What is the treatment for shoulder impingement?

In general, the treatment of impingement (also known as bursitis, rotator cuff tendinitis) is initially non-operative. This often includes the judicious use of steroid injections and physiotherapy. An injection aims to reduce inflammation in the tendons and physiotherapy aims to restore function and address issues, for example postural problems, to reduce the risk of a recurrence of symptoms.

Sometimes, if these measures are not successful, a keyhole operation known as a subacromial decompression may be considered.

What is the treatment for frozen shoulder?

There have been many treatments tried over the years, some more successful than others.

For most people, the appropriate initial treatment is a steroid injection into the shoulder joint performed by an experienced practitioner, followed by physiotherapy. The injection is sometimes repeated if the desired response is not achieved after the first.

Further treatment options may depend on the level of symptoms and disability caused by the disease. If they are mild, a patient may opt for no further treatment on the basis that the shoulder will usually improve, at least to a degree, over a year or two. If the shoulder is a more significant issue, a keyhole operation may be performed to free up the shoulder. This is called a frozen shoulder release and is the ‘Gold Standard” operation for frozen shoulder these days.

Can shoulder arthritis be treated?

The short answer is yes.

In all but the more advanced cases, steroid injections can be used to provide relief of symptoms.

The effects are usually temporary, but can in many cases last for a long time, sometimes for a year or more. If the benefit is long lasting, the injections can be repeated intermittently.

Physical therapy can also be of benefit.

If these measure are, or over time become, ineffective then shoulder replacement can be performed in a similar way to replacement of hips and knee joints.

How do you treat an unstable shoulder?

This depends on the cause of the problem.

If you have a normal shoulder then have a significant injury causing a dislocation and damage to the shoulder, an operation to stabilise the shoulder may be appropriate.

If the shoulder has dislocated without injury, this may be because the joint is naturally loose and/or there may be a problem with the muscles around the shoulder which contribute to stability. In this case, specialist physiotherapy is much more likely to be recommended, at least as a first line treatment.

Often the above causes of instability can co-exist and the treatment needs to be tailored to the individual.

Can shoulders be replaced?

Yes, in fact shoulders are the third most common joint to be replaced after the knee and hip. There are different types of replacement available depending on factors such as the state of the tendons and age.

Are steroid injections safe?

If used correctly, steroid injections are a safe and effective treatment. They work by reducing inflammation and pain. There are some risks which should be explained to you before receiving an injection, the most important being an infection, of which there is about a one in five hundred chance. Read more about steroid injections

Can I have more than one steroid injection?

Yes, you can safely have more than one injection. There are limits , however, and it is felt that you should not have more than three injections in one site over a twelve month period. There is some evidence that giving injections more frequently can result in a weakening of the local tissues. Read more about steroid injections

Can I drive after shoulder surgery?

There is usually some period of restriction on driving, the length of which will depend on the procedure. Having access to an automatic car can often shorten the period of restriction, as one of the arms is not required for changing gear. You should discuss the restrictions with both your surgeon (who usually sets the restrictions) and your motor vehicle insurers (who, for the most part will likely accept the advice of the surgeon).

Will I need a sling after surgery?

For the majority of procedures the shoulder will need to be rested in a sling for a period of time. The length will depend on the operation and you will be given individualised instructions by your surgeon. The period can be anything form a day up to six weeks for bigger procedures.

I have a rotator cuff tear. Should I have it fixed?

This depends on a number of factors. If, for example, you are a younger patient who has had a tear of the rotator cuff as a result of an injury and it remains symptomatic, then it is likely that a repair would be advised. If you are an elderly patient with mild symptoms, then it is less likely that a repair would be the recommendation. Sometimes tendons can’t be reliably repaired and sometimes tears do not need to be repaired. Your surgeon should advise you what is best for your individual circumstances.

Will I need physiotherapy after my shoulder surgery?

Physiotherapy has an important role after most types of shoulder surgery. It is helpful to encourage movement in a safe way whilst tissues heal and to ensure that movement is of good quality in order to prevent further problems. After movement is restored, strengthening is often required and again, physical therapy input can this aspect of recovery is undertaken in a safe and effective way.

Can shoulder surgery cause other problems? What are the risks?

The majority of people who have shoulder operations have no complications afterwards and most operations are considered low risk.

No operation is without some risks and accordingly shoulder surgery can result in some problems.

Most of these are minor and can be easily treated, but some, such as nerve damage, although very rare, can be more difficult to deal with. it is important that the risks of any surgical procedure are explained to you before you consider whether to go ahead with an operation. It is the responsibility of the surgeon to inform you and answer any questions you may have about the operation. The more common, and less common but important, general risks of a shoulder operation include infection, post operative frozen shoulder, nerve and blood vessel damage, blood clots in the legs or lungs and failure to improve or worsening of symptoms. There are one or two other risks specific to particular procedures.

When these risks are listed all together it can sometimes seem a bit daunting, but it should be remembered that the risk of shoulder surgery leaving you worse off is less than one percent!

How painful is a shoulder replacement?

A shoulder replacement is a significant operation but modern pain relieving measures mean that the patients shoulder should be uncomfortable rather than painful. The operation is usually done under a general anaesthetic, but a nerve block is also used such that the arm will be pretty much pain free when the patient wakes up following the procedure. Following this pain killers are provided such that pain is kept to a minimum. In fact, some people say that after a day or two after the operation, the continual pain associated with arthritis has already gone.

How long does it take to recover from a shoulder replacement?

The answer to this depends slightly on the type of shoulder replacement. The need for a sling may vary for a few days up to four weeks. The speed at which the shoulder can be moved also varies. in some cases there are no postoperative restrictions at all.

The shoulder may continue to improve after a replacement for six to eight months, but the shoulder shoulder be recovered enough to allow most activities well before that. For example, most people should be able to drive within a couple of months at most and often much sooner.

Can I get frozen shoulder on both sides at once?

Yes. Although it is commoner to get one at a time, it is not that unusual to have both shoulders affected at once.

What is frozen shoulder?

Frozen shoulder is a condition where the shoulder becomes increasingly painful and more stiff over time. There are other causes of stiffness and pain in the shoulder but frozen shoulder is a specific disease. Frozen shoulder can occur in most age groups but is most common in patients in their 40s and 50s and is slightly more common in women. Certain groups such as diabetic patients are very prone to getting it.

What are the symptoms of frozen shoulder?

Frozen shoulder symptoms can come on fairly gradually. The sufferer often starts by noticing an aching around the outer and sometimes front part of the upper arm. Over time the person will notice the shoulder is stiffening up. Activities such as reaching behind and reaching out suddenly become painful. If the shoulder is jolted or thrust out rapidly the patient may notice excruciating pain which may last for a few minutes or even hours. The symptoms are often troublesome at night and can often disturb the sleep. Occasionally the sufferer may notice nerve type symptoms such as tingling and shooting pains down the arm.

Why does frozen shoulder happen?

Frozen shoulder occurs when the lining of the ball and socket joint and the shoulder becomes inflamed. Abnormal cells then formed in the capsule around the joint. These behaves like a mixture between scar forming cells and muscle cells. They lay down scar and then to add insult to injury they contract-like muscle cells. These changes account for the pain and stiffness in the shoulder. Although we know what happens in frozen shoulder no one really knows exactly why. Frozen shoulder can come out of the blue which is known as primary frozen shoulder. Alternatively frozen shoulder can come on after any other shoulder problems and this is known as secondary frozen shoulder. There are certain other conditions such as diabetes and thyroid problems which have an association with developing frozen shoulder and even some medications can increase the risk of getting one

How long does frozen shoulder last and will it go away?

The standard answer to this is about 1-3 years without treatment. However symptoms can last significantly longer and there is good evidence that in about 10% of people the symptoms of stiffness at least may last for ever. There is also evidence that in the majority of cases frozen shoulder will improve over time but if untreated, there will almost always be some residual lack of movement in the shoulder.

How is frozen shoulder treated?

There are a number of treatments that have been used for frozen shoulder, some more effective than others. Physical therapy can help some of the symptoms but there is not a great deal of evidence that when used alone it can change the natural course of the problem. Steroid injections into the ball and socket joint have been shown to be of benefit and combining steroid injections and physical therapy has been shown to be even better still. If these conservative measures do not sort the problem then surgery can be considered. The modern approach for this is to perform a keyhole release of the tight structures in the shoulder. There a number of other treatments some of which have conflicting evidence as as to whether they work and some of which are just not worth bothering with at all!

Who should I see about my frozen shoulder?

There is some evidence that the earlier a steroid injection is given into the shoulder the better and I usually therefore say to people that they are best off initially seeing someone who is able to provide such an injection. If a steroid injection and physical therapy have not led to significant improvement and you have not already involved a orthopaedic shoulder specialist in your care then that is probably time to do so.

Do I need a scan for my frozen shoulder?

The short answer to this is “no”.

An experienced clinician will have no trouble at all in diagnosing frozen shoulder and an MRI scan is rarely needed. If however there were thought to be other potential problems in the shoulder (as in the case of secondary frozen shoulder) then a scan may be suggested. There are some changes that can be seen on an MRI scan which are suggestive of a frozen shoulder but the patient's symptoms and examination are normally more than enough to make the diagnosis.

Will frozen shoulder come back?

The short answer to this is “no”.

The evidence suggests that if someone has had a genuine frozen shoulder which has fully resolved they are unlikely to get the same condition again in the same shoulder. Not infrequently, I see patients who present with a frozen shoulder and they have been told they have had it before some time ago. Closer questioning, however, often reveals that the initial diagnosis some years back was probably incorrect. There is no doubt, however, that if you have had a frozen shoulder you can subsequently get the same problem in the other shoulder. This more often occurs as two separate events but occasionally both shoulders can become frozen at the same time. It is likely that if you have had one frozen shoulder you are at slightly higher risk of developing another frozen shoulder on the other side when compared to the general population as a whole.

What has frozen shoulder got to do with diabetes?

There is absolutely no doubt that people with diabetes have a significantly increased risk of developing a frozen shoulder compared to the general population. It is likely also that the symptoms may be longer lasting and somewhat harder to treat than those in the non-diabetic population. There are a number of theories as to why the problem may be more common in diabetics including those based on abnormalities with collagen or scar formation and formation of new blood vessels which we know occur in the diabetic patient. But don’t worry, I won’t bother you with with the details of this right now.

I have a tear in my rotator cuff. Do I need surgery?

The answer to this is often no. For example if you have no symptoms or symptoms that are controlled with non-operative means such as physiotherapy, then surgery is not usually suggested. If symptoms are bad enough and particularly if non-operative measures have failed, surgery may be appropriate. This will often be to repair the tendons with a keyhole operation, but in some instances a repair may not be feasible and there are a number of other surgical options in these cases.

Do shoulder replacements work?

Although shoulder replacements are probably not as good as hip replacement (which is the most successful intervention in the whole of medicine for improving quality of life), the results are still good with over 80% of people having a very good result with which they are pleased. Fortunately it is rare for people to regret having had this operation.

What are the risks of shoulder surgery?

The risks are individual to each type of operation and will also depend on certain characteristics of the patient, but there are a number of potential risks which are relevant to most operations.

These include infection, nerve and blood vessel injury, clots in the legs and the lungs, stiffness and a failure to improve. Fortunately these are rare and the vast majority of shoulder operations are uneventful with no complications. Your surgeon should always explain the risks in detail to you as an individual patient as they will be slightly different for different patients.

Can I drive after shoulder surgery?

For the vast majority of shoulder operations there will be some restriction on driving for a period following the procedure. This period varies and is often anything from a week to six weeks after the operation. If you have access to an automatic car, it may be possible to drive sooner.

Can I shower after a shoulder operation?

In general wounds need to be kept dry for a minimum of 72 hours. and are usually kept covered for one to two weeks. Showering in a modified way avoiding water soaking the dressings should be possible whilst the wounds are still covered. Specific instructions are normally given to the individual patient prior to hospital discharge and will depend somewhat on the type of operation

Can I drive home after a shoulder operation?

For the vast majority of operations (not just on the shoulder) a patient should not drive themselves home after the procedure. This can be as much related to the temporary after effects of the anaesthetic as the surgery.

How long will my arm be in a sling after my operation?

This depends very much on the procedure. In some case the sling can be left on for a day or just for comfort. At the other end of the spectrum, for example after the repair of a massive rotator cuff repair, a sling may be required for up to six weeks.

When can I return to work after a shoulder operation?

This depends on two factors: firstly the type of operation and secondly the type of work you do (and whether you need to drive yourself to your workplace).

In general, if you do a sedentary desk job working on a keyboard, you should be able to return in a few days or so. With other procedures such as reconstructive surgery, restrictions on working may be more prolonged. If you are in a very physical job, it may not be possible to return, other than on modified duties for up to three months or more after bigger operations.

Athletic shoulder