The shoulder is the most common injury site in competitive diving

diving shoulder injuriesCompetitive diving has become increasingly popular in recent years. However, up until recently, very little research has been carried out to understand the potential injuries involved with this admired and much-loved sport.

Now, a new paper written by a sports medicine physician from Loyola Medicine, has revealed some of the risks competitive divers face. Among them, the shoulder was found to be one of the most common injury sites in the sport.

Both training and competing pose shoulder injury risk

The paper, which was published within the Current Sports Medicine Reports, discovered diving shoulder injuries could occur due to both training and competing. Most worryingly, it revealed that even when a dive is executed perfectly, shoulder injuries could occur.

Perhaps the largest contributors towards the risk of shoulder injury in competitive diving, are impact force and velocity. Divers using a 10-metre platform can hit the water at a staggering 37mph. Once they hit the water, their velocity can reduce by as much as 50% in less than a second.

Such high velocities and impact force pose a risk both during the dive, as well as over time due to repeated exposure. It is thought competitive divers train for around 40 hours each week. Springboard divers can carry out as many as 150 dives each day. While they tend to hit the water at a much lower speed of 19mph, over time due to how many dives they carry out during training, shoulder injuries can occur.

Injuries can even occur during on-land training

While competitive divers are most at risk of shoulder injuries in the water, they’re also at risk of developing an injury on-land too. Strenuous training to condition the body such as gymnastics, trampolining and strength training all increase the risk of injury.

Add to that the strict diets divers often follow, and the risk is increased further due to fatigue and low energy levels. It also increases the incidence of eating disorders within the sport.

This new research helps divers, their trainers and physicians, to better understand the risks involved. However, it also highlights the need for further research into repetitive exposure to the large forces which have been shown to disappear when the diver hits the water.

What it does show for now, is that competitive divers need to be careful of overtraining and the importance of using the correct diving techniques.

Can competitive diving injuries be prevented?

As mentioned earlier, competitive divers are at risk of injury even if they execute a perfect dive. However, there are ways to potentially lower the risk of shoulder-related diving injuries.

Strengthening the shoulders and back is one of the best ways to prevent against dislocation and other common injuries. It is also important for divers to avoid overtraining and to ensure they are choosing a reliable, experienced and responsible trainer.

If a shoulder injury does occur, immediate treatment should be sought. In severe cases, surgery may be required to prevent injury reoccurrence. However, the earlier it is treated, the less invasive the treatment will need to be and the less likely it is to impact a diver’s career.

Surgeons suffering from ‘epidemic’ of shoulder strain

shoulder strain injuriesA new study has revealed surgeons are now suffering from more painful shoulders, arms and backs than labourers and coal miners.

Previous studies have shown an estimated four out of five surgeons experience significant pain whilst carrying out procedures. Now, the most recent findings show just how damaging work-related injuries can be for a surgeon. With over 8.9 million working days lost per year in the UK due to work-related musculoskeletal disorders, it’s important to realise that it’s not just those in industries involving heavy and physically demanding labour that are at risk of developing MSK problems.

Poor working environment and repetitive movements blamed for rise in shoulder strain injuries

The rise in shoulder strain injuries within the surgical sector is said to be down to a poor working environment. The recent study carried out by the Harvard Medical School’s Associate Professor, Dr Bernard Lee, did a meta-analysis of 21 different articles. Together, they included data from 5,828 doctors from 1974 to 2016.

It looked into the prevalence of disease in the back, neck and shoulder and the results were alarming. Approximately 17% of doctors studied, suffered with degenerative cervical spine disease. This was followed closely by shoulder rotator cuff pathology in 18% of surgeons.

Long working hours and repetitive movements are contributing to the rise in shoulder strain injuries. If these issues are not addressed, ultimately it will go on to affect the quality of patient care. Even surgeons who carry out minimally invasive procedures are starting to suffer from musculoskeletal problems. The largest study of North American surgeons, revealed a staggering 86.9% of surgeons carrying out laparoscopic surgeries suffered physical discomfort.

Understanding work-related musculoskeletal problems

It isn’t just surgeons who suffer from work-related musculoskeletal problems. Any profession which requires repetitive movements of the arm and shoulder can pose a risk of injury.

In severe cases, it is possible for workers to develop osteoarthritis; a condition which is typically associated with old age. Repetitive stress and strain placed onto the joint cartilage causes it to weaken over time, leading to the condition. It is especially common in workers who operate tools and machinery which transmit shocks and vibrations. It can also be caused by repetitive movements and awkward postures.

Even those sat working at a computer for long periods of time can develop shoulder-related injuries. Repetitive strain injuries can be caused when the tendons and muscles between the wrist and the neck are tensed up for long periods of time. Workers could also experience trapped nerves and erosion of the joints.

Can work-related shoulder injuries be avoided?

Paying attention to posture is also important in the prevention of work-related shoulder strain injuries. Headsets can prove beneficial in the prevention of shoulder strain for workers which spend a lot of time on the phone.

If a shoulder injury does occur, it is vital workers seek treatment as soon as possible. The earlier the problem is treated, the less recovery time will be required. In severe cases, where shoulder injuries have been left untreated, it can prevent them from going back to work, or at least carrying out the same type of job they did prior to the injury. If you suspect you have a work-related shoulder strain, book a consultation today to see what treatment options are available.

Study Finds Reverse Shoulder Replacement Can Be a Lasting Solution to Irreparable Rotator Cuff Tear

A new study published within the Journal of Bone & Joint Surgery, has revealed a reverse shoulder replacement could be an effective and long-lasting solution, to irreparable rotator cuff tears.

Previously, concern has been raised over the durability of the procedure in patients under the age of 65. The findings of the study can now ease those concerns, providing orthopaedic surgeons a deeper understanding of the benefits of the procedure.

What is an irreparable rotator cuff tear?

Irreplaceable rotator cuff tears are the most problematic for orthopaedic surgeons to work on. There’s a lot of controversy and debate over which methods should be used to treat patients. So, what exactly is it?

Irreparable rotator cuff tears are massive tears which aren’t able to be treated with conventional methods. After the tendon is massively torn, the muscle starts to be replaced with scar tissue and fat. This in turn prevents the muscle from contracting enough to rotate the ball of the shoulder socket.

The symptoms vary between patients, though all typically experience a high level of pain. Treatment is decided based upon an individual’s specific symptoms, though surgery is often favoured for younger patients. While in the past there has been concern over the effectiveness of surgery in those under the age of 65, the latest study suggests it could be the best form of treatment moving forward.

Why is the study promising?

The study conducted by researchers from the University of Zurich, analysed 20 patients who had undergone a reverse total shoulder arthroplasty (RTSA) procedure. Their average age was 57, and each had been left with what is known as Pseudo paralysis; meaning they were unable to lift the affected arm.

While traditional shoulder replacements would prove ineffective for these patients, the RTSA method has shown to work well. This is because it uses different muscles, rather than placing an implant into the rotator cuff, to move the shoulder. Initially, this type of surgery was mainly carried out on older patients. However, due to advancements in the field, the method has been improved. This means younger patients can now benefit from long-lasting effects.

In the study, the 20 patients received follow-up assessments between 8-19 years after the reverse shoulder replacement was performed. Three of these patients had undergone a double reverse shoulder replacement, taking the total surgeries for the group to 23. An average Constant Score of 59 was recorded, up from 24 prior to surgery. This score was based upon strength, pain, motion and ability to perform daily tasks.

Complication rate higher in RTSA patients

The only negative shown in the research, was the increased risk of complications. Out of the 20 patients, six of them required a further surgery, while it failed completely in two of them. Complications were shown to affect 39% of patients.

However, despite the higher complication rate, 72% of the patients were happy with the results of the procedure.

While the complications do need to be factored in when deciding whether or not RTSA is right for a patient, this new research shows the results can hold up for a lot longer than previously thought. It is worth noting that there are several treatment options available, so RTSA may not be appropriate for all patients. If you think you are suffering with an irreparable rotator cuff tear, it is important to seek advice from a shoulder specialist prior to undergoing treatment. Call us on 0203 195 2442 to arrange a consultation.

Shoulder Tendon Injuries Found to be Most Common Tendon Injury at Rio Olympic Games

shoulder tendon injury at Olympic GamesThe Rio Olympic Games might be a distant memory for sports fans, but for researchers the data it provided has been analysed and valuable conclusions have been drawn that could help prevent sport injury rates in the future. The most recent research to be released has revealed that athletes at Rio were most likely to suffer from shoulder tendon injuries.

Female track and field athletes were particularly found to have the highest risk compared to other events.

The results, published within the British Journal of Sports Medicine in two different studies, have been the first to include epidemiological data on tendon abnormalities.

All sports injuries from the Rio Olympics were recorded

The study was conducted by researchers in New York, Norway, Brazil, Pennsylvania, France, Germany and Switzerland. All sports injuries reported by athletes taking part in the Rio Olympics in 2016 were recorded and analysed.

In total, the researchers studied 156 tendon abnormality injuries and 25 bone stress injuries. There were 11,000 athletes who took part in the games, representing 200 different countries.

It was discovered that while bone stress related injuries occurred more frequently within the lower extremities of the body, tendon abnormalities were largely found in the shoulder. Imaging was carried out on the injured athletes within the Olympic Village, before being reviewed by two different board certified musculoskeletal radiologists.

A common injury which can jeopardise an athlete’s career

Tendon injuries are common, but they can have a devastating impact on an athlete’s career. Typically, this is because the injury isn’t treated quickly enough. Like any shoulder injury, the longer an athlete leaves it before seeking treatment, the worse it will become.

Failure to detect and treat tendon injuries will prevent the athlete from not only competing, but training too. If surgery is required, it could put them out of action for months, if not a year. However, despite the risks, a substantial number of Olympic athletes continue to train and compete when already suffering from injuries.

It has even been reported that up to 95% of athlete’s who competed in the earlier London Olympic Games in 2012, were injured. As an athlete, competing at the Olympic Games is a dream come true and the culmination of many years of hard work, so it’s unsurprising so many risk further injury by competing with an existing injury.

The study therefore highlights the importance of seeking early treatment, and why imaging could be the best preventative measure.

Further studies required to understand shoulder injury mechanisms

Although the research has proven useful in terms of identifying potential preventative measures, further research is required to understand the mechanisms of tendon related injuries. This will in turn help coaches and specialists create a discipline specific and robust preventative strategy.

For now, the research has shown just how beneficial imaging screening data could be for athletes during the pre-competition stage. It would help to detect chronic legions and act as a preventative measure to ensure any tendon damage is identified and treated early.

While no athlete wants to be out of action, any shoulder pain should be looked into as early as possible. The earlier the problem is detected, the easier it will be to treat and the less damage it will do to your career. If you are concerned you may have a shoulder tendon related injury, book a consultation with a shoulder specialist today by calling us on 0203 195 2442.

Resistance training could be key to staving off shoulder tendon damage


shoulder tendon damageNew findings published within the FASEB Journal, has revealed resistance training could help to prevent shoulder tendon damage. As we age, our tendons become naturally weaker and prone to damage. This means athletes and those who use their shoulders excessively, are more likely to develop long-term problems.

Research into how tendons age is ongoing: in a 2015 study carried out by Queen Mary, University of London, it was discovered that the material between the tendon fibre bundles stiffened as it got older and this was responsible for older patients being more susceptible to tendon injuries.

We know that resistance training can help deliver many benefits throughout a person’s life and here we’ll take look at what this latest study has revealed and how resistance training could help to stave off shoulder tendon damage.

What the study revealed

The study carried out by the University of Brasilia, used groups of rats to determine whether resistance training could work to reduce age-related tendon damage. Four different groups of rats were used, with some remaining sedentary and others participating in resistance training.

Two of the groups were young rats, while the other two were older rats. Within both the young and old groups, one was sedentary, while the other group was progressively weight trained over a 12-week period. Tests were then carried out to determine what effects the resistance training had. It was then that it was discovered the resistance trained rats had fewer signs of tendon damage than the sedentary ones.

The benefits of resistance training for the shoulder

This new study provides a vital insight into the possible prevention of tendon damage, though further research is required to see whether the effects are the same in humans. However, there are some known benefits of resistance training in relation to the prevention of shoulder injuries.

For example, it is well documented that strengthening the rotator cuff can help prevent shoulder injury. Athletes are commonly advised to strengthen the muscles surrounding the shoulder to prevent injury from occurring. It makes sense, as a lot of shoulder-related injuries are caused by weak tendons. So, by strengthening them, it could prevent a wide range of tendon related injuries.

Strengthening and stretching is key

Those looking to not only prevent but treat shoulder injuries, would benefit most from a strengthening and stretching program. Together, they can help to significantly reduce shoulder pain and ensure the shoulders have maximum flexibility and strength.

However, it is extremely important to ensure you seek a diagnosis before undertaking resistance training or stretching the shoulder. There are many different types of shoulder injuries and without diagnosis, you could end up making the injury worse.

A shoulder specialist will be able to determine the best course of treatment and whether a strengthening program would be ideal. If you’re looking to prevent shoulder tendon damage, or you’re experiencing shoulder pain, contact us today to book a consultation.

Shoulder injuries decimate team lists ahead of the Rugby World Cup

rugby shoulder injuriesThe Rugby World Cup may be a year away, but some of the sport’s biggest stars are already out of the tournament. Ireland’s Garry Ringrose, New Zealand’s Nehe Milner-Skudder, South Africa’s Jaco Kriel and Australia’s Izack Rodda, have all been impacted by shoulder injury which sees them potentially missing out on World Cup glory.

Rugby is renowned for its increased risk of shoulder injuries, but the incidence rate appears to have increased in recent years. Not only are rugby-related shoulder injuries becoming more commonplace, but their severity is also increasing too. Here, we’ll explore the type of shoulder injuries common in rugby players and what could be done to prevent them.

Which types of shoulder injuries are rugby players commonly exposed to?

There are a lot of different types of shoulder injuries rugby players are exposed to. However, the most common appear to be:

Labral tears – Out of all of the different shoulder injuries rugby players face, labral tears are one of the most common. The Labrum is incredibly important for proper shoulder function. The cartilage basically provides additional support for the bones within the shoulder. If it tears, it can have a significant impact on the shoulder movement.

In rugby players, a labral tear can occur due to an awkward fall, dislocation, direct impact, or overuse of the shoulder. It’s a painful injury, with the pain worsening when the arm is lowered or raised. Some patients may also hear a popping sound alongside movement of the shoulder.

Rotator cuff injuries – Another common injury, the rotator cuff can become damaged during rugby tackles, or due to an awkward fall. It’s typically injured when the player lands with their arm extended, causing pressure to push the arm too far backwards or downwards.

There are different grades of rotator cuff injuries, with full tears of the tendon being the least common, but most severe a player could face. These types of injuries are also more difficult to treat.

Shoulder instability – Players can develop shoulder instability due to overuse or a sudden injury. With this condition, the upper arm bone is forced out of the shoulder’s socket at the head.

While shoulder instability is most commonly associated with overhead sports, it can occur gradually in rugby players; particularly if they have suffered previous dislocation of the shoulder.

What could be done to prevent shoulder injury in the rugby player?

There are a number of ways rugby players can reduce their chances of suffering shoulder-related injuries.

Firstly, building up strength and flexibility within the upper body will help protect the joints. The more flexible the shoulder joint is, the less likely it will become damaged during a bad fall or direct impact. To prevent injuries caused by overuse of the shoulder, it is important for players to adequately rest between training and matches.

Although it is possible to prevent some rugby-related shoulder injuries, in direct contact sports there is always an increased risk. If you do develop a shoulder injury, the best thing you can do is seek treatment as soon as possible. Problems arise and careers are ruined, when players do not seek immediate treatment. The longer a shoulder injury is left untreated, the worse it becomes and the higher the risk a player will have long-term shoulder issues.

Optimising outcomes from shoulder arthroplasty in York

London Shoulder Specialist member Mr Steven Corbett is attending the British Shoulder and Elbow Society meeting tomorrow on optimising outcomes from shoulder arthroplasty. Held in York, this is the annual meeting of BESS working groups dedicated to driving standardisation in shoulder and elbow arthroplasty, particularly in relation to optimising outcomes for patients.

There will be presentations in implants, procedure techniques, peri-operative care pathways, physiotherapy provision and developing national guidelines for managing joint infections. Mr Corbett is working with colleagues on an approved management care pathway for infected shoulder replacements.

Early Surgical Intervention in Rotator Cuff Tears Produce Long-Term Benefits

A new French study has revealed the benefits of early surgical intervention in isolated rotator cuff tears. According to the study’s findings, if surgery is performed early enough for supraspinatus tears, it helps to improve function and strength, amongst numerous other benefits.

Here, we’ll look at the findings which have been published in The Journal of Bone & Joint Surgery and what it means for patients.

Can the findings be trusted?

The study was conducted by an Orthopaedic Surgery Research Group in France and it followed a total of 511 patients. However, only 288 patients went on to have a follow-up, leading some experts to question the results.

The 511 patients had undergone surgery to repair full thickness supraspinatus tears in 2003. Results of the study were written up at a 10-year follow-up appointment. Out of the 288 patients who did go back for a follow-up, 210 received a magnetic resonance imaging (MRI) scan. This revealed the majority of patients had experienced significant improvement.

The standard Constant score was used to assess shoulder strength, motion, pain and daily activity abilities. In the majority of patients, their score had risen from an average 52 to 78. The scans also revealed around 80% of the tendons had healed, but there was still a minor residual tear found in most cases.

The follow-up also revealed patients who were found to have a build-up of fat in the repaired muscle didn’t heal and recover as well as those who didn’t. Fat build-up within the muscle is a sign of muscle degeneration.

Although the researchers themselves do admit there are limitations of the study due to the fact so many patients didn’t return for a follow-up, they still feel it provides a reliable analysis of how surgery could help to improve the outcome of supraspinatus tears. It’s certainly the longest-term study carried out to assess the benefits of surgery in isolated rotator cuff tears.

What are supraspinatus tears?

There are four major tendons within the rotator cuff of the shoulder, and the supraspinatus is one of them. It is also the most common type of rotator cuff tear patients suffer with. A tear, either partial or full-thickness, can occur because of a trauma, or through repeated micro-traumas.

The majority of full-thickness supraspinatus tears, tend to start out as partial tears and they worsen over time. This backs up the results of the French study in the fact surgery should be carried out early to prevent the condition worsening.

What treatment options are available?

Treatment is decided based upon the severity of the tear. Surgery currently tends to be used as a last resort. Instead, specialists prefer to start out with a physical therapy treatment plan; especially if the tear is only minor. This is because in the past, surgery was known to come with long, often painful recovery times.

However, surgical techniques have advanced and as the French study shows, surgery could be the most effective treatment for early supraspinatus tears. One thing all experts can agree on is the earlier a patient seeks treatment for this type of rotator cuff tear, the better the outcome will be.

Overall, the study’s findings are promising and they do give a good indication of the long-term success rates of early surgery in supraspinatus tears. It also showed the success rate remains the same regardless of whether open or closed surgical techniques are used.

London Shoulder Specialists at the Fortius International Sports Injury Conference

London Shoulder Specialists at FISIC 17This week, the Fortius Clinic hosts FISIC ’17, a multidisciplinary sports conference covering sports injuries ‘from start to finish’. Aimed at orthopaedic surgeons, sports physicians, physiotherapists and other healthcare professionals with an interest in sport, at all levels, it takes place at The Queen Elizabeth II Conference Centre in Westminster, London, on 27th to 28th September.

FISIC ’17 has been awarded 12 CPD points from the BOA, 15 points from the RCP and 12 points from the RCR.

Members of the London Shoulder Specialist team are on the faculty for the event, covering a number of different sessions.

Mr Andrew Wallace is chair of a session on upper limb throwing injuries on Wednesday and one on progression from shoulder instability to stiffness on Thursday. In the Wednesday session, fellow colleague Ms Susan Alexander will cover throwing injuries shoulder pathology in relation to the SLAP and biceps.

Also on Wednesday, two of the LSS team will be presenting on upper limb problems in the cyclist, chaired by Mr Steven Corbett. Mr Andy Richards will be discussing traumatic injuries of the clavicle and, then, Mr Corbett will present on ACJ dislocations. Then, Mr Richards will discuss forearm stiffness in the injured forearm session.

Thursday morning sees a session on sport after arthroplasty, drawing Fortius consultants from all disciplines. Mr Steven Corbett will focus on returning to sport after a total shoulder replacement (TSR).

A key session on the Thursday will focus on football and return to play at an elite level. Mr Andrew Wallace will be discussing contemporary management of shoulder injuries in elite football. He’ll also be reflecting on when to operate on a full thickness tear in the session focusing on the rotator cuff. The role of allograft reconstructions will also be featured in this session, presented by his colleague Mr Ali Narvani.

Two Stryker sponsored workshops on superior capsular reconstruction will also be presented by Mr Ali Narvani.

The shoulder symptoms you shouldn’t ignore

Shoulder problems are extremely common, yet they’re also often ignored. Although some find the issue resolves itself without intervention, the majority of shoulder injuries and conditions will worsen over time.

shoulder symptomsThe impact of musculoskeletal conditions on the economy cannot be underestimated MSKs are one of the primary causes of absenteeism and the UK has one of the highest rates in Europe. Statistics released from the Health and Safety Executive, found that in 2015/16 there were 3,138,000 working days lost due to Work Related Upper Limb Disorders, with workers in the construction industry and skilled trade occupations having significantly higher rates of upper limb disorders.

Here, we’ll look at some of the most common shoulder symptoms you shouldn’t ignore and why it’s important to seek a diagnosis as early as possible.

Common shoulder symptoms to watch out for

Many people underestimate the severity of shoulder symptoms and the effect it can have on their lives. The shoulder is the most mobile joint within the body, making it extremely vulnerable to injury. Symptoms which develop within the shoulder can pinpoint to a number of injuries which is why they need to be checked out as quickly as possible. The most common symptoms to watch out for include:

Pain: The most common shoulder symptom patients experience is pain. Unfortunately, it can link to a wide range of different injuries and conditions, making it difficult to diagnose a specific cause purely from this symptom alone. For example, it could be a sign of a rotator cuff tear, shoulder instability, arthritis or a dislocation.

It is common for patients to put shoulder pain down to overusing the arm, misalignment while sleeping or as a temporary symptom brought on by injury. However, pain in the shoulder should never be ignored, especially if it is severe or brought on due to injury.

Stiffness: Shoulder stiffness is another common symptom often ignored and, like pain, it can be a sign of a more serious issue. Frozen shoulder is a common cause of stiffness within the shoulder joint and it is often mistaken for arthritis. If the condition is behind the stiffness you’re experiencing, you will notice it becoming gradually stiffer and more painful over time.

Stiffness can also be a sign of a dislocated shoulder, a shoulder separation or rotator cuff calcific tendonitis, amongst others.

Swelling: You may notice swelling directly after an injury, or it may develop gradually over time. It can also present itself either on the top of the shoulder or all over. Again, this symptom will typically be accompanied by pain and though it may go down on its own, swelling could pinpoint a more serious injury.

Weakness: If you’re struggling to move the arm or carry out daily tasks due to weakness in the shoulder, this absolutely shouldn’t be ignored. It could be a sign of shoulder impingement, a rotator cuff injury, or shoulder instability.

Locking: This is another potential symptom of shoulder instability. If you notice the joint popping, clicking or locking as you move the arm, you should get it checked out as soon as possible.

The above are the main symptoms to watch out for, but any issues you have with the shoulder should always be looked at by a doctor or a shoulder specialist. If these symptoms relate to a shoulder injury, the earlier you seek treatment the more likely it is to respond to conservative management.

Overall, if you’ve been experiencing pain, stiffness or numbness in the shoulder, it’s important to get it looked at as soon as possible. Never ignore shoulder symptoms, especially if the pain is becoming increasingly worse.