Rotator Cuff Tear

Large-scale UK Study Evaluates Treatment For Rotator Cuff Tears

Although physiotherapy and corticosteroid injections are commonly used in the treatment of rotator cuff disorders, their effectiveness hasn’t previously been proven. Now, a new large-scale study has provided some insight into patient outcomes, following these common treatments.

Here, we’ll look at what the study found and why physiotherapy is largely used to treat rotator cuff tears.

Understanding the new study

The large-scale study was a randomised, controlled, pragmatic, and multicentre trial. A total of 708 patients aged 18 and over who had a rotator cuff tear, were recruited from 20 National Health Service trusts within the UK.

It excluded those who had other shoulder conditions, alongside a history of shoulder trauma. Patients were randomly assigned a treatment program. The treatments included a single physiotherapy session with or without corticosteroid injections and ongoing physiotherapy sessions.

The results showed that progressive exercise wasn’t more effective than a best practice advice session for improving pain and function. It also showed that corticosteroid injections don’t provide long-term benefits for patients suffering from a rotator cuff disorder.

Its findings towards physiotherapy were promising, with patients experiencing significant improvements over progressive exercise.

Is physiotherapy better than surgery?

If you suffer a rotator cuff tear, there are several treatment options available. While surgery might be required, physiotherapy and conservative treatments can be beneficial.
A physiotherapist can help to address issues with pain and stiffness within the joint. They will work with you to improve coordination, build up muscle strength, and improve your range of motion.

If you do need to undergo surgery, a physiotherapist can still help both before and after the procedure.

The three stages of rehabilitation

After a rotator cuff repair surgery, there are typically three stages of rehabilitation you’ll go through with a physiotherapist.

Stage 1: The first stage aims to aid tendon and bone healing while preventing issues with scar tissue and stiffness. You’ll focus on lighter activities during this first phase, such as scapula and passive exercises.
This rehabilitation stage can take anywhere from 1-6 weeks.
Stage 2: In the second stage, you’ll start to use your shoulder muscles again, switching to more active exercises. Aquatic therapy, isometric exercises, and progressive scapula exercises are all used during this stage.
You’ll go through stage 2 rehabilitation for around 7 to 12 weeks.
Stage 3: In the final stage, you’ll start to introduce resistance training into your treatment plan. This includes functional lifting and resistive exercises.

Patients will typically go through stage 3 rehabilitation for 12 or more weeks.

The above is just a brief guideline for what to expect when undergoing physiotherapy for a rotator cuff tear. To determine whether physiotherapy is a good treatment option for you, book a consultation with a shoulder specialist today.

Bankart Repair for Shoulder Dislocation

Bankart Repair Advisable for First-Time Shoulder Dislocation New Study Finds

A recent meta-analysis of current evidence in literature compared arthroscopic Bankart repair versus non-operative management for first-time dislocators. Management of first shoulder dislocation following reduction remains controversial and decision making involves consideration of factors such as natural history and effect of surgical intervention on the natural history. This new study has concluded that first-time shoulder dislocations may benefit from Bankart repair.

Here, we’ll look at what the latest study found and what Bankart repair technique actually is.

What the study revealed

There was a total of 10 prospective studies included in the latest research, including a total of 569 patients. The aim of the review was to compare the Bankart repair method against conservative management for first-time shoulder dislocations.

A meta-analysis of current evidence was performed, with recurrence, return to play and further treatment compared. The results showed that the Bankart repair technique produced a lower rate of recurrent instability. It also resulted in an increased number of patients who could return to play. Compared to 80.8% of patients who were treated with conservative management techniques, 92.8% of Bankart repair patients could return to play.

The conclusion of the study was that Arthroscopic Bankart repair had a 7-fold decreased recurrence rate. This indicates that patients with a first-time shoulder dislocation who play sports may benefit more from the Bankart repair treatment method.

The Bankart repair technique

The Bankart repair technique is a commonly used technique to treat shoulder instability. It was first described by American orthopaedic surgeon Lanny Johnson in 1980 and it is aimed at treating Bankart lesions. In a shoulder dislocation, the labrum can pull away from the front of the socket, resulting in a Bankart lesion.

The Bankart repair technique reattaches the labrum to the socket. It is usually carried out through arthroscopy which is a minimally invasive technique. Small incisions are made before a camera is inserted to help the surgeon see what they are doing. They can repair any tears within the tendon, cartilage or muscle before stitching and closing the incisions.

Patients will usually need to keep their arm in a sling for the first month after surgery. The exact physical therapy regime depends on the extent of the repair and varies between surgeon to surgeon.

Surgical approach vs non-surgical treatment

In a review published in the Archives of Bone and Joint Surgery in 2016, London Shoulder Specialist Mr Ali Narvani and his fellow authors focused on surgery vs non-operative treatment for traumatic first-time shoulder dislocation. In particular, highlighting some of the issues that influence the decision-making process between the surgeon and the patient.

In order to determine which treatment method would be better for the patient, a number of factors need to be considered. Age, lifestyle and the severity of the dislocation will all impact which treatment method should be used. The study found that individuals younger than 25 are likely to re-dislocate without surgery which also reduces the risk of recurrent instability that appears to raise the risk of developing arthritis in the future.

If you are suffering from a first-time dislocation, it is important to undergo a consultation with a shoulder specialist. The surgeon will be able to determine the best approach based upon your individual circumstances.

Rotator Cuff Tear Consultation

Your Rotator Cuff Tear Consultation: Frequently Asked Questions

If you have been diagnosed with a rotator cuff tear, you will likely have a lot of questions regarding the condition and its treatment. Prior to any treatment being offered, a consultation will first need to be undertaken.

This offers you the opportunity to ask any questions you may have about the treatment method. The surgeon will also be able to discuss the injury and advise you on the best course of treatment moving forward.

Here, we’ll answer some of the frequently asked questions about rotator cuff tear consultations. This should give you an idea of what to expect and what to ask during your consultation.

Is there any difference between an open and arthroscopic repair?

There are two surgical methods that can be used to treat rotator cuff tears. These include open and arthroscopic repair. The arthroscopic approach results in a smaller incision site. However, it works on the exact same tissues as the open procedure. A small camera is inserted to allow the surgeon to see what they are doing. The entire repair is carried out without having to open the entire shoulder area.

Open surgery, on the other hand, creates a much larger incision and opens up the area. This results in a longer recovery process.

Is there an alternative to shoulder surgery?

Prior to surgery being carried out, the surgeon will always attempt to rectify the problem via alternative methods. This includes physical therapy, anti-inflammatory medications and injections. Not all rotator cuff tears require surgery, it just depends upon the severity of the tear and whether alternative methods have worked to clear it up.

Will I need to wear a sling after the surgery?

If you do undergo surgery, you will need to wear a sling for a period of four to six weeks. This will depend upon the size of your rotator cuff tear and how extensive the surgery was. The sling will need to be worn at all times and you may also be required to wear a small foam cushion placed between the arm and the body.

Always follow the surgeon’s advice regarding proper use of the sling to aid your recovery.

Will I need to attend physical therapy?

You will generally be required to attend physical therapy. This helps to aid the recovery process and improve motion within the arm and shoulder. You will typically need to start attending physical therapy appointments six weeks after the surgery.

How long will it take to recover?

The recovery process from rotator cuff surgery can be quite long. If you have undergone an arthroscopic procedure, you can expect the recovery to last a few months. If you have undergone open shoulder surgery, however, you may need to wait six months for the shoulder to heal. Your surgeon will be able to tell you how long your individual recovery is expected to take.

These are just some of the most frequently asked questions regarding rotator cuff tear repair. Remember, the consultation is your chance to find out as much about the procedure and recovery as you can.

During the current COVID-19 crisis, all non-urgent / elective surgery bookings and appointments are postponed, but the London Shoulder Specialists are still available for consultation. Consultations can be carried out either by telephone or video link.

Appointments can be arranged by emailing appointments@fortiusclinic.com or by calling 020 3195 2442.

shoulder stiffness scan

MRI Can Predict Shoulder Stiffness After Rotator Cuff Tear

A new study has shown that an MRI could predict shoulder stiffness in patients with rotator cuff tears. There were two important findings discovered through the study, which is the first of its kind to identify joint capsule abnormality as a factor within shoulder stiffness after a rotator cuff tear.

Here, we’ll look at the study in more detail and why its findings are important for patients.

Understanding the study

The study, carried out in Korea, assessed 106 patients who had small to large full-thickness rotator cuff tears. They also had axillary recess thickness, alongside joint capsule oedema. The researchers looked at the degree of retraction, obliteration of the subcoracoid fat triangle and the fatty degeneration of the torn muscle.

An operative report and MRI findings determined the tear location and size. They also looked at the links between the MRI findings and preoperative passive range of motion. It was discovered that fatty degeneration was a predictor of a limited range of movement in terms of internal rotation. It was also discovered that males with posterosuperior rotator cuff tears were a predictor of shoulder range of movement on external rotation.

The most significant finding, however, was that there appeared to be a negative linear correlation between a limited range of movement in forward elevation and the joint capsule thickness in the glenoid area. There was also a correlation between the joint capsule oedema in the humeral area and external rotation.

Shoulder stiffness linked to reduced risk of re-tear

Interestingly, another study has shown that patients who experience shoulder stiffness after rotator cuff surgery, experience a reduced risk of a re-tear. However, this only applied to patients who experienced stiffness at six and twelve weeks after the operation.

Compared to those who experienced no stiffness at all, patients experienced a reduced re-tear rate. They were also found to have better outcomes after six months. It also showed that those who went into the surgery with already stiff shoulders were more likely to experience stiffness after the procedure too.

Why the new research is important for patients?

The newest study in Korea is important as it highlights the potential benefits of using MRI to detect and treat patients with rotator cuff tears. Shoulder stiffness is said to affect up to 40% of patients who experience a rotator cuff tear.

Now, surgeons and shoulder specialists know that the recess of the armpit and joint capsule swelling can be used as an indicator for frozen shoulder. If they can identify the risks of a frozen shoulder, they will be better able to treat the patient.

Losing motion in the shoulder after surgery can significantly impact quality of life. Therefore, having early access to the right treatments to improve the range of motion is important. MRI scanning is a simple and effective way to help identify the risks and generate a treatment plan early.

If you have further questions for the London Shoulder Specialists, call 0203 195 2442.