Higher risk of complications after shoulder replacement surgery in diabetes patients

infected shoulder replacement in diabetes patientsNew research suggests that patients with diabetes who undergo shoulder replacement surgery may have an increased risk of complications. Results of the study, published within the Journal of the American Academy of Orthopaedic Surgeons, revealed there was a particularly high risk of deep infection and postoperative wound complications.

This is the first time that diabetes has been linked to complications within shoulder surgery, though it has long been linked to an increased risk of hip and knee replacement surgery. As the number of patients with diabetes seeking shoulder replacement surgery is sure to rise, researchers wanted to determine the true risks involved.

What did the study reveal?

The study was carried out to determine the link between deep postoperative infection and preoperative levels of HbA1c, after shoulder replacement surgery. It delved into data from 18,729 patients who had a shoulder replacement surgery between the years 2007 and 2015. Out of these patients, 8,068 had Diabetes and approximately 2,537 of them had their HbA1c levels tested within three months prior to the surgery.

The researchers looked at the wound complication rate after six months, and the deep infection rate within one year of the surgery. It was discovered that patients who do have diabetes, have a 1.4% risk of developing an infection and a 0.7% risk of developing a deep infection. In contrast, patients without diabetes had a 0.9% risk of infection and a 0.4% risk of a deep infection.

So, it does show patients suffering from diabetes do have a great risk of complications However, that risk is still extremely small.

How accurate is the study?

Although the study has proven successful in identifying an increased risk in diabetes sufferers, it did have its limitations. The main thing which could impact the accuracy of the study is the analysis of HbA1c levels. The tests to measure HbA1c levels can be inaccurate, particularly if the patient is suffering from another condition which may be impacting their blood sugar.

The study was also reliant upon a pretty large database, relying upon the accuracy at which the data was coded. So, the results may not be as reliable as the researchers might have hoped.

How to spot an infected shoulder replacement

The risk of infection after a shoulder replacement surgery is extremely rare. However, it is worth being aware of the signs of an infected joint such as the shoulder.

The main symptoms of an infected shoulder replacement include:

  • Stiffness or pain within the joint
  • Fatigue
  • Swelling
  • Wound drainage
  • Redness and warmth surrounding the wound

If you notice any of these symptoms, you should consult your surgeon immediately. In case of an infection, there are several treatment options available, but early intervention is always best.

Superspecialisation in young athletes means greater risk of injury burnout

injury burnout in young athletesThere has been a significant increase in the number of young athletes partaking in sport ‘superspecialisation’. Believing that focusing on one sport and dedicating 110% to it from a young age will lead to them becoming a much better athlete, these young athletes are actually at great risk of burning themselves out.

Not only that, but they are also setting themselves up for an injury which could jeopardise their career. Surgeons are seeing an increasing number of young athletes seeking treatment for overuse injuries, especially in the shoulder.

Here, we’ll look at how superspecialisation can lead to a greater risk of injury burnout in young athletes.

Why superspecialisation poses a risk of injury burnout in young athletes

It’s easy to see the logic behind young athletes wanting to focus specifically on one sport. After all, the more you practice just one sport, the better at it you’ll become right?

Unfortunately, there isn’t actually any evidence to suggest that superspecialisation does make you a better athlete. In fact, there’s even been some evidence to suggest that partaking in multiple sports rather than just one, is what creates a better athlete. Partaking in multiple sports also greatly reduces the risk of injury.

 

The trouble is, when young athletes over-train in one sport, they’re placing themselves at a high risk of repetitive injuries. Overuse shoulder injuries are especially common and can prove damaging to a young athlete’s career. Those who do multiple sports, on the other hand, are continuously using different muscles groups, reducing the risk of injury.

Female athletes at greater risk of overuse injury

Interestingly, the type and frequency of the injuries developed through superspecialisation is totally different between young men and women. In fact, it’s estimated that young women are up to seven times more likely to develop an injury through superspecialisation.

It is thought that hormonal and anatomic differences contribute towards the greater risk in young women. The type of sport also makes a difference, with young women more likely to suffer an injury playing softball, volleyball and football. For young male athletes, overhead sports tend to pose the greatest risk.

Common shoulder injury burnout in young athletes

The main shoulder injuries young athletes partaking in superspecialisation risk, are overuse injuries. Any athlete can develop a shoulder injury because of overuse of the arms, but young athletes are particularly susceptible due to the fact the ligaments, tendons and muscles are not yet fully mature. This means they haven’t yet developed maximum strength, making them prone to tears and stretching. Tendonitis, rotator cuff tears and shoulder instability are just some of the common injuries young athletes face.

If caught early enough, shoulder injuries can often be repaired via plenty of rest and strengthening exercises. However, if left untreated, the shoulder injury is likely to worsen, leading to potentially months out of the field and a long and painful recovery.

While superspecialisation may seem like the best option to become a better athlete, young people do need to be aware of the increased dangers it brings. Shoulder injuries can lead to significant time out and in some cases, could completely destroy a young athletes career. Those who believe they have injured their shoulder should always seek immediate diagnosis. The earlier the problem is diagnosed, the easier and less painful it will be to treat.

Wimbledon Special: avoiding tennis shoulder injuries

The countdown to Wimbledon 2018 is on and tennis stars from across the world are ramping up their training for one of tennis’ most glittering prizes. However, with vigorous training comes an increased risk of injury – especially to the shoulders.

Tennis players are at risk of numerous types of injuries, but shoulder injuries are potentially one of the worst. They can put a player out of action for months, possibly even ending their career depending upon the severity. So, what shoulder injuries are tennis players susceptible to and how can they be prevented?

Common tennis shoulder injuries

preventing tennis shoulder injuriesDue to the highly dynamic and unusual motion, the shoulders are put through during overhead throwing sports such as tennis, the risk of injury is pretty high. Below, we’ll look at some of the most common shoulder injuries tennis players face throughout their career.

  • Labral injury:  The shoulder joint socket is surrounded by the labrum, a layer of fibrous tissue. Repetitive overhead motions can cause this tissue to tear, leading to significant pain, joint instability and a limited range of motion. Labral injuries are by far one of the most common shoulder injuries suffered by tennis players.
  • Shoulder bursitis: Commonly linked to shoulder impingement, this condition is caused by the rotator cuff rubbing against the front of the shoulder blade. The friction leads to the bursa becoming inflamed. This condition tends to develop quite slowly, becoming worse over time. Eventually, the shoulder will become very stiff and if it’s left untreated, could freeze up altogether.
  • Rotator cuff tears: Although rotator cuff tears are less common, they do tend to be one of the more serious shoulder injuries in tennis players. The tears typically occur due to overuse of the shoulder, or because of a traumatic injury. The tear can be partial or complete, causing pain whenever the arm is raised or lowered, along with weakness in the arm and in some cases, muscle atrophy.
  • Rotator cuff tendonitis:  Another rotator cuff injury tennis players face is rotator cuff tendonitis. This basically means the tendons become inflamed and it occurs due to overuse of overhead motions.

Each of the shoulder conditions above can vary in severity, making them difficult to diagnose and treat; especially by a GP. Therefore, it is crucial for patients to seek a diagnosis as quickly as possible from a qualified shoulder specialist.

Preventing tennis shoulder injuries

It isn’t always possible to prevent shoulder injuries, especially if you’re partaking in the sport at a professional level. However, building up the strength in the shoulder and back muscles can help lower the risk slightly.

Making sure you’re following the proper posture when carrying out overhead serves is also crucial to injury prevention. However, if a shoulder injury does occur, it is vital you seek early diagnosis.

Tennis players are at an increased risk of shoulder injury. Therefore, if any pain is felt in the shoulder, it is highly recommended the player seeks treatment as quickly as possible. All shoulder injuries will become worse if left untreated. This could lead to significant time away from the sport.

New study into a personalised approach to dealing with shoulder pain

personalised approach to shoulder painA new UK study is set to establish whether a personalised approach to dealing with shoulder pain could be an ideal solution for patients. It is estimated one in five adults within the UK suffer from shoulder pain. However, despite seeking treatment from their GP, 40% of patients continue to experience long-term shoulder pain.

Scientists from the Keele University are being jointly funded by the Arthritis Research UK and the National Institute for Health Research (NIHR). It is set to be the largest study of its kind and the hope is to provide patients with a treatment plan which will best fit their needs.

Here, you’ll discover more about this new study and what it could mean for the future of shoulder pain treatment.

What will the shoulder pain study involve?

The study is set to be one of the largest ever to be carried out into shoulder pain management. It will consist of four different stages and is reportedly costing £2.7 million.

In the first stage, researchers from the Arthritis Research UK Primary Care Centre will analyse existing research alongside the University of Oxford. They’ll use the findings of this research to determine which factors will influence the likelihood of specific treatments benefitting patients.

The second stage will see the researchers follow 1000 patients who have sought help from a physiotherapist or GP for their shoulder pain. This will aid in the development of a decision making and screening tool which will be trialled during a randomised study. It is reported that 500 of the participants will be from Oxfordshire.

New tool could help identify need for intervention

The researchers are hoping that the new tool developed during the study will be able to be used to assess the cause and outcome of shoulder issues. This, in turn, will help them to develop a more personalised treatment plan to match the condition.

As it stands, GPs and physiotherapists don’t currently have a tool which can help them identify a patient’s risk of experiencing long-term shoulder pain. So, if the new tool does prove successful, it will ensure patients who are at an increased risk, get the appropriate treatment they need early on. It will also help patients who aren’t suffering from serious shoulder problems, avoid unnecessary invasive treatments.

Shoulder problems need to be treated as early as possible

The one thing that is known about shoulder problems, is they need to be treated as early as possible. This is because, the longer the condition is left untreated, the worse it will become. Many patients are currently being failed by their doctors because there simply isn’t a reliable diagnostic tool available.

Existing research has shown that each patient experiences shoulder pain differently, making it difficult for doctors and physicians to determine how severe the problem is.

This new study is certainly promising and if successful, could prove to be a game changer in the diagnosis and treatment of shoulder pain. In the meantime, patients are advised to seek treatment for any shoulder pain they may experience from a qualified, expert shoulder specialist.

Cortisone injections for rotator cuff tear linked to raised risk of revision surgery

cortisone injections and rotator cuff surgeryNew research presented at the Specialty Day for the American Orthopaedic Society for Sports Medicine, has revealed cortisone injections pose an increased risk of rotator cuff surgery revision.

It was discovered that patients who receive cortisone injections within six months of the surgery, were more likely to require a revision surgery in the future. The researchers now suggest surgeons either avoid using the injections, or delay surgery in light of the findings.

How are cortisone injections used to treat the shoulder?

Cortisone injections are a popular treatment for shoulder injuries, often used in combination with rehabilitation. They’re typically used as a potential alternative to surgery. Shoulder surgery is known to have a long recovery period, especially rotator cuff surgery. So, the injections are used by surgeons in an attempt to prevent the need for surgery.

However, in a lot of cases, cortisone injections alone do not prevent the need for surgery. Many patients, therefore, end up requiring surgery within six months of having the injections. However, as this new research from the Medical University of South Carolina shows, these injections can potentially increase the risk of revision surgeries.

Understanding the new shoulder research

The research led by Sophia A. Traven, studied 4,959 patients who had undergone an arthroscopic primary rotator cuff repair. It was discovered 553 of the patients ended up needing a further operation. Out of these 553 patients, 70.9% of them required a revision rotator cuff repair.

Interestingly, patients who had been given cortisone injections within six months of their shoulder surgery, showed to have an increased risk of requiring revision surgery within three years. Patients who received cortisone injections between 6 and 12 months before the surgery showed no increased risk.

Researchers believe the results of the study prove there is a time-dependant relationship between revision surgery and cortisone injections. This could prove crucial to surgeons looking to improve the outlook of shoulder surgery.

Although the research is certainly interesting, the team have stated more research is now required to look into the issue further. They plan to research whether the type of injection matters, and whether or not the number of injections a patient has, can have an impact on the healing process.

Other factors which contribute to failed rotator cuff surgery

Rotator cuff surgery is known to have a higher failure rate than other types of shoulder surgery. It is generally performed as a last resort, but it does prove a largely effective solution when all other methods have failed.

There are numerous reasons a rotator cuff repair can fail. Patients over the age of 55 are known to be at an increased risk. The size of the tear or whether more than one tendon is affected will also determine the chance of success. Smoking, poor overall health and poor muscle or tendon health are also risk factors to be addressed.

Overall, this new research is promising for surgeons, as it could help to reduce the risk of revision surgery. However, other factors will still need to be considered when deciding appropriate treatment.

The Happiness Factor: living with chronic shoulder pain

living with chronic shoulder painA new study published within The Journal of Bone and Joint Surgery 2017, has revealed the effect shoulder arthroplasty has on a patient’s happiness. A team from Harvard, led by Dr Jon J.P Warner, carried out the research to see just how much of a difference shoulder surgery can make to a patient’s quality of life.

Up until now, the majority of research into shoulder surgery has related solely to the procedure itself. However, as growing emphasis is starting to be placed upon patient-centred outcomes, a look into the psychology of patients can prove useful for surgeons.

Here, we’ll look at what the study revealed, and the difference shoulder arthroplasty can make on a patient’s psychological state.

What did the shoulder arthroplasty study reveal?

The study, entitled ‘Changes in Psychological Status and Health-Related Quality of Life Following Total Shoulder Arthroplasty’, involved 46 patients who were due to have a total shoulder arthroplasty. They each completed a Visual Analog Scale to measure pain, along with the Subjective Shoulder Value, the American Shoulder and Elbow Surgeons Scale, the Abbreviated Version of the World Health Organization Quality of Life Scale and the Hospital Anxiety and Depression Scale.

It was revealed that total shoulder arthroplasty had a significant impact on anxiety and depression scores. It also boosted overall optimism and attitude. The only thing the surgery did not appear to do was improve the patient’s social relationships.

What it is like living with chronic shoulder pain

Chronic shoulder pain is known to have a significant impact on psychological health. The majority of patients tend to suffer in silence with shoulder pain for long periods of time before seeking treatment. The longer the pain is left untreated, the unhappier patients become. It is estimated that 1 in 10 people in the UK are living with chronic pain and it can negatively affect sleep, relationships, work and state of mind.

Early treatment can make a substantial difference to patient happiness

In terms of increasing patient happiness, it is vital treatment is sought as soon as possible. Patients need to seek help for shoulder pain much earlier if they want to avoid experiencing conditions such as depression and anxiety.

Chronic shoulder pain is categorised as pain that has been present for at least six months. So, if patients were to seek treatment earlier, they could not only avoid chronic pain, but also increase their overall happiness.

Surgeons are used to dealing with the mechanical side of shoulder surgery. However, Dr Warner now believes they need to start focusing more on the psychological side too. Doing so will help to improve patient satisfaction and ultimately lead to many seeking earlier treatment.

Overall, surgeons are starting to consider the happiness of their patients and this new research could prove to be an extremely useful guideline for them to follow. Total shoulder arthroplasty could significantly change a patient’s life.

Non-surgical approach recommended for shoulder instability in young athletes

 

shoulder instability in young athletesAccording to recent research, young athletes suffering from shoulder instability would most benefit from a non-surgical approach. It also revealed a Non-Operative Instability Severity Score tool (NSIS), would help to identify patients at a higher risk, who could require other treatment options.

The research, conducted at the Steadman Hawkins Clinic of Carolinas, was presented at the American Orthopaedic Society for Sports Medicine. It assessed high-school students who had suffered anterior shoulder instability for the first time. The results are promising, highlighting that current controversial non-surgical techniques could be the best way forward.

Majority of participants could return to sport

The research followed a total of 57 adolescents who had been initially treated with a non-operative approach. It revealed an impressive 79% of them were able to return to sport. Not only that, but they didn’t need to miss any playing time or practice.

The researchers were also able to identify risk factors which could ultimately contribute towards the failure of non-operative techniques. One of the highest risks discovered was bone loss. It was revealed patients with bipolar bone loss had a 67% rate of failure.

NSIS tool helps identify higher-risk patients

As it stands, non-surgical approaches are controversial. It can be difficult for physicians to decide how to treat shoulder instability in young athletes. However, this recent research has identified the NSIS tool can help to establish the best course of treatment.

The NSIS ranges from 1-10. After analysing the NSIS results of the participants, it was discovered those with a score less than 7 had a 97% success rate. Those who scored more than 7 however, had a 59% success rate. So, the NSIS tool could help to identify those at a greater risk, allowing physicians to opt for an alternative treatment option.

The research also discovered other risk factors as well as bone loss, including age, gender, type of sport and the type of instability. Those who were over the age of 15 and female were shown to have a higher risk.

While the results of this latest study are promising, the researchers claim larger, more in-depth studies will be required to build upon the data collected.

The importance of seeking early treatment

Shoulder instability in young athletes is common, with many patients waiting too long to seek treatment. Pain is the most common symptom of shoulder instability, making it easy for patients to avoid seeking treatment as they mistakenly believe it’s temporary.

The trouble is, leaving shoulder instability untreated will cause the problem to become much worse. Unless treated quickly, non-surgical approaches wouldn’t necessarily be viable. Therefore, the earlier the problem is detected, the higher the chance it will be able to be treated non-surgically.

Overall, young athletes need to be aware of the risks of developing shoulder instability and the treatment options available. This latest research shows non-surgical treatments can prove effective at resolving the issue. However, further research does need to be required to determine just how effective a non-surgical approach is on a larger scale.

Golf and the shoulder: how to prevent injury

golfing shoulder injuriesGolf is often assumed to be a gentle, relaxing sport. However, as professional golfers know only too well, the risk of injury can be pretty high. It is estimated that 62% of amateur golfers suffer a severe injury which impacts their ability to play.

In particular, shoulder related injuries in the sport are common. Even professional golfers find themselves at risk of painful rotator cuff injuries. Last year, Masters former champion Danny Willett, was forced to end the season early, due to a rotator cuff injury. Now, as the 2018 Masters tournament tees off in Atlanta, players will no doubt be keen to avoid the same fate as Willett.

While the risk of shoulder injury is always going to be present, there are things you can do to minimise the risk. Here, we’ll look at how to prevent injury to the shoulders when playing this popular sport.

Common golfing shoulder injuries

Golfers can suffer an injury in both their leading and their non-leading shoulder. When they swing the club, the leading shoulder is pushed into a pretty extreme adducted position. The non-leading shoulder is at the same time, pushed into a more abducted externally rotated posture. This combined movement causes each shoulder to experience different pathologies.

As each shoulder is forced into different positions, the injury risks differ between them. The leading shoulder is at a higher risk of developing posterior instability and AC joint pain. The non-leading shoulder is more likely to develop SLAP tears and anterior instability. Both shoulders have an equal risk of developing subacromial impingement and rotator cuff tears.

How can you prevent golfing shoulder injury?

Although injuries cannot be 100% avoided, there are things you can do to prevent the risk of shoulder injury in golf.

Labral tears, for example, have become a very common injury in the leading shoulder, and they’re reportedly caused by a poor backswing technique. If you keep the arm too tight against the chest when you swing the club backwards, it can easily tear the labrum. This is responsible for stabilising the shoulder joint and a tear will lead to extreme pain around the rear of the shoulder.

This type of labral tear can be prevented by swinging less and turning more. This may not easy for some golfers, as it can prove to be physically challenging to turn the upper body more.  It is also important to stop the arm from swinging once the body has stopped turning. Experts suggest trying to swing using the turn, rather than relying upon the shoulder muscles.

Other ways to prevent shoulder injury include taking part in a specialised golf training program and ensuring good conditioning. A golf-specific program will help to develop and strengthen the muscles around the shoulder and the back, helping to reduce the risk of injury.

Overall, shoulder injuries are common in golf so preventative measures are necessary for those looking to stay on the course. It is also important to seek treatment as soon as an injury occurs. The longer you leave it, the worse the injury will become and the more time you will spend being unable to play.

Returning to Work After Shoulder Arthroplasty

returning to work after shoulder surgeryThe number of total shoulder arthroplasties carried out on patients under the age of 55 has seen a significant increase in recent years. As the number of younger patients seeking shoulder surgery continues to increase, returning to work understandably becomes a serious concern.

A recent study has reviewed the prognosis for younger patients to return to work after undergoing shoulder surgery. Here, we will look at the results of the study and how shoulder surgery can affect your return to work.

Majority of patients under age 55 return to work

The study was carried out to determine the ability of patients aged 55 and under, to return to work after anatomic total shoulder surgery. The researchers looked into the intensity of work carried out, the time taken out of work and when the patients returned.

It was revealed that 92% of patients were able to return to work within 2.1 months after the surgery. All of the patients who had a sedentary, light or moderate intensity job returned to work. For those who had a heavy intensity job, 64% were able to return. Most patients – 92% in all – claimed they were either satisfied or very satisfied with their results.

Although this is just one study, it does appear to highlight the prognosis for younger patients to return to work after shoulder surgery is excellent.

Tips to ensure a successful return back to work

Although the study showed the majority of younger patients typically return to work within 2.1 months, there are things you can do to ensure optimal recovery. Patients who smoke, for example, are advised to quit prior to the surgery as tobacco use has been linked to a longer, more painful recovery.

In regard to when you should return to work, you will need to follow your surgeon’s advice. The complexity of the shoulder joint means that it is under pressure even in sedentary jobs where you perform repetitive actions. Therefore, you will need to be realistic about what you can achieve.

You should never attempt to return to work before your shoulder surgeon advises. This is because although some types of shoulder surgery enable you to go back to work within a week, total shoulder arthroplasty is a more complex surgery. The shoulder will need approximately six to eight weeks to recover. If you attempt to go back to work too early, you could end up reinjuring the shoulder and further surgery could be required.

Compared to rotator cuff surgery, where patients could end up out of work for a much longer time period, the 2.1-month prognosis for younger patients after shoulder arthroplasty is relatively quick. As with all types of shoulder injuries, the earlier it is treated, the more successful surgery will be and the less recovery time you will need.

If you have been experiencing shoulder pain, or you think you may need a shoulder arthroplasty, book a consultation today. Putting off the surgery because you’re worried about the potential time off work could result in a worsening of the shoulder condition which could end up requiring you to take even more time off.

Smoking and Shoulder Surgery Recovery

smoking and shoulder surgery recoveryA new study has revealed that smoking after shoulder surgery can negatively impact the outcome of the procedure, as well as cause increased pain in patients. Smokers were also found to use more narcotics in order to control the pain after surgery, compared to non-smokers.

We’ll look at how smoking impacts shoulder surgery recovery and the measures that patients can take to ensure optimal recovery.

Smoking increases risks and cost of recovery

The new study, carried out by Dr Thomas Throckmorton and his colleagues at an American university, revealed tobacco users have a reduced mean improvement in their VAS scores than non-tobacco users. It looked into results of 163 patients who had undergone a total shoulder arthroplasty.

After 12 weeks, the study also showed tobacco users required more oral morphine; suggesting tobacco increases the amount of pain felt after shoulder surgery. The findings were published within the Journal of Shoulder and Elbow Surgery.

This isn’t the first time a study has revealed the negative impact of smoking. Several studies have revealed the adverse effects smoking can have on surgical recovery. In 2015, a study determined that smoking has a negative impact on the outcome of soft tissue-based shoulder injuries from both a clinical and basic science outcome perspective.

It wasn’t all bad news, however. The researchers didn’t find any real difference between the risk of complications or length of hospital stay in the two groups. What it does show is that tobacco use does negatively impact both the outcome of the surgery and it can lead to a tougher recovery.

Quitting smoking greatly reduces shoulder surgery risks

We are well aware of the damage that smoking can do to our lungs, but it can also negatively impact on our bones, muscles and joints, often contributing to a poor outcome from orthopaedic surgery. Nicotine can slow down the production of cells that form bones meaning broken bones can take longer to heal in smokers. Smokers also have a higher rate of complications from surgery including poor wound healing and higher infection rates.

A promising discovery made in the study was patients who quit smoking prior to having shoulder surgery can expect the same potential outcome as a non-smoker. So, if a patient is concerned about the potential tougher recovery, if they quit beforehand they can significantly reduce the tobacco-related risks.