New study into a personalised approach to dealing with shoulder pain

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

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

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

What will the shoulder pain study involve?

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

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

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

New tool could help identify need for intervention

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

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

Shoulder problems need to be treated as early as possible

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

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

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

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

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

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

How are cortisone injections used to treat the shoulder?

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

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

Understanding the new shoulder research

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

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

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

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

Other factors which contribute to failed rotator cuff surgery

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

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

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

The Happiness Factor: living with chronic shoulder pain

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

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

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

What did the shoulder arthroplasty study reveal?

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

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

What it is like living with chronic shoulder pain

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

Early treatment can make a substantial difference to patient happiness

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

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

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

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

Non-surgical approach recommended for shoulder instability in young athletes

 

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

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

Majority of participants could return to sport

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

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

NSIS tool helps identify higher-risk patients

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

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

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

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

The importance of seeking early treatment

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

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

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

Golf and the shoulder: how to prevent injury

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

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

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

Common golfing shoulder injuries

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

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

How can you prevent golfing shoulder injury?

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

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

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

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

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

Returning to Work After Shoulder Arthroplasty

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

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

Majority of patients under age 55 return to work

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

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

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

Tips to ensure a successful return back to work

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

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

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

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

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

Smoking and Shoulder Surgery Recovery

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

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

Smoking increases risks and cost of recovery

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

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

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

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

Quitting smoking greatly reduces shoulder surgery risks

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

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

Why are Partial Rotator Cuff Tears Such a Common Injury?

There are many different shoulder injuries a patient can suffer with, but by far one of the most common is the partial rotator cuff tear. The earliest recorded incidence of this type of injury dates back all the way to 1788. Since then, the injury has become a lot more common; especially amongst athletes.

Here, we’ll look at why partial rotator cuff tears are such a common injury and how they can possibly be prevented.

What is a partial rotator cuff tear?

The rotator cuff consists of four tendons which attach to both the shoulder blade and the humerus bone. They’re largely responsible for the movement of the arm, and they’re known to weaken over time. Overusing the tendons is what typically results in a tear.

A partial tear is diagnosed when it hasn’t gone all the way through the tendon. If the entire tendon is torn all the way through, it’s referred to as a full-thickness tear. However, the severity of a partial tear can differ between patients. This is because partial tears can be anything from just 1mm deep which is approximately 10 per cent of the tendon, up to 50 per cent of the tendon, and in some cases, more.

Sometimes it can be challenging to distinguish between a partial tear from a full tear, or a partial tear from tendonitis. Therefore, it’s essential that you’re seeking diagnosis from a highly skilled, experienced orthopaedic surgeon that specialises in the shoulder alone.

Why is the partial rotator cuff tear so common?

The main reason partial rotator cuff tears are so common, is because they develop gradually over time when the rotator cuff is used. For athletes who carry out repetitive overhead movements for example, there’s a significant chance a tear will develop over time.

However, it isn’t just athletes who are at risk. In fact, it’s unlikely that any person over the age of 40 will come back with a clear shoulder MRI scan. This is because the tendons naturally weaken with age. Some patients who have been diagnosed with a partial tear don’t recall suffering any form of trauma. It is a common misconception that rotator cuff tears are caused purely through trauma. If you are over 40, any repetitive movements to the rotator cuff can cause a tear to gradually develop.

So, the majority of partial rotator cuff tears are down to degeneration due to either activities or age.

Can the partial rotator cuff tear be prevented?

It isn’t always possible to prevent partial rotator cuff tears, but there are some things you can do to lower the risk. Making sure to warm up properly before carrying out any vigorous exercise is highly recommended. Activities such as weight lifting for example, can place significant pressure on the rotator cuff. Without warming up, it could quickly become torn and inflamed.

Strengthening exercises can also help to build up the tendons, making them more resistant to injury. Stretching is also recommended to those who have suffered a previous tear as it can prevent further injuries down the line.

Overall, partial rotator cuff tears are common, particularly in athletes and men over the age of 65. However, the good news is that effective treatments are available and most partial tears can be treated without surgery. However, it will depend upon how severe the tear is. The key is to seek treatment as soon as you suspect there may be a problem with the shoulder.

Skiing, Snowboarding and the Shoulder

snowboarding and the shoulderAs excitement builds for the start of the Winter Olympics which commences today, the athletes will be entering their very final training and prep stages for one of the most important sporting events in their career.

The UK has reportedly doubled its investment in the Winter Olympics due to be held in South Korea, from £13.5m in 2014, to a staggering £27.9m for this year’s games. As the event continues to grow in importance to the UK, sports such as skiing, and snowboarding are also seeing a spike in popularity. While it is fantastic to see more people taking up these active sports, it is also important to be aware the risks involved; particularly those to the shoulder.

Upper extremity injury rate has risen while lower extremity injuries decline

Over the years, the rate of lower extremity injuries occurring in Alpine sports has declined, while upper extremity injuries have increased. It’s estimated that upper extremity injuries account for 20 to 35 per cent of Alpine skiing injuries, and a staggering 50 per cent of snowboarding injuries.

The rate of shoulder specific Alpine sports injuries are thought to account for 22 to 41 per cent of upper extremity injuries in skiing and 20 to 34 per cent of injuries in snowboarding. As these sports become more popular, it’s likely we’ll see an increase in shoulder-related injuries.

Understanding the most common shoulder injuries

The shoulder injuries which occur in Alpine sports, tend to be caused by falls. However, aerial manoeuvres carried out in snowboarding, and pole planting in skiing can also lead to injury. Here, we’ll look at the most common shoulder injuries experienced by athletes and budding winter sport enthusiasts.

Glenohumeral instability – shoulder instability is quite a common injury and it occurs when the soft tissue cannot keep the humeral head connected to the glenoid fossa. This, in turn, causes it to partially or fully dislocate; compromising the function of the shoulder.

In skiing and snowboarding, a fall could cause trauma to the area, causing additional laxity within the soft tissue.

Rotator cuff strain – another common injury, rotator cuff strains or tears, are by far the most common shoulder injury that patients present with. Although most common in overhead sports such as tennis, those partaking in Alpine sports are also at risk.

Any of the four tendons of the rotator cuff can be torn, with injuries ranging from mild to severe. Tears can also occur due to overuse of the tendons, so athletes who train too frequently are also at risk.

Clavicle fractures – the falls suffered by skiers and snowboarders, pose a significant risk of clavicle fractures or a broken collarbone. It is one of the major bones in the shoulder and is prone to breakage if it is placed under significant pressure. This type of injury is especially painful and typically requires a sling to be worn unless it is an unusually complex fracture, when surgery may be required.

These are just three of the most common shoulder injuries experienced by skiers and snowboarders. Treatment will depend upon the type and severity of the injury.

Can ski and snowboard related shoulder injuries be prevented?

Due to the nature of winter sports and the higher risk of falls, it isn’t always possible to prevent injury. However, with adequate training, it is possible to reduce the risk.

One thing you can do is build up your cardiovascular endurance. This will help to reduce the strain placed upon the body during skiing or snowboarding. Activities such as cycling, running and swimming are all great cardiovascular exercise.

Focusing on exercises which also strengthen the shoulders is also important. If you’re new to Alpine sports, taking lessons can also reduce your risk of injury. However, even pro athletes are at risk of injuring the shoulder.

Even following the advice above cannot guarantee you won’t injure your shoulder. However, the sooner you seek treatment, the better. If left untreated, shoulder injuries can become much worse and take longer to fix. Those experiencing significant shoulder pain after a sojourn on the slopes should, therefore, seek a diagnosis as quickly as possible.

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.