Earlier this month, the third Fortius International Sports Injury Conference took place in London. The two-day event brings together orthopaedic surgeons, sports physicians, physiotherapists and other healthcare professionals with an interest in sports injury and invites leading international experts to present and debate on multi-disciplinary panels.
The shoulder is one of the most complex and largest joints within the body. Therefore, it’s unsurprising it’s prone to a lot of different injuries. One of the most common causes of these injuries is overuse.
Here, we’ll discuss why the shoulder is prone to overuse injuries and the most common types of injuries it presents.
Why are shoulder overuse injuries so common?
The shoulder is one of the most used joints in the body and it is exposed to a lot of repetitive motions in daily use. With this in mind, it’s easy to see why overuse injuries are commonly experienced in patients.
These types of injuries can occur for a number of reasons. The overuse of the shoulder can lead to inflammation of either the fibres within the joint or the sac which cushions the joints. They can also be brought on by repetitive overhead arm movements, or through muscle strain.
While overuse injuries can occur through daily overuse, it’s typically athletes who are most susceptible to these types of injuries.
What types of shoulder overuse injuries can present?
There are three main injuries which can present due to overuse of the shoulder. These include:
If the muscle fibre becomes torn, it’s classified as a strain. If it’s the ligament that’s torn, it will be classified as a sprain. Both of these injuries have differing levels of severity, ranging from grades 1 to 3. If the injury is classed as a grade 3, it means the tissue has been completely ruptured.
Patients who have existing shoulder injuries or who repetitively lift can suffer with Bursitis. This is where the small Bursa sacs which lubricate and cushion the bones, ligaments and tendons, becomes inflamed. Occasionally, it can also be brought on by a direct hit to the shoulder.
Finally, Tendinitis occurs when the tendon sheaths of the shoulder become inflamed or irritated. Overuse causes a lot of friction which irritates the sheaths. Lifting weights which are too heavy or putting excessive strain onto the tendons can lead to this type of injury.
Study reveals sports specialisation in young athletes to be a key issue
Thanks to huge sporting events such as the Olympics, more young people are getting into sport than ever before. While this is largely a positive thing, a new study has highlighted the dangers sports specialisation presents in young athletes.
The ‘Growing Up Today’ study, analysed data from 10,138 young athletes in the United States. Interestingly, it discovered that young female athletes partaking in sports specialisation were at an increased risk of developing an injury. It also found that those specialising in one sport had an increased level of activity.
The results of the study clearly show that partaking in one sport excessively does increase the risk of overuse injuries. Therefore, athletes need to be aware of the risks involved when failing to give the shoulder adequate rest or pushing themselves too hard.
If you suspect you have an overuse shoulder injury, book a consultation with a specialist today. The earlier you seek treatment, the less impact the injury will have on your life, work or sporting opportunities.
Shoulder injuries, particularly to the rotator cuff, can be very painful, debilitating and also slow to heal as many professional athletes can attest. Speeding up shoulder injury healing has been the focus of much research and one particular type of treatment that has received a lot of attention in recent years is the application of stem cell therapy to promote shoulder healing.
While there has been a proliferation in clinics offering stem cell therapy for the treatment of a wide range of soft tissue and joint injuries, is it really a good treatment option? Here, we’ll look at whether or not stem cell therapies are truly useful in the treatment of shoulder injuries.
What are stem cell therapies?
Stem cell treatments and therapies have been a popular area of research for a wide variety of conditions. For years, they have been used in a range of settings such as growing skin stem cells for skin grafts, and blood stem cells to combat diseases.
The patient’s own stem cells are harvested – either from fatty tissue or bone marrow – and then delivered into the affected area; the theory behind the science is that your body’s own repair mechanisms are used to promote healing.
During the healing process, it is thought that the grafted stem cells are able to differentiate into specialised cells, whether that is muscles, tendons, cartilage or bone, depending on the nature of the injury. They also cause other important cells and growth factors to flood the site of the injury, repairing and regenerating the damaged tissue.
In terms of shoulder treatment, stem cell injections are provided into the affected area. There is no standardised approach and clinics will differ in terms of how the procedure is performed, but generally, it is carried out using image guidance and it’s a minimally invasive treatment. The stem cells are harvested from the patient’s fatty tissue or bone marrow, before being separated and consolidated and injected into the shoulder.
Stem cell therapy is largely used to treat partial tears and minor to moderate injuries. If the injury is severe or there’s a full tear, the only effective treatment option would be surgery.
Studies reveal little evidence to show these therapies work
There have been two crucial studies published recently within the Journal of Shoulder and Elbow Surgery. Both reveal there is actually little evidence to suggest stem cell therapies work.
Clinical data to support the claims of the effectiveness of stem cell therapies is limited. Furthermore, there appears to be a lot of patient-specific factors which can contribute towards the effectiveness of these therapies. These include medications, age, sex and genetic factors.
The studies concluded that although these treatments have great potential based upon laboratory studies, a lack of clinical data for their use in shoulder treatments is extremely limited.
Why are stem cell therapies in shoulder treatment controversial?
At the moment, stem cell therapies within shoulder treatment are considered controversial. This is because of a couple of factors, including the fact that there’s little evidence to back up their effectiveness.
These treatments are costly, and many medical insurance policies don’t cover them. This can be an issue for patients who want to undergo the procedure.
As the results are unproven, it also means that patients could be delaying the treatment they need. If they undergo the injections which ultimately aren’t effective, the injury could become worse. This would then mean they need to undergo more invasive treatment, often surgical, to rectify the problem.
At the London Shoulder Specialists, while we always stay abreast of the latest developments and we are keeping a close eye on the potential of stem cell therapy in the treatment of shoulder injuries, we advise patients to understand the limitations. With very little clinical data to support the effectiveness of these treatments, more recognised and proven techniques should first be considered. If you’re suffering from a shoulder injury, book a consultation with a specialist today. They will be able to diagnose the problem and recommend the best course of treatment.
To arrange a consultation with the London Shoulder Specialists, call +44 (0) 203 195 2442.
Shoulder fractures can be particularly painful, limiting movement within the arm. Depending upon the severity of the fracture, surgery tends to be the most common shoulder fracture treatment option. However, could wearing a sling be just as effective?
Here, we’ll look at surgery for shoulder fractures versus wearing a sling.
Study reveals slings just as effective at treating fractures
A recent study carried out by the Aarhus University in Denmark, has revealed that slings are just as effective at healing shoulder fractures as surgery. Together with departments from Sweden, Finland and Estonia, the researchers studied 88 patients with shoulder fractures over the age of 60.
The patients were followed for two years, with half receiving surgical treatment and the other half given a sling during recovery. The results showed no difference in improvement between the sling and the surgical groups. The patients who underwent shoulder surgery didn’t experience any less pain or improvement in movement than those who wore a sling.
This shows that surgical treatment is unnecessary in the case of bone displacement fractures. As it doesn’t provide any improvements compared to wearing a sling, the study highlights that surgery shouldn’t be the first course of action when treating fractures.
When might shoulder surgery be needed?
While the majority of shoulder fractures could heal just as well in a sling, there are exceptions where surgery may be required.
If the rotator cuff is damaged during the trauma to the shoulder, surgery may be the best option. This is because rotator cuff tears, in particular, don’t tend to heal by themselves. It does depend upon the severity of the tear, but usually, patients do require surgery to fix it.
Each shoulder fracture case should be looked at independently to assess whether or not surgery is required.
Will the results change the clinical shoulder fracture treatment approach?
The researchers behind the latest study are hoping the results will alter clinical treatment approach. It clearly shows that surgery doesn’t improve the outcome compared to wearing a sling.
As with any surgery, shoulder surgery for treating fractures comes with a number of risks and complications. It also requires a sometimes-lengthy recovery process. So, if the same results could be experienced by the patient wearing a sling, it would eliminate these risks and be much better for the patient’s wellbeing.
This was a fairly small-scale study. Therefore, more in-depth, larger studies may be required to fully change the opinions of surgeons. It’s also important to note that the patients in the study didn’t have damage to the rotator cuff. So, while wearing a sling may be just as effective as surgery in shoulder fractures, if there are any accompanying injuries, surgery may be preferential.
Those who do suspect they have a shoulder fracture, should seek a diagnosis from a shoulder specialist. They will be able to determine the severity of the injury and whether or not surgery will be required. This latest study does prove useful for shoulder specialists, enabling them to make better shoulder fracture treatment decisions for bone displacement fractures.
As an eventful and often nail-biting summer of cricket comes to a close with England securing a 2-2 draw in the Ashes yesterday, the London Shoulder Specialists explains why the shoulder is so susceptible to being injured in cricket.
Like any sport, cricket poses numerous injury risks. One of the most common is overuse and injury to the tendons and muscles of the shoulder. This type of injury can be painful and if left untreated, lead to months out of the game. However, there are ways to prevent cricketing shoulder injuries.
Here, we’ll look at the most common cricketing shoulder injuries and how they can be prevented.
Common cricketing shoulder injuries
Rotator cuff tendonitis occurs due to a repetitive throwing action in cricket. The tendons around the rotator cuff swell, causing pain and limited movement. Impingement syndrome, otherwise referred to as cricketer’s shoulder, is typically triggered by rotator cuff tendonitis. The swollen tendons end up trapped within the subacromial space.
The symptoms for both of these injuries are similar, and treatment typically requires rest, physiotherapy and depending upon the severity of the injury, surgery. If left untreated, inflammation is likely to continue to develop,
Problems can also occur with the labrum which is a ring of tissue around the socket of the shoulder.
Does cricketer’s shoulder differ from throwing shoulder?
Cricketer’s shoulder is often referred to as throwing shoulder. However, a recent study has revealed there are differences between the two conditions.
The study included 106 elite cricketers from South Africa and consisted of numerous tests, measurements and questionnaires. Results showed that the musculoskeletal profile of the cricketer’s shoulder is different from that of thrower’s shoulder.
Two risk factors of cricketer’s shoulder were identified in the study. These included a shortened non-dominant pectoralis minor muscle and a thicker dominant supraspinatus tendon.
How can cricketing shoulder injuries be prevented?
While cricketing shoulder injuries are a high risk for professional athletes, there are ways to limit the risks. One of the main thing patients can do is strengthen the shoulder and back muscles.
There’s a lot of different exercises you can do to strengthen the muscles and tendons. Ideally, you’ll want to seek advice from a shoulder specialist or physiotherapist as to which exercises would be better for you. They’ll be able to take into account the amount of time you play cricket and the level at which you play at. This will enable them to recommend specific exercises which may help you.
Ensuring you rest adequately between matches is also recommended. The shoulder needs time to rest and heal. The majority of shoulder injuries in cricketers occur due to overuse. So, allowing time between matches to rest the shoulder will greatly reduce the risk of injury.
Cricketer’s shoulder can be painful and if left untreated, it could lead to significant time away from the sport. As soon as you feel pain within the shoulder, it’s important to seek a diagnosis. The earlier an injury is treated, the sooner you can get back to being on top of your game.
A new, large-scale study has revealed that shoulder tendon repair surgery is more effective in the long-term than physiotherapy for rotator cuff tears. Although surgery is often used as a last resort, this study clearly highlights its benefits for long-term success.
Here, we’ll look at the results of this latest study and the surgical repair options available to treat rotator cuff tears.
Shoulder tendon repair more effective for small and medium tears
The study, which used a ten-year follow-up to produce its results, showed that tendon repair could be more effective for small and medium tears. The researchers analysed data from a total of 103 patients. Each had rotator cuff tears which were a maximum of 3cm.
The 103 patients were randomly chosen for either physiotherapy or primary tendon repair. Follow-ups were then conducted at six months, one year, two years, five years and finishing on the 10th year. The follow-up data looked into patient satisfaction, shoulder pain, and strength and motion.
It was discovered that the efficiency of treatment was higher for patients who underwent tendon repair. In all of the follow-ups after the surgery, the function of the shoulder was reported as stable. However, in the patients who underwent physiotherapy, stability of the shoulder was shown to actually decline. At the ten-year follow-up review, tendon repair had the best scores overall in terms of pain, mobility and stability.
Although this study only focused on small and medium rotator cuff tears, it does show the benefits early surgery could provide.
When is surgery recommended for rotator cuff tears?
At the moment, surgery is used as a last resort to treat rotator cuff tears. Non-surgical methods are attempted first, particularly if the tear is small or medium in size. However, it is known that unrepaired tendons actually widen over time, resulting in a need for more invasive surgery later on.
Patients usually need to wait six months to a year before surgery is recommended. The only exception to this is if the rotator cuff tear is large or if there is a significant weakness within the shoulder and arm.
The surgical options available
There are a number of surgical options available to repair a rotator cuff tear. The type of surgery used will depend upon a number of factors such as the severity of the tear and the quality of the bone and tendon.
The three most common surgical options include open repair, all-arthroscopic repair and a mini open repair. If you are suffering from a rotator cuff tear, you’ll be advised which treatment option would best fit your circumstances.
Overall, rotator cuff tears can be extremely painful, and surgery is usually used as a last resort. However, this latest research shows the importance of early surgery to provide better long-term outcomes for patients. Those who are suffering from a rotator cuff tear should book a consultation to determine its severity and the best course of treatment moving forward.
Like the majority of shoulder-related injuries and conditions, one of the main symptoms of calcific tendonitis is severe pain. Occurring when calcium builds up around the muscle or tendon, the condition can be excruciating to deal with.
Now, new research has potentially highlighted the cause of pain in calcific tendonitis. The researchers are hopeful the results of the study could lead to the development of new ways to treat the pain caused by the condition.
What is calcific tendonitis?
Calcific tendonitis is a painful condition that occurs when calcium deposits build up around the tendon. As they accumulate, the tissues located around the deposits can start to become inflamed. This is what then causes the severe pain associated with the condition.
Previously, the exact cause of calcific tendonitis is unknown, although it isn’t thought to be linked to osteoporosis, diet or injury. As the calcium deposits build up, they also cause pressure which decreases the space between the rotator cuff and the acromion. This then leads to impingement.
There are actually two different types of calcium tendonitis, referred to as reactive calcification and degenerative calcification. The condition mostly affects patients over the age of 40. While it can occur in several parts of the body, it most commonly presents within the shoulder.
What did the research reveal?
The recent study, published within the Journal of Bone and Joint Surgery, has potentially identified the cause of the pain experienced by those with the condition. Patients who experience calcific tendonitis have been discovered to have an increase in pain receptor and blood vessel growth.
The fact more blood vessels have been found in patients with the condition, suggests this could be a leading cause of the pain. A total of 30 patients underwent an ultrasound during their arthroscopic surgery. The images captured showed that compared to patients who had simple rotator cuff tears without signs of calcification, there was increased nerve growth and increased blood vessel growth.
Those who were found to suffer from calcific tendonitis, found it difficult to sleep because of the pain. The findings of this study were similar to those which were carried out on patients with frozen shoulder.
What treatment options are available?
Patients who are suffering from calcific tendonitis, are usually treated with a combination of physical therapy and medication. Anti-inflammatory drugs can help to reduce the swelling and therefore decrease some of the pain. Corticosteroid injections can also be provided to reduce swelling and pain.
If medication and physical therapy don’t work, there are other treatment options available. These include several types of shockwave therapy, therapeutic ultrasound and surgery. It’s important that patients understand their options, along with the risks and complications of each procedure before deciding whether or not to undergo the treatment.
Patients who suspect they may be suffering from calcific tendonitis should book a consultation with a shoulder specialist. The specialist will be able to diagnose the issue and address its severity before deciding upon the appropriate course of treatment. While the condition can be extremely painful, there are treatments available to reduce the pain until the deposits can be eliminated.
If you’re concerned you’re suffering from this shoulder condition, call 0203 195 2442 to arrange your appointment with the London Shoulder Specialists.
A new study has suggested that a hormone which is commonly created during pregnancy, could be the key to treating frozen shoulder.
Frozen shoulder is a very common condition. It affects over nine million people in the US and one million people in the UK. Causing severe, sudden shoulder pain and a feeling that the arm is locked into place, it can be a debilitating condition which has so far proved very tough to treat.
The findings of the latest study carried out by a scientist from Boston University, and his research team at The Grinstaff Group, could provide a much easier treatment process. Here, we’ll look at what the study found and whether a pregnancy hormone really could be the key to melting away frozen shoulder.
How was the research conducted?
The research was inspired by Edward Rodriguez, an orthopaedic surgeon from the Beth Israel Deaconess Medical Centre. He discovered some of his female patients experienced relief from frozen shoulder when they were pregnant. He wanted to establish whether biochemical changes that occurred during pregnancy could help treat frozen shoulder.
The research team began by reading everything they could relating to pregnancy hormones. They discovered a hormone known as Relaxin, which helps to stretch the tissues and ensure they aren’t too rigid. Interestingly, both men and women create the Relaxin hormone, but pregnant women produce more of it to prepare the body for birth.
To test whether the hormone was indeed responsible for melting away frozen shoulder, the team injected it into rats that had stiff shoulder joints. They injected the Relaxin hormone directly into the shoulder joint.
What were the findings?
The team discovered that by injecting the hormone directly into the shoulder joint of rats, it managed to restore full range of motion.
It is a particularly exciting discovery given that the hormone is naturally present in the body. It poses hope for a cure for frozen shoulder. Further research will need to be carried out to determine whether the hormone has the same effect on humans. However, researchers are hopeful they have found a potential cure.
How is frozen shoulder currently treated?
At the moment, there are several forms of treatment patients can undergo to treat frozen shoulder. Physical therapy, medications, ice packs and surgery are the most common treatments prescribed to patients.
Surgery is used as a last resort when other approaches have failed to provide relief. Physiotherapy is also used after surgery to regain motion and strengthen the shoulder. There are risks which come from any surgical procedure, so these do need to be discussed with the surgeon beforehand.
Frozen shoulder largely affects those over the age of 50. It can vary significantly in severity and can prove to be debilitating, affecting sleep and the ability to carry out daily activities. While there are effective treatments available, the condition currently has a painful and often long recovery time. So, this new research provides hope for a cure which could speed up healing and significantly reduce the pain of the condition.
The largest medical study into mountain biking has revealed bikers are most susceptible to shoulder and collarbone injuries. Carried out by researchers from the Edinburgh Napier University and funded by the Enduro World Series, the three-year study was carried out to determine rider health and injuries.
Here, we’ll look at how the study was carried out and what it revealed about the risks of shoulder sport injuries.
What did the study involve?
The researchers looked at injury information from more than 2000 athletes who took part in 10 different Enduro World Series events from 2017 to 2018. The injury rate was just 8.9%, which is a fairly low rate compared to figures from the RIO Olympic Games 2016 and of those seen in other sports such as rugby.
They also looked at a different study, which covered a wider participation base. They looked into another almost 2000 riders who came from 60 different countries. These varied from recreational riders, to amateur riders and those who competed in Enduro World Series races. This gave the researchers a much broader look into injury occurrence at all ability levels.
Which sport injuries were found to be most prevalent?
Although the injury incidence rate was fairly low, there were some sport injuries found to be more common than others. It was revealed that shoulder and collarbone injuries were the most common in riders, particularly during Enduro World Series races.
It was discovered that 71% of injuries bikers suffered, were caused due to coming into contact with the ground. Other causes included recurrence injuries and overuse injuries. The most common type of injury included lacerations, bruising and fractures.
Interestingly, the study revealed that concussion rates were low. It was estimated that a rider would need to compete in approximately 263 professional biking events to suffer just one concussion. It also showed that women were more likely than men to suffer a concussion. This is something which could benefit from further research.
In response to the findings, the Ensuro World Series has released informational documents. These include information on how riders can prepare for the challenges of events, along with key information for event staff. They are also working on providing more education regarding concussions and giving medical event staff more in-depth training.
The importance of building up shoulder strength
The findings of this latest study show the importance of building up shoulder strength in bikers. Although it can’t prevent damage caused by direct trauma to the joint, developing upper body strength is essential to keep you in control and for effective bike handling which will stop you crashing even when fatigue sets in.
Shoulder sport injuries can be particularly difficult to recover from. They typically feature a long recovery time and can cause a lot of pain and suffering to the biker. By building up the strength in the shoulder, it could help bikers avoid these potentially nasty injuries.
If a shoulder or collarbone injury does occur, seeking treatment quickly is crucial. The earlier the injury is treated, the less chance there is it could worsen. Seeking early treatment also means less invasive methods may be used to correct the problem.
If you’ve been suffering from a burning, painful sensation in the shoulder, it could be down to a number of conditions. As the shoulder is one of the largest and most mobile joints in the body, it’s prone to injury and may generate the same types of symptoms.
Two of the most confusing causes of burning and pain in the shoulder include Tendonitis and Tendinosis. These conditions are often confused with one another, but they do have their differences. Here, we’ll look at how Tendonitis and Tendinosis differ and the treatment options available.
What is shoulder tendonitis?
Tendonitis is a short-term condition, caused by a direct injury of the tendon. This causes inflammation, pain, warmth, redness and swelling. There are different types of the condition, with the most common affecting the rotator cuff of the shoulder.
Most commonly, it occurs due to overuse of the tendon. It’s especially common in athletes and labourers who frequently use the shoulder. Injuries can range from mild to severe and patients may find they have trouble moving the arm into specific positions.
What is shoulder tendinosis?
Tendinosis presents the same type of symptoms of Tendinitis, although it’s a completely different condition. It’s considered a chronic condition, which means it is either recurring or persistent. It is usually caused by repetitive trauma and unlike Tendinitis, it doesn’t lead to inflammation.
As inflammation isn’t present, you won’t experience symptoms such as warmth or redness in the area. It can occur anywhere in the body, but it is particularly common in the shoulder.
New study provides insight into why shoulder tendinosis occurs
A recent study has provided valuable insight into why Tendinosis may occur. The study carried out by the Philadelphia University and Thomas Jefferson University, discovered how tendon injuries in humans develop and the processes that occur.
The researchers analysed tendon tissue taken from patients, which would typically be discarded after surgery. After seeing the different processes at work, they then began experimenting, manipulating the oxygen levels within the tendon. They also discovered that if they could raise Rac1 production, they could potentially prevent Tendinosis from occurring, helping the cells of the tendon retain their shape.
Understanding how the tendon cells change their shape, allows the researchers to potentially manipulate them. However, further research is required to better understand how the pathways work and how they could be manipulated.
What treatment options are available?
In both Tendonitis and Tendinosis, the first point of treatment is typically rest and physiotherapy. With Tendonitis, ice packs and cortisol injections can also prove useful to treat the inflammation. However, these treatments aren’t useful with Tendinosis.
In mild cases of Tendinosis, physical therapy and rest are the best treatment options. However, if the injury is more severe, surgery may be required. This does mean the recovery period will be quite lengthy.
If you’re concerned you may be suffering from Tendonitis or Tendinosis of the shoulder, it’s important to seek an accurate diagnosis. From there, you’ll be provided with a suitable treatment plan based upon the type and severity of the condition.