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.

Ali Narvani Arthoscopy rotator cuff repair review

Mr Ali Narvani comments on Rotator Cuff Tear Review in Arthroscopy

London Shoulder Specialist Mr Ali Narvani and his team had a letter to the editor featured in October’s Arthroscopy, commenting on a recent review of modern literature relating to rotator cuff tears published in the journal earlier this year.

The review, entitled ‘Arthroscopic Superior Capsular Reconstruction for Massive, Irreparable Rotator Cuff Tears: A Systematic Review of Modern Literature’ by Catapano et al, was published by a group of US and Canadian orthopaedic and sports medicine experts in the April 2019 issue.

Mr Narvani’s letter congratulated the study’s authors but highlighted one major limitation they felt had not been acknowledged in the review. A statement that “graft tears did not differ significantly, with combined clinical and/or radiographic retear rates of 3.4% to 33.3% in patients with dermal allografts compared with 4.7% to 36.1% in those with TFL grafts”, did not reflect that magnetic resonance imaging (MRI) was not performed in all patients in the majority of studies.

Mr Ali Narvani and his colleagues agreed that although superior capsular reconstruction provides good short-term clinical outcomes, with similar results between tensor fasciae latae and dermal graft, they felt that the same may not be concluded as far as re-tear rates.

For more advice on rotator cuff repair surgery and to arrange a consultation with Mr Ali Narvani at the London Shoulder Specialists, please call us on 0203 195 2442.

smoking and shoulder surgery risks

Quit It: Smoking Increases Risks After Shoulder Surgery

Shoulder surgery, like any surgery, doesn’t come without its risks. However, in certain patients these risks are elevated. And it seems that smokers are particularly vulnerable to complications after shoulder surgery.

The impact of tobacco use on complications after hip and knee surgery has been well documented, but a recent study in The Bone and Joint Journal has looked at whether smokers are at increased risk of poor medical and surgical outcomes after shoulder arthroplasty.

Here, we’ll look at how smoking increases risks after shoulder surgery and why now is a great time to quit.

What risks do smokers face after surgery?

According to studies, the main risks smokers face after surgery include poor wound healing, infection and less than optimal final outcomes.

The study in The Bone and Joint Journal analysed a total of 196,325 non-smokers (93.1%) and 14,461 smokers (6.9%) that underwent TSA during a five-year study period. Smokers had increased rates of 30- and 90-day readmission, revision within 90 days, infection, wound complications, and instability of the prosthetic joint.

In another study, featuring 235 patients, it was discovered that good results were seen in 84% of non-smokers, yet just 35% in smokers. This shows just how significant the effects of smoking can be. With less than half of smokers experiencing good results, it shows just how significant the risks are.

Smokers have also been found to suffer more pain before and after shoulder surgery. This is because cigarettes have a detrimental impact on the healing of the bone and soft tissue. Infection rates are also higher and there is also an increased risk of surgical revision.

Why does smoking increase shoulder surgery risks?

The reason smoking increases the risks of surgery is because it causes the heart and lungs to not function as well as they should. This can lead to breathing difficulties during and after the procedure.

Smoking is also known to reduce blood flow. This is what slows down the healing process, increasing the risk of infection. It is also known to contribute towards heart disease. This in turn will increase the risk of a heart attack during and after surgery.

Will quitting before the surgery make a difference?

Smokers are always recommended to quit prior to undergoing surgery. Did you know that even if you just quit the day before the surgery, it can still greatly reduce the risks? This is down to the fact that the minute you stop smoking, the body automatically starts to heal itself. All of the harmful chemicals and toxins start to decrease immediately. This improves blood flow, reducing the risk of poor healing.

However, while you can benefit from stopping the day before, the sooner you quit the better the outcome will be. Ideally, you should quit at least a week before the surgery. You’ll also want to avoid smoking during recovery. For this reason, it is the perfect time for smokers to quit for good.

All of the evidence collected through numerous studies, points to smokers having increased risks during and after shoulder surgery. While patients obviously know smoking isn’t good for their health, few realise just how much it increases their risk of recovery. If you need shoulder surgery and you’re a smoker, now is the time to think of quitting for good. If you don’t, you may not receive the best results and you could end up needing a revision surgery.

For more advice on how best to prepare for shoulder surgery, call us on 0203 195 2442.

shoulder surgery waiting lists

British Orthopaedic Association Urges Restarting Orthopaedic Shoulder Surgery

According to data released by NHS England, elective orthopaedic surgery has experienced one of the lowest returns to normal activity in August 2020. Now, the British Orthopaedic Association is urging the restart of orthopaedic surgery.

Here, we will look at why the sector is experiencing a slower return to surgery and the risks delayed treatment presents.

COVID and the impact on shoulder surgery waiting lists

At the moment, orthopaedic surgery comes just ahead of oral surgery at the bottom of the NHS priority list. Only 5 out of 19 surgical sectors are currently back at normal levels. This falls well below the NHS England’s targets.

As a result, a lot of orthopaedic patients are facing significant delays in their treatment. At the end of August 2020, more than 24,000 patients had been waiting for treatment for more than one year. There were also 302,426 patients who had been on the waiting list for 18 weeks.

So, what is the British Orthopaedic Association proposing to do about the current situation? They have put forward a number of arguments for restarting the sector.

The argument for resuming orthopaedic surgery

Due to the ongoing issues caused by delaying treatment, the British Orthopaedic Association is urging the restart of orthopaedic surgery. As the NHS is unlikely to return to pre-coronavirus levels anytime soon, the following arguments are being put forward:

  • A national discussion about how the UK can prioritise and deliver surgery
  • Hip and knee replacements are highly effective and have the lowest cost of QALY of any operation
  • More investment into cold elective orthopaedic centres to combat the backlog
  • Elective surgery continues to take place during a second wave of the virus

These are the main arguments being put forward to tackle the ever-growing issue. A national discussion would help surgeons to come together and explore the options available to safely restart surgeries. The government also needs to realise the cost of delaying treatment, both in terms of patient’s lives and the financial costs passed to the state.

What are the risks of delaying shoulder surgery?

Patients are seeing both their physical and mental health deteriorate as their surgery is delayed. Patients who were already in pain have had to suffer due to the increased waiting times. Many are finding the situation intolerable.

Those with severe arthritis are in danger of losing their independence. As their mobility continues to decline, they are relying more upon others to help them get by. Alongside increased pain and lower independence, it is also causing wider issues. Patients are finding it more difficult to work, and they are relying more upon the state for support and care in their daily lives.

Delaying surgery is having a significant impact on those awaiting orthopaedic surgery. Unless steps are taken now, shoulder surgery waiting lists are only going to get worse and patients will continue to suffer unnecessarily. If you’re interested in discussing self-pay options for shoulder surgery, call us on 0203 195 2442 to speak to one of the team.