Rotator cuff surgery

Can a Torn Rotator Cuff Heal Without Surgery?

If you have a torn rotator cuff, you might be wondering what your treatment options are. Nobody wants to undergo surgery unnecessarily. However, can a torn rotator cuff heal without it?

Here, you’ll discover more about rotator cuff tears and the treatment options available.

What is a rotator cuff tear?

There are four tendons and muscles that are responsible for stabilising the shoulder. A rotator cuff tear is diagnosed when one of them rips or tears. If the muscles become damaged or frayed, it is considered a partial tear. However, if the tendon comes away from the bone or it tears all the way through, it is considered a complete tear.

Most tears are caused over time through wear and tear. They can also be caused by a fall or injury and are more prevalent in athletes. If it is caused by wear and tear, it will be referred to as a degenerative tear.

Symptoms of a torn rotator cuff

The symptoms of a torn rotator cuff will vary depending upon whether you suffered a sudden or gradual tear. The most common symptoms include:

  • Pain when moving the arm upwards or downwards
  • Increased pain when the shoulder is resting, particularly at night
  • Weakness within the arm
  • A cracking sensation when the shoulder is moved in specific ways

If the tear occurs suddenly due to an injury, you will likely experience intense pain and a snapping sensation. If it occurs gradually, you will notice weakness and pain in the arm worsening over time.

Rarely, a rotator cuff tear doesn’t cause the patient any pain. However, weakness within the arm and other symptoms will be present.

Will you need rotator cuff surgery?

Not all patients require rotator cuff surgery to correct a tear. However, there is a possibility the tear could worsen over time. If the tear is small to medium in size, non-surgical treatments may be advised to see if they can rectify the issue.

It is thought that around 80% of patients experience relief from their symptoms with non-surgical treatments. These include rest, physical therapy, nonsteroidal anti-inflammatory medication, and steroid injections. Sometimes certain activities may also need to be avoided.

While non-surgical methods can help some patients return to daily activities, they don’t always prevent the need for surgery. If your symptoms don’t improve or the tear worsens, you will need to undergo a surgical repair.

Another factor in your decision to undergo surgery is the level of activity you are hoping to return to. Older patients that have suffered a degenerative tear may be satisfied with the improvement in pain and mobility delivered by non-surgical treatments. Younger patients hoping to return to play at their previous level may opt for surgical repair followed by a rehabilitation programme. In a study published in the Arthroscopy, Sports Medicine, and Rehabilitation journal earlier this year, researchers from Dublin found that after arthroscopic rotator cuff repair, athletes aged 30 years or younger show excellent functional outcomes with high rates of patient satisfaction and return to play after the procedure.

In rotator cuff surgery, the tendons are typically re-attached to the upper arm bone. There are several techniques that can be carried out to make the repair. The surgeon will determine the best method to use during your consultation.

If you have been diagnosed with a rotator cuff tear, book a consultation to discuss your treatment options today.

Diabetes and frozen shoulder

Everything You Need to Know About Diabetes and Frozen Shoulder

November marks World Diabetes Awareness month, so we thought it was an ideal time to raise awareness of frozen shoulder. This painful condition can arise as a complication of Diabetes.

Known to cause issues with mobility, frozen shoulder is a condition that often worsens before it gets better. However, there are ways to manage it to limit pain and stiffness. Here, you’ll discover everything you need to know about Diabetes and frozen shoulder.

What is frozen shoulder?

Frozen shoulder is a condition in which the shoulder becomes progressively more stiff and painful. It typically lasts for months, and sometimes years, impacting your ability to carry out daily activities.

Also referred to as Adhesive Capsulitis, it develops when the ligaments of the shoulder joint become swollen and stiff. As the tissue becomes inflamed, it can cause issues with healing. A frozen shoulder usually gets better over time without treatment, but recovery is often slow and can take at least 18 to 24 months.

How are Diabetes and frozen shoulder linked?

While frozen shoulder can impact anyone, mainly affecting people aged between 40 and 60 and women more often than men, those with diabetes are known to be twice at risk of developing the condition. Research has shown that it is likely a result of how it impacts collagen formation within the shoulder.

It is thought that high blood sugars form advanced glycosylation end products (AGEs). The AGEs latch onto tendons and ligaments, limiting movement in the shoulder. Combined with impaired blood circulation also due to high blood sugar levels, the shoulder stiffens up and becomes inflamed. If Diabetes isn’t controlled, it can lead to a whole host of skeletal and muscular problems.

What treatment options are available?

Treatments for frozen shoulder are designed to minimise the pain and help to restore movement by stretching the shoulder capsule. It is rare to need surgery to treat the condition, though it may be recommended when nothing else is working.

Most patients find that the condition clears up within a year. The most common treatment options include:

  • Physical therapy
  • Steroid injections
  • Shoulder manipulation
  • Joint distension

Physical therapy tends to be the most common and effective option. A trained physician will help to improve range of motion in the shoulder using targeted exercises. Steroid injections and joint distension techniques are effective at helping to control the pain.

When might I need surgery for frozen shoulder?

If your frozen shoulder isn’t improving through non-surgical methods, surgery may be recommended. This involves removing the scar tissue, alongside adhesions from within the joint of the shoulder. Small incisions are made around the joint using an arthroscopic method before the affected tissue is removed.

To find out which treatment option is right for you, book a consultation with one of our shoulder specialists today. You will be advised whether surgery is suitable, or whether non-surgical methods are your best option.

shoulder instability and osteoarthritis

Study Finds Early Surgical Intervention in Shoulder Instability May Prevent Osteoarthritis

A new study has found that when shoulder instability is treated early, it may prevent osteoarthritis. The results were presented at the American Association of Orthopaedic Surgeons 2021 meeting. It also suggests that older adults are at an increased risk of developing arthritis within the shoulder. Here, we will look at what the study found and how shoulder instability and osteoarthritis are linked.

What did the study find?

The study, carried out by the Mayo Clinic, is the largest one to assess anterior shoulder instability in the US population. It included 154 patients taken from a regional database. They had a follow-up for an average of 15.2 years.

It was revealed that 22.7% of patients in the study went on to develop arthritis symptoms in the shoulder when they didn’t have shoulder stabilisation surgery. Univariate analysis was carried out, revealing that those who did have symptoms of arthritis were more likely to be current or ex-smokers. Manual labourers and older adults were also identified to be at a higher risk.

What is shoulder instability?

Shoulder instability is diagnosed when the ligaments, labrum, or capsule of the joint are torn, detached, or stretched. There are different types of shoulder instability including:

  • Shoulder dislocation – the head of the humerus dislocates from the joint
  • Labral tear – the labrum is peeled off or torn away from the glenoid

Some people are naturally more prone to shoulder instability due to their genetics. The shoulder ligaments are naturally looser, increasing the risk of dislocation.

Pain and a feeling of the shoulder giving in are common symptoms of shoulder instability. If a dislocation has occurred, you may also feel and hear the joint popping out of place. Bruising, swelling, and poor joint mobility are also common symptoms to watch out for.

How are shoulder instability and osteoarthritis linked?

Known as post-traumatic osteoarthritis or PTOA, it has been estimated that over 40% of individuals that sustain an injury to the ligament or meniscus will go on to develop PTOA and the trauma caused by repeated shoulder dislocations results in damage to the shoulder joint that makes patients more susceptible to arthritis.

Treating shoulder instability

Shoulder instability can vary in severity. The type of instability you are experiencing, alongside its severity, will determine the best course of treatment.

For minor dislocations and instability, keeping the arm in a sling and undergoing physiotherapy may be the best option. However, for more severe cases, surgery may be required. You can speak to the surgeon about your likelihood of developing osteoarthritis and the preventative measures you can take.

Book a consultation with the London Shoulder Specialists today to discuss your shoulder instability treatment options.

shoulder pain management

What’s the Best Pain Relief if You’re Suffering from Shoulder Pain?

Shoulder pain is a common problem that can strike at any age. Linked to a wide range of conditions and injuries, it can significantly disrupt your daily life. Living in constant pain can be debilitating. However, help is available. While you are awaiting treatment for the source of the pain, you can use several shoulder pain management methods to help you cope.

Here, you’ll discover some of the best pain relief methods you can try when you are suffering from shoulder pain.

Painkillers

Pain killers are one of the most effective ways to treat shoulder pain. Depending upon the severity of the pain you are experiencing, there are different types of painkillers you can try.

If your pain level is mild, you should find over the counter painkillers are effective.

Paracetamol is typically recommended over Ibuprofen. This is because it will not interact or interfere with any existing medications. However, if the pain is caused by inflammation in the shoulder joint, Ibuprofen will typically be the better option.

Be advised that if you are taking paracetamol, they will need to be used up to four times a day to be effective. Ibuprofen should only be used for a period of two weeks, followed by a break. This is because, over time, they can lead to kidney damage when used consistently.

Always speak to your doctor before taking any pain medications. This will ensure they are safe to take with any existing medications you are on. If the pain is moderate to severe, you can also request prescription painkillers. These are much stronger and will need to be taken exactly as instructed.

Heat or cold therapy

You can also relieve shoulder pain with heat or cold therapy. If your pain stems from inflammation, cold therapy is the better option. However, if the pain is linked to muscle spasms, you will find heat therapy the more effective choice.

An ice pack can be used for cold therapy, and it is best used to treat conditions such as Bursitis or Frozen Shoulder. A hot water bottle or warm compress can be used to relax tense muscles, allowing for better mobility of the joint if muscle spasms occur.

Non-surgical management

Surgery isn’t always required to eliminate shoulder pain. Some conditions can benefit from non-surgical management such as physiotherapy.

Physiotherapy can help to ease pain, as well as boost mobility. It helps by strengthening up the shoulder joint, improving posture, and loosening tight tissue. This type of treatment may be used in conjunction with steroid injections.

Surgical methods

In some cases, non-surgical methods may not eliminate the shoulder pain completely. Instead, you may need either open or arthroscopic surgery to treat the underlying cause. A capsular release procedure may be required for Frozen Shoulder, while a rotator cuff repair will help repair damaged tendons.

To discover the optimal shoulder pain management approach, book a consultation with the London Shoulder Specialists today. After assessing the condition, a customised treatment plan will be recommended to help you eliminate the pain for good.

Glenoid Bone Loss

Treatment Options for Glenoid Bone Loss in the Shoulder

Glenoid bone loss is common in those who suffer from anterior instability of the shoulder. The bone loss occurs in the shoulder socket, leading to issues with recurrent dislocations. Each dislocation can result in further bone loss.

If you have been diagnosed with glenoid bone loss in the shoulder, you may be wondering what your treatment options are. Read on to discover everything you need to know about glenoid bone loss and its treatment options.

What is Glenoid bone loss in the shoulder?

Glenoid bone loss is typically caused when the shoulder dislocates. It is a common issue, found in around 40% of those who have suffered a single dislocation. In those who have experienced recurring dislocations, 85% have signs of Glenoid bone loss. This shows that frequent dislocations increase the risk of further bone loss.

Most of the time, it is thought to be caused by compression fractures that occur at the time of dislocation. When bone loss occurs, the humeral head can’t be supported in the socket. This increases the risk it will dislocate again. It is a nasty cycle that will continue unless treatment is sought.

How is the condition diagnosed?

Glenoid bone loss can be diagnosed and measured using CT, radiographs, or MRI scans. The preferred method is a CT scan due to its ease and accuracy.

In early cases, the CT scan will show the rim of the anterior Glenoid has straightened. The amount of bone loss can be measured by comparing the maximum width on the normal side to that on the affected side.

If a dislocation has occurred, an MRI scan will be used to diagnose Glenoid bone loss, rather than a CT scan.

What are your treatment options?

If you are diagnosed with Glenoid bone loss, there are treatment options available. These include arthroscopic soft tissue stabilisation and bony restoration.

Surgery does tend to be the most effective treatment option. When performed correctly, it can prevent future dislocations and fully restore shoulder function. There are pros and cons to each surgical option available. For this reason, you should run through your options with a shoulder specialist to see which is better suited to you.

Non-surgical treatments are available if surgery is determined to be too high of a risk. A rehabilitation plan will be created in a bid to improve the range of motion. Strengthening up the muscles and tendons around the shoulder can also help to prevent future dislocations.

If you suspect you have Glenoid bone loss in the shoulder, book a consultation with one of our leading surgeons today. Without treatment, the condition could continue to worsen until the shoulder can no longer stay in its socket. This makes it crucial to seek treatment sooner rather than later.

Shoulder Pain

Why is my Shoulder Pain Worse at Night?

Shoulder pain is a common symptom associated with a variety of conditions. Whatever the cause, patients often find their pain is much worse during the night. This can lead to problems with sleep, and over time a reduced quality of life.

So, why is shoulder pain typically worse at night? Discover everything you need to know below…

What causes the pain to worsen at night?

When you have shoulder pain, it’s common for the pain to be worse at night. The reason for this is often inflammation.

As you go about your day, the constant movement prevents inflammation from building up in the shoulder. During the night, you move a lot less and spend hours often in one position. This allows the inflammation to build up, causing additional pain.

Your sleeping position could also contribute to an increase in pain. If you lie directly on the affected shoulder, it will compress the inflamed areas.

Common shoulder conditions that cause pain at night

While all kinds of shoulder injuries and conditions can cause worse pain at night, the main culprits tend to be:

  • Bursitis
  • Tendonitis
  • Rotator cuff tears

Bursitis is caused when the bursa becomes inflamed. It tends to worsen until the condition is treated, leading to severe swelling and pain. Laying on your side will cause the pain to worsen during the night.

Tendonitis also occurs due to inflammation, and it often develops due to overuse of the shoulder. With this condition, you’ll find it more difficult to fall asleep and stay asleep. Some experts theorise that the pain may also worsen due to the effects of gravity. When you lie down, the tendons and muscles within the shoulder settle in a slightly different position. This can prevent blood flow to the area, causing severe pain.

Rotator cuff tears and injuries are well known for keeping patients awake. They can occur due to injury, lifting heavy objects, or overuse of the muscles and tendons. The pain tends to become worse during the night due to your sleeping position.

So, what can you do if any of these conditions are keeping you awake? Thankfully, there are some things you can do that can help.

If you are struggling to get a decent night’s sleep due to shoulder pain, there are some helpful tips you can follow.

Firstly, if you haven’t already then you should seek treatment for the cause of the shoulder pain. There are a lot of treatment options available in the form of conservative management and surgical intervention. After undergoing an assessment, an effective treatment plan will be created.

You should also pay attention to your sleeping position, avoiding sleeping directly on the bad shoulder. Working on your range of motion throughout the day will also help. The stronger the shoulder becomes, the less it is likely to hurt. However, make sure you follow the advice of a qualified physiotherapist prior to starting any shoulder exercises.

If shoulder pain is keeping you up at night, book a consultation with one of our specialists today.

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.

Shoulder Pain

Shoulder Pain Indicated as Among Most Persistent in New Pain Mapping Study

A new body-mapping study has revealed shoulder pain is one of the most persistent types of chronic pain. The study identified nine distinct types of chronic pain to aid in the diagnosis and treatment process for patients.

Here, we’ll look at what the new pain mapping study discovered, alongside common causes of shoulder pain.

What did the pain mapping study involve?

The new pain mapping study included a total of 21,500 people who had attended the severe pain management clinics at the University of Pittsburgh. A computer clustering analysis was carried out on patient body maps to determine patterns of pain distribution.

The results showed there were nine clear types of chronic pain a patient could experience. The researchers believe the identified patterns of pain distribution could help to predict pain impact, severity, physical function, and predicted outcomes.

So, what did it find in relation to those experiencing shoulder pain? Unfortunately, it wasn’t great news…

Patients with long-term shoulder pain saw the least improvement

More than 7,000 people involved in the study, went on to fill in a follow-up questionnaire. This was done three months after the body pain map.

Results showed that those who experienced abdominal pain went on to see the biggest improvement. However, those who experienced shoulder, neck, and lower back pain saw the least improvement.

Just 37% of those suffering from lower back, shoulder, and neck pain saw an improvement after three months. The researchers noticed that patients within this subgroup also had some of the same characteristics as those in the widespread pain groups. This could suggest that they are in the early stages of widespread, generalised, chronic pain.

A new long-term study into pain duration and stability within this group has now been recommended.

Common causes of shoulder pain

Shoulder pain is a very common problem that can vary greatly in severity. There are a lot of different causes of shoulder pain, with some proving to be more debilitating than others. Some of the most common causes of shoulder pain include:

  • Osteoarthritis
  • Rotator cuff tear
  • Bursitis
  • Tendinitis
  • Frozen shoulder

Osteoarthritis is a leading cause of ongoing shoulder pain. It causes the cartilage within the joint to break down over time. This in turn leads to a lot of pain and stiffness within the shoulder.

Rotator cuff tears are also common, and they can also develop over time. As the tendon within the shoulder wears down gradually, the pain will start to develop. You can experience partial or full tears, and they tend to be most common in those aged over 50.

Each different cause of shoulder pain will require a different treatment plan. Therefore, if you are suffering from chronic shoulder pain, it is important to seek a diagnosis. Once the cause has been established, an effective treatment plan can be created.

rotator cuff disorders diagnosis

Rotator Cuff Disorders: Tendonitis or Tear?

Shoulder pain is something most of us experience at some point in our lives. However, if the pain doesn’t go away, it could be a sign of a more serious injury.

There are lots of shoulder injuries you can develop, and rotator cuff disorders are particularly common. Here, you’ll learn about the different rotator cuff disorders and how to spot the differences between them.

What is rotator cuff tendonitis?

Rotator cuff tendonitis is inflammation or irritation of the rotator cuff muscles. The condition can range in severity, and in extreme cases cause the rotator cuff to become trapped below the acromion. This causes extreme pain, requiring immediate treatment.

Tendonitis occurs over time and can be caused by several factors. You can develop it due to playing overhead sports, or simply by sleeping in an awkward position on the shoulder.

What is a rotator cuff tear?

A rotator cuff tear develops when the attachment from the tendon at the head of the humerus rips. The supraspinatus is the main tendon affected, though a tear could also develop in the other surrounding tendons.

A lot of the time, they occur over time, starting with the fraying of the tendon’s fibres. If the shoulder is used despite continuing pain, the tendon could go on to tear. You can either experience a partial, or full-thickness tear.

Symptoms to watch out for

While both tendonitis and a rotator cuff tear can cause significant pain, there are some differences in their symptoms.

With tendonitis, you’ll find that symptoms often start out mild and worsen in severity over time. They include:

  • A clicking sound when using the shoulder
  • Pain when lifting or reaching for something
  • Stiffness
  • Pain even when the shoulder is still

When the condition starts to worsen, you may also have difficulty reaching around your back, and experience more pain at night when trying to sleep.

With a rotator cuff tear, symptoms will depend upon the type of tear you experience. However, some general symptoms to look out for include:

  • Pain when trying to sleep
  • A weakness in the shoulder and arm
  • Pain when you aren’t using the shoulder
  • A popping or cracking sound when using the shoulder

If you suffered an acute tear, the pain will usually be more severe, and loss of strength will occur immediately. If it is a degenerative tear, it will cause some pain, but not as intense as an acute tear. Without treatment, a rotator cuff tear will advance until pain medication no longer has any effect.

Whether you are suffering with a rotator cuff tear, or tendonitis, there are some effective treatment options available. Non-surgical options include rest, physiotherapy, non-steroidal anti-inflammatory medications, or steroid injections. Alternatively, surgery may be required for more severe injuries.

If you are experiencing pain or weakness within the shoulder, it could be a rotator cuff disorder. Book a consultation with a shoulder specialist now to diagnose and begin treatment for the injury.

recurrent anterior instability study

London Shoulder Specialist Study Recently Published in the American Journal of Sports Medicine

A recently published study carried out by a team including London Shoulder Specialist Mr Ali Narvani has assessed the different treatment options for recurrent anterior instability. Up until now, there has been little research carried out into the effectiveness of existing treatments.

Here, we will look at what the recent study revealed and what it means for patients.

Understanding the recent study

Published in the American Journal of Sports Medicine, this recent study pooled data from 2018, across seven cohort studies. It compared Latarjet and Bankart treatments for anterior shoulder instability. Both continuous data and dichotomous data were pooled from a total of 3,275 patients.

Results showed that the Bankart technique had an increased risk of recurrence and re-dislocation. However, it had a decreased risk of infection compared to the Latarjet technique. Both had a similar Rowe score, revision, and haematoma formation rates.

What is the Bankart technique?

During the Bankart procedure, the overstretched or torn labrum and capsule are repaired deeper within the shoulder joint. The surgery is usually performed arthroscopically, but an open procedure can also be used. The method chosen for your repair will be discussed with you during your consultation.

In most cases, the surgeon uses a nerve block during the surgery. This helps to completely numb the area for up to a few hours. Painkillers will be provided to ease the pain after the procedure to make the recovery more comfortable.

What is the Latarjet technique?

The Latarjet technique focuses on relocating a piece of bone, complete with an attached tendon, to the joint of the shoulder. It is commonly performed on patients with recurrent instability that is brought on by a Bankart lesion. This procedure is often recommended for patients where a labrum repair doesn’t fix the damage within the joint.

Understanding shoulder instability

Instability in the shoulder arises when the upper arm bone is pushed out of its socket. It can happen due to an injury or from overuse. Shoulders are susceptible to repeated dislocations after they have been dislocated once. If it keeps happening, it is referred to as chronic instability.

Shoulder instability may be directional, or multidirectional. With directional instability, it can affect the anterior or posterior of the joint. With multidirectional instability, both the front and the back of the joint are affected. Anterior instability tends to be the most common form patients experience. This is likely since the capsule of the joint is weaker in the front of the joint.

Treatment for shoulder instability will depend upon the location and cause of the issue. As the new study suggests, the Latarjet procedure is more effective at reducing the likelihood of recurrence. However, for some patients the Bankart procedure may be the better option.

Call +44 (0) 203 195 2442 to book a consultation to discover the best course of treatment for your shoulder instability today.