known to be one of the most painful conditions you can suffer with, treatments are available. To discover which treatment option is right for you, book a consultation with a shoulder specialist today.

Shoulder Dislocation Treatment

Shoulder Dislocation Treatment Assessed in the British Medical Journal

The British Medical Journal (BMJ) has recently assessed the treatment of shoulder dislocation. Causing a lot of pain and discomfort, shoulder dislocations tend to have a significant impact on daily activities. Understanding how to treat them correctly can reduce costs as well as prevent recurring dislocations.

Here, we will look at what the BMJ assessment revealed and the various shoulder dislocation treatments available.

What did the assessment reveal?

The latest assessment into the treatment of shoulder dislocations revealed some interesting statistics. Relating to traumatic anterior shoulder dislocation, the authors of the study hope it will help surgeons better manage and treat their patients.

It revealed that patients who have a suspected dislocation should be referred to emergency services to receive a reduction. It also showed that patients most likely to experience their first traumatic first-time anterior shoulder dislocation, are men aged from 16 to 20, and women aged 61 to 70. Interestingly, men aged 40 and over were also identified as being more at risk of a reoccurring dislocation.

In terms of treatment, it was revealed that there is no evidence to suggest what period of immobilisation of the shoulder is required for preventing recurrence. Typically, the advice is to immobilise the shoulder for a period of one week. It was also found that younger patients who led an active lifestyle, were more likely to achieve better outcomes from surgical treatment than older patients.

Who is more susceptible to shoulder dislocations?

Anybody can experience a shoulder dislocation in their lifetime. However, there are certain groups that are more susceptible.

It is known that around 70% of shoulder dislocations occur in men. As touched upon earlier, men aged 16 to 20 and women aged 61 to 70 were most at risk of suffering a dislocation in the UK.

Shoulder dislocation treatments

There are a number of treatments which can be used to treat a shoulder dislocation. Firstly, a closed reduction is typically attempted.

This is basically where the shoulder is pushed back into its joint by the doctor. It can be uncomfortable, but you may be given a muscle relaxer or a mild sedative to help ease discomfort. An X-ray will be carried out afterwards to ensure the shoulder is back in position.

After the dislocation has been pushed back in, it will typically be immobilised for a set time period to help it heal. This involves wearing a sling to keep the shoulder in position. Pain medication may be provided during recovery, alongside physical therapy. In some cases, surgery may be required. If the closed reduction failed, surgical treatment may be the only option.

It is important for patients to understand their options when it comes to the treatments available. Younger patients were shown to fare better when undergoing surgery compared to older patients. However, like all surgeries there are complications and risks to be aware of. Patients need to have a full understanding of all of their options in order to make the best treatment decision.

For more advice on shoulder dislocations and instability, call 0203 195 2442 to arrange a consultation with our shoulder consultants at our London shoulder clinic

Mr Ali Narvani publishes shoulder dislocation article

Mr Ali Narvani co-authors article published in the Archives of Bone and Joint Surgery

London shoulder specialist Mr Ali Narvani was recently published in the Archives of Bone and Joint Surgery. Entitled ‘Posterior Shoulder Instability: The Augmented McLaughlin Procedure’, the article presented another option for the management of chronic posterior dislocations.

Mr Narvani and his fellow authors carried out research at two centres in the UK; Rowley Bristow Orthopaedic Unit in Ashford and St Peter’s Hospital NHS Foundation Trust in Surrey.

The authors posited that posterior shoulder dislocation, while a relatively rare shoulder condition, is frequently missed and often associated with a significant defect on the antero-medial aspect of the humeral head (the reverse Hill-Sachs lesion). There have been several stabilisation techniques developed and the authors described an additional technique by augmenting the reverse Hill-Sachs lesion with layers of extracellular matrix. This filled the humeral defect and reduced the risk of subsequent instability of the shoulder.

For more advice on shoulder dislocations and instability, call 0203 195 2442 to arrange a consultation with our shoulder consultants at our London shoulder clinic

delaying rotator cuff repair

Delayed Rotator Cuff Repair May Increase Risk of Revision Surgery in the Future

A new study has revealed that delayed rotator cuff repair may increase the risk of revision surgery later on. The research, carried out by the Hospital for Special Surgery, discovered waiting more than 12 months for the surgery, significantly increased the risk of revision surgery.

Here, we’ll look at what the latest study revealed and the importance of faster rotator cuff repair surgery.

Rotator cuff repair study

The latest study included 2,759 patients, split into three groups. The first group included 57.4% of the patients who underwent early rotator cuff repair within 6 weeks. The second group was made up of 40% of patients who had a routine repair within 6 weeks and 12 months. Then the final group of 5.3% had delayed treatment after 12 months.

After a five-year follow up, there was a total revision rate across all patient groups of 9.6%. However, it was patients in the delayed group who required the most revision procedures. Patients who underwent a delayed rotator cuff repair experienced a revision rate of 15.2%. Patients in the routine group had a revision rate of 8.3% and those in the early group had a revision rate of 9.9%.

The results of the study show that rotator cuff repair surgery would be safest carried out within 6 weeks to 12 months. It also clearly highlights the risks of delayed surgery.

What is rotator cuff repair?

A rotator cuff repair is a type of surgery which aims to repair a torn tendon within the shoulder. The rotator cuff is made up of tendons and muscles which ultimately protect the shoulder joint. Over time, the tendons can tear whether due to overuse or because of an injury.

The majority of patients are placed under general anaesthetic when they undergo a rotator cuff repair. It can be carried out using an open or an arthroscopy technique. During the procedure, the surgeon reattaches the tendons to the bone, typically using small rivets.

What other treatments are used for rotator cuff injuries?

Although surgery is considered the best course of treatment for a rotator cuff repair, there are other options available. If the tear is minor, patients may be able to undergo physical therapy and other non-surgical treatments.

Like with any type of injury, it’s important to let the shoulder rest when it is injured. So, if you do have a rotator cuff tear, try and rest up as much as possible. Physical therapy tends to be the best form of non-surgical treatment. A physiotherapist will teach you shoulder strengthening exercises that relieve pain and increase mobility.

Before deciding upon a treatment plan, it is important to address the severity of the tear. There are different levels of rotator cuff injuries and yours will affect the treatment you need to undergo. So, if you suspect you have a rotator cuff injury, book a consultation with a shoulder specialist to determine the best course of treatment.

shoulder labrum tears

Understanding Shoulder Labrum Tears

The shoulder is a complex joint and it is susceptible to a wide range of injuries. Shoulder labrum tears are just one type of injury that can cause pain and instability.

So, what are shoulder labrum tears and how can you tell if you are suffering with this type of injury?

What is the shoulder labrum?

The labrum of the shoulder is there to reinforce the ball and socket joint. It is made of cartilage fibrous tissue, and it is where the ligaments attach that support the socket. It basically acts as a suction cup for the joint, keeping it in place.

The shoulder labrum is largely responsible for keeping the shoulder stable. Therefore, if it tears, it can lead to shoulder instability as well as pain. The question is, what causes the joint to tear?

There are a number of reasons why the labrum might tear. The most common causes include overuse of the shoulder, repetitive motions and trauma. Those who play sports are particularly susceptible to a torn shoulder labrum.

It is also important to note that there are different types of shoulder labrum tears you can experience. The type of tear you have will determine how it needs to be treated.

Understanding the different types of tears

There are different types of labrum tears you can experience. The most common types of labrum tears include SLAP and Bankart tears.

SLAP tears are common in athletes and they occur where the shoulder connects to the bicep at the top of the upper arm. These types of tears tend to be caused by quick-snap, high energy movements.

Bankart tears are most common in younger patients and they tend to mostly occur after a dislocation of the shoulder. When the joint comes out of its socket, its capsule can pull down onto the lower labrum, causing it to tear. As the labrum is now unstable, it could cause the shoulder to dislocate again.

How are shoulder labrum tears treated?

There are different types of treatments available to repair a labrum tear. Surgery isn’t always necessary depending upon the severity of the tear.

If it is minor, rest and physical therapy may be all that is needed to treat the issue. This is especially true in the case of SLAP tears, which typically prescribe rest, physical therapy and anti-inflammatory medications. Minor Bankart tears with dislocation can also be treated with rest and physiotherapy.

For more severe tears, surgery may be required. It is typically used as a last resort and an arthroscopy method is used. In older patients, non-surgical treatment is typically advised, especially if they don’t engage in physical activity. However, younger patients may want to consider surgery if they plan on playing sports.

Overall, shoulder labrum tears are a common injury and they vary in severity. If you suspect you have a shoulder labrum tear, it is important to seek an accurate diagnosis from a shoulder specialist. They will be able to identify the best course of treatment if a tear is diagnosed.