shoulder labral tear

Is surgery necessary to repair a shoulder labral tear?

A shoulder labral tear is a common shoulder injury, particularly for athletes that participate in sports that involve overhead motion, such as netball, swimming or weightlifting. They most commonly occur due to wear and tear, though they can also occur due to trauma or injury.

If a shoulder labral tear is diagnosed, there are non-surgical treatment options which can help you resume normal day-to-day activities with full mobility and reduced discomfort. However, to return to competing at your previous level in your chosen sport then a surgical repair of the labrum may be required.

What is a labral tear?

The labrum in the shoulder is basically a cartilage disc which is attached to the shoulder socket. It plays a crucial role in ensuring the ball of the shoulder is kept securely in place. It also helps to ensure stability and movement within the shoulder.

Like any part of the shoulder, the labrum is susceptible to injury. Repetitive movements are the most common cause of labral tears, meaning they are especially common in athletes. As the labrum is exposed to repetitive strenuous movements, it will start to fray over time, becoming prone to tears.

There is also the possibility trauma, or an injury could lead to a labral tear. These types of sudden tears tend to be more severe, with some resulting in a total dislocation of the shoulder.

What symptoms does a shoulder labral tear present?

Many shoulder injuries present similar symptoms. If suffering from a shoulder labral tear you will typically feel either an aching or pain within the shoulder, and the joint may be weak or unstable. You may also experience a popping sensation, along with pain when you carry out certain overhead movements, such as throwing a ball. A shoulder specialist will be able to diagnose the problem correctly and recommend the best treatment option for you.

Is shoulder surgery the best option?

Surgery is typically the main course of treatment offered for labral tears. However, it will depend upon your lifestyle and how severe the tear is.

If you live a more inactive lifestyle and the tear isn’t too serious, you may choose not to opt for a surgical repair. Non-surgical treatment options include taking a break from activities that are causing pain and using anti-inflammatory medications to decrease pain and swelling in the shoulder. Once pain and swelling have decreased, then physical therapy can help to strengthen the shoulder muscles, improving function and mobility.

However, if you’re a keen sports player and you want to get back to playing as soon as possible, surgery will be the best option. This is because the labrum isn’t able to fully repair itself, so while the tear may improve, without surgery it’s unlikely to ever fully heal. This means there could still be some level of pain and weakness experienced if you do choose to avoid surgery.

If you suspect you are suffering from a shoulder labral tear, book a consultation with the London Shoulder Specialists today. You will be assessed to establish whether or not a labral tear is responsible for your shoulder pain and from there you will discover the best treatment options moving forward. To book an appointment, call +44 (0) 203 195 2442.

anterior shoulder pain

Determining the Cause of Anterior Shoulder Pain

The shoulder is one of the most complex and largest joints within the body. Therefore, there are a lot of ways you can injure it on a day-to-day basis.

Most commonly, shoulder pain occurs in the posterior (back) of the shoulder. However, there are a few types of injuries which can lead to pain in the anterior (front) of the shoulder. If you’re experiencing anterior shoulder pain, determining the root cause is crucial before treatment can be recommended. Here, you’ll discover some of the most common causes of anterior shoulder pain and the types of treatments available.

Anterior shoulder pain and rotator cuff injuries

Rotator cuff injuries are one of the most common injuries to result in pain throughout the shoulder. If it becomes inflamed or injured, it can lead to anterior shoulder pain. The type of pain experienced can range from more of a dull aching, to sharp, intense pain and even potentially immobility.

Most commonly, an injury to the tendons of the rotator cuff is caused by repetitive injury. However, you can also damage the rotator cuff through a sudden injury. These types of injuries tend to lead to other symptoms too such as shoulder weakness, popping of the shoulder and with severe tears, you may struggle to actually use the shoulder and arm.

Anterior shoulder pain and fractures, breakages and injured tendons

The most common causes of anterior shoulder pain are fractures, breakages and injured tendons. If you place a lot of repetitive strain onto the shoulders, through heavy lifting for example, or through playing sports, it can lead to a repetitive injury.

If you’re suffering from a fracture, you’ll typically notice severe pain, along with bruising and swelling. They tend to result from a fall onto the arm or shoulder. There’s also the possibility that you may have dislocated the shoulder. If the arm looks out of place, or if there is pain, numbness, weakness and swelling, it’s likely a dislocation injury.

Anterior shoulder pain and Adhesive Capsulitis

Also referred to as frozen shoulder, Adhesive Capsulitis typically develops if the shoulder hasn’t been used properly. It can occur through biceps tendinopathy, rotator cuff tendinopathy or trauma to the shoulder.

If this is the cause of your shoulder troubles, you’ll experience pain, as well as a decrease in the motion of the arm. Your shoulder joint may also feel stiff.

Anterior shoulder pain and shoulder osteoarthritis

Finally, osteoarthritis can also cause anterior shoulder pain. Also referred to as wear and tear arthritis, it’s caused when the bones rub against one another, wearing away the cartilage between them. Common symptoms of osteoarthritis in the shoulder include pain, stiffness and swelling of the joint.

Different types of shoulder injuries will require different types of treatment and delaying seeking diagnosis and treatment, typically means the problem will worsen rather than resolve itself. For an appointment with the London Shoulder Specialists, call 0203 195 2442.

physio for shoulder pain

Physio for Shoulder Pain Works Better When You Actually Believe It Will Help

A new observational study has revealed that physio for shoulder pain works better when patients believe that it will help. Carried out by researchers from the University of Hertfordshire and the University of East Anglia, the results of the study highlight just how powerful the mind can be at helping the body to heal.

Here, we’ll look at the findings of the study and how self-belief and positivity can potentially help to ease shoulder pain.

Understanding the study

In the first study of its kind, researchers followed over 1000 patients who were undergoing physiotherapy for shoulder pain. All of the patients were receiving physiotherapy at 11 NHS trusts, along with social enterprises throughout East England.

The team analysed 71 different patient characteristics and clinical findings before and during their first physiotherapy session. Then, they assessed follow up information provided by 811 patients six months after. It was discovered through the follow up information provided, that the majority of patients experienced improvement through physiotherapy.

The results revealed that those who experienced a higher level of pain and disability at the start, also experienced higher levels within six months than those who had a lower level of pain. However, the most surprising finding was that those who believed physiotherapy would work, experienced more significant improvements.

The more positive you are, the better you’ll heal

The study found that the more positive patients are about the effectiveness of physiotherapy, the better they healed within six months. For example, those who thought they would fully recover after physiotherapy, healed better than those who thought they would see the pain much improve.

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They also discovered that although those with a higher level of pain and disability at the start had higher levels six months on, those who had the confidence to do things despite their pain generally experienced better results. In fact, through self-belief, some patients with a higher baseline of disability and pain experienced better results than those with low baselines levels.

The study follows on from previous research which has revealed that a patient’s expectation of recovery could predict the outcome of physiotherapy for neck and back pain, as well as orthopaedic surgery.

Could the findings help patients avoid surgery?

So, if self-belief can significantly improve shoulder pain and enhance the effectiveness of physiotherapy, does this mean that patients could avoid surgery? It would largely depend upon the type of injury sustained. Significant injuries are still likely to require surgery is physiotherapy isn’t working.

Physiotherapy does tend to be the first treatment option for shoulder pain and for patients that do not respond to conservative approaches, shoulder surgery is often the best option to reduce pain and increase mobility.

If you are concerned about your shoulder pain, it’s best to seek treatment as soon as possible. There are lots of different causes of shoulder pain so getting a proper diagnosis is key. Book a consultation with a shoulder specialist today to determine the cause and best course of treatment for your shoulder pain.

Mr Andrew Wallace attends Sydney Shoulder Symposium

Mr Andrew Wallace attends Sydney Shoulder Symposium

London Shoulder Specialist Mr Andrew Wallace recently attended the 13th Royal North Shore Shoulder Symposium: Advanced Shoulder Technologies held at Royal North Shore Hospital, Sydney as invited guest speaker.

Mr Wallace gave several lectures at the Symposium, two of which have been published in this month’s issue of the Shoulder and Elbow Journal.

Mr Andrew Wallace published in Shoulder and Elbow JournalThe first article focused on the shoulder condition that Winston Churchill suffered from and which was to affect him from his younger years and through into his later political career. Entitled ‘Faithful but unfortunate’, the article reviews the historical record of Churchill’s shoulder instability and looks at one of Churchill’s contemporaries, ASB Bankart, who was to propose the surgical approach to management of the unstable shoulder that has become the ‘gold standard’ of treatment.

The second article reviewed arthroscopic Bankart repair with remplissage for non-engaging Hill-Sachs lesion in a group of 20 professional collision athletes and concluded that this combined approach was able to demonstrate good outcomes with lower recurrence rates.

To arrange a consultation with Mr Wallace at the London Shoulder Specialists, call 0203 195 2333 or email

article on shoulder surgery

Mr Steven Corbett publishes arthroscopy article in The Bone & Joint Journal

London Shoulder Specialist Mr Steven Corbett and colleagues have recently published an article in The Bone & Joint Journal. Entitled ‘The assault on arthroscopy: is there a middle ground?’, the article evaluates the role of shoulder surgery in light of the economic analysis of the CSAW (Can Shoulder Arthroplasty Work) trial that is also published in this issue of the journal.

The CSAW trial focused on the use – or overuse – of shoulder arthroscopy and subacromial decompression procedures.

They also reference the evidence of clinical trials investigating the role of arthroscopy in the treatment of orthopaedic conditions.

Mr Corbett and his fellow authors believe the CSAW trial is an important project and its results should be carefully considered but had some concerns with the scope of the study.

They highlight the limitations of the project, whilst welcoming further studies to help the management of patients.

The CSAW trial was supported by the British Shoulder and Elbow Society who are reviewing the current guidelines it provides to orthopaedic surgeons in the light of its findings.

The article concluded that “as a surgical community, we welcome any and all studies that explore the efficacy of operations and the surgical pathway, and will continue to engage with them.

“While there is no doubt that the overuse of arthroscopic procedures needs to be rationalized, it is still important not to withhold surgery from those who need it.”

Mr Ali Narvani on irreparable rotator cuff tears

London Shoulder Specialist Mr Ali Narvani’s article on irreparable rotator cuff tears

An article on Superior Capsule Reconstruction was recently published in The Archives of Bone and Joint Surgery by London Shoulder Specialist Mr Ali Narvani. Alongside colleagues based at Rowley Bristow Unit, Ashford and St Peter’s NHS Trust, Chertsey, Mr Narvani’s article focused on the management of irreparable rotator cuff tears, a shoulder condition that remains challenging.

Superior Capsule Reconstruction (SCR) was first introduced in 2012 by Dr Teruhisa Mihata, a Japanese orthopaedic surgeon, and since then has grown in popularity as an option to treat severe irreparable rotator cuff tears.

Mr Narvani and colleagues reviewed the available literature on the procedure and their conclusion was that short-term clinical results show it is a promising treatment option but further long-term trials, which compare SCR to other treatment options are required. Clarification on the importance of the choice of graft type and thickness is also needed.

pinched nerve in the shoulder

Can a pinched nerve in the shoulder go away by itself?

A pinched nerve in the shoulder, also known as a compressed or entrapped nerve, can be incredibly painful and debilitating. The good news is that most cases of pinched nerves will resolve itself with rest or over-the-counter anti-inflammatory medications, but there is a point when you should seek medical intervention for a pinched nerve in the shoulder.

The suprascapular nerve can become compressed or restricted, either due to direct trauma or due to overuse injury. Shoulder dislocations, labral tears or cysts can all press on the nerve. Repeated overhead movements can result in a pinched nerve in the shoulder so this can be a common problem for athletes such as swimmers or tennis players, or those who work in certain jobs.

What are the symptoms of a pinched nerve in the shoulder?

A pinched or compressed nerve will cause pain and numbness in the shoulder region. You may also experience muscle weakness that extends down the arm to the hand and neck pain when you turn your head. As well as numbness, you may find you have tingling in the hand and fingers.

Your shoulder specialist will take account of your symptoms when diagnosing the cause of the pinched nerve and determine the amount of pain you’re experiencing and how your range of movement is affected. An X-ray or CT scan be used to identify any bones that may be pressing on the nerve and an MRI will assess the soft tissue and nerves.

How is a pinched nerve in the shoulder treated?

Depending on the cause of the pinched nerve, how severe the pain you’re experiencing is and how it’s impacting on your ability to perform daily activities, your shoulder specialist will typically advise a non-surgical approach first.

Non-surgical treatments for a pinched nerve include non-steroidal anti-inflammatory drugs, and oral and injectable corticosteroids to target inflammation and swelling. Physical therapy and lifestyle changes are also advised, but if a non-surgical approach fails to produce a decrease in pain and increase in function, surgery may be recommended.

Arthroscopic decompression of the suprascapular nerve is done through small keyholes, cutting the ligament above the nerve to allow more space. This procedure should result in full movement and reduction of symptoms.

If you’re worried you’re suffering from a pinched nerve in the shoulder, call 0203 195 2442 to arrange a consultation with the London Shoulder Specialists.

Physical Therapy May Reduce Need for Rotator Cuff Surgery

surgery for rotator cuff tearsResults from a new study presented at the annual meeting for American Shoulder and Elbow Surgeons, have revealed physical therapy may reduce the need for surgery for rotator cuff tears. After following participants for five years, the researchers discovered patient expectation was the main predictor of surgery.

Surgery for rotator cuff tears is renowned for its long and often painful recovery process. So, could these latest results change how rotator cuff tears are treated? Here, we’ll look at the study and its findings, and whether physical therapy could prove more effective than surgery.

The findings of the study

 The study led by John. E. Kuhn followed a total of 433 patients for five years, who had been diagnosed with an atraumatic full-thickness rotator cuff tear. Data was provided via questionnaires on factors such as willingness to undergo surgery, symptom characteristics, comorbidities, patient-related outcome and demographics.

The researchers also created a physical therapy routine that the participants followed, and they were assessed at 6 and 12 weeks. During the final evaluation, the patients were asked to choose between three different options. These included, cured with no follow up required, improved followed by continued therapy and an assessment in 6 weeks, and no better with the option of surgery.

Out of all of the participants, just 24% had opted to have rotator cuff surgery, with 75% choosing not to undergo surgery. Those who did undergo surgery, largely did so within the initial 12 weeks of therapy. Activity scale, smoking and patient expectations were the three driving factors behind the 2-year results. After five years, the size of the tear and workers compensation both had a major influence on surgery decisions.

The most significant finding was that patients who believed the physical therapy would work, did find it to be effective. So, patient expectations certainly play a role in the effectiveness of physical therapy.

Should surgery be used as a last resort for rotator cuff tears?

These new findings certainly aren’t surprising. Shoulder specialists have been using physical therapy as a first response treatment for years now. Due to how complex rotator cuff surgery can be and the long recovery time, it is typically used as a last resort treatment. However, what the research could aid with, is convincing patients that physical therapy can work. As there is a direct link between patient expectations and therapy outcomes, ensuring they understand the benefits of physical therapy is crucial.

It is also important to recognise when surgery would be most effective. This can typically be determined fairly early on if the pain isn’t subsiding. However, numerous factors will be assessed before deciding whether or not surgery is the best course of treatment moving forward.

This new research highlights the importance and effectiveness of physical therapy as a first treatment option for rotator cuff injuries. It also provides hope for patients, showing surgery may not necessarily be required. Those who do suspect they are suffering from a rotator cuff injury should seek treatment as soon as possible. The earlier it is diagnosed, the more effective physical therapy is likely to be.

Shoulder dislocation vs shoulder subluxation

As the shoulder is the largest and one of the most used joints in the body, it is prone to a wide range of injuries. Two common injuries which can arise are shoulder dislocation and shoulder subluxation. So, what is the difference between the two and what treatment options are available?

Shoulder dislocation

A shoulder dislocation occurs when the ball of the joint completely separates away from the socket. It’s a fairly common injury due to how shallow the socket is. It doesn’t take much force for the ball to be knocked out of the socket and most patients tend to suffer from an anterior dislocation. This is where the ball comes out of the socket and is pushed towards the front.

Shoulder dislocations tend to occur due to a fall as the basic instinct is to put your arm out to stop yourself as you hit the ground. The force of the fall can then dislocate the shoulder.

Shoulder subluxation

A shoulder subluxation is actually a kind of dislocation, only the ball and socket don’t fully separate. Instead, they remain connected but severely out of alignment.

This type of injury usually occurs if there has been some form of damage to the tendons or muscles surrounding the ball and socket. An injury, such as a torn rotator cuff, can lead to the weakening of the ball and socket, allowing them to slip out of alignment. As the ball and socket aren’t completely separated, there is the possibility they could pop back into place by themselves.

As shoulder subluxation and shoulder dislocation can cause very similar symptoms, it can be difficult to know which one a patient is suffering with. Therefore, a proper diagnosis by a shoulder specialist is crucial to determine which type of treatment is required.

How are shoulder dislocation and subluxations treated?

If your shoulder is dislocated, it is really important not to try and pop it back into place yourself. There have been many instances on television, where you see people popping their own shoulders back into place. However, if done incorrectly, it could actually damage the muscles and ligaments of the shoulder joint. So, it is much safer to pop the arm into a sling until you can get to the doctor or shoulder specialist.

You will be given an assessment and potentially an x-ray to determine whether you are suffering from a dislocation or subluxation. From there, your shoulder specialist will be able to see the true extent of the injury and they will be able to assist in popping the shoulder back into place before a treatment plan is created.

Depending upon the extent of the dislocation, the specialist may decide to pop it back into place while the patient is under general anaesthetic. Once it is in place, a sling will usually need to be worn for a few weeks while it heals and sets back into place.

Overall, shoulder dislocations and subluxations are similar injuries, but subluxations are typically less severe. If you’re worried you may be suffering from a dislocation, it’s extremely important to visit a shoulder specialist before attempting to treat it.

Yoga and Pilates for Shoulder Injury Prevention

British competitive swimmer Ben Proud who is a World and European Champion in freestyle and butterfly races recently spoke about how he does yoga and Pilates to prevent shoulder injuries derailing his medal-winning hopes. Over half of his workout routine is dedicated to shoulder rehab and he finds these types of exercise are best for shoulder injury prevention.



Even if you’re not a competitive swimmer, you can be prone to shoulder injury; the shoulder is one of the most used joints in the body, making it susceptible to a wide range of injuries. While treatments have come a long way in the past decade, shoulder injury recovery can still prove to be a long and potentially painful process. Therefore, those who are at risk of developing shoulder issues, such as professional swimmers and young athletes, ideally need to focus on preventative measures.

One of the best ways to prevent injury is to build up the muscles and strength within the shoulder. While there are lots of ways to do this, yoga and Pilates are known to be especially effective. Here, we’ll look at how these two forms of exercise can aid in shoulder injury prevention.

How do yoga and Pilates help with shoulder injury prevention?

Yoga and Pilates work in several ways to prevent shoulder injuries. Firstly, the poses can really help to build up the muscles surrounding the shoulder and rib cage. The stronger these muscles become, the more resistant to injury they are going to be.

Another way these exercises help is by teaching you how to use the muscles of the shoulder blades and rotator cuff more effectively. This, in turn, allows you to reduce the strain placed upon the muscles due to incorrect posture and movement.

Finally, both yoga and Pilates are designed to strengthen the core. Focusing largely upon the deeper, smaller muscles located in the stomach and back, the poses help to build up strength, allowing the core to better control the spinal position during dynamic movements. Building up a strong core can really help to prevent against numerous types of injury, including shoulder injuries.

Which poses should you focus on?

While a lot of yoga and Pilates exercises can really help to build up strength and stability in the shoulder, some are considered better than others and you should always moderate if you feel you are putting pressure on the shoulder joint. For example, the plank pose is known to be one of the most effective core-building exercises. However, it can place a significant amount of pressure onto the shoulders; especially if you’re a beginner to this type of exercise, so it is best to moderate the action by starting off with the Wall Plank Pose.

Whether you wish to prevent a shoulder injury occurring or looking for a workout routine post-shoulder surgery to help you return to full function, yoga and Pilates could be the solution.