Shoulder Injuries

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Shoulder injuries range from simple strains of the tendons through to complex fractures and dislocations.

Managing shoulder problems correctly is vitally important to long-term outcomes, as the shoulder joint is prone to stiffness and pain.

Our specialists are leaders in the treatment of shoulder injuries (fractures, dislocations, tendon injuries) and their consequences (arthritis, stiffness, pain). Members of the Nexus team have helped shape national and international practice in the management of shoulder injuries, with their research published in the highest impact scientific literature.

No other joint relies so heavily on the communication between the orthopaedic surgeon and physiotherapist in an attempt to regain movement whilst allowing the tissues to heal. We work closely with our physiotherapy colleagues to ensure the best possible outcome.

CLAVICLE FRACTURES

Fractures of the clavicle (collar-bone) usually occur after a heavy fall onto the shoulder, typically after falling off a bike or ladder.

Key Points — Diagnosis and Management

These points will be discussed in more detail when you meet your surgeon.

  • Clavicle fractures range from simple, undisplaced injuries that can be managed without surgery, to those that are very displaced.
  • The majority of people with this problem can be managed without surgery.
  • The clavicle is easier to fix when the injury is ‘fresh’, but if the fracture doesn’t heal this can be done at a later stage.
  • People with physical jobs, ongoing pain, or concerns regarding the way the shoulder looks are more likely to undergo surgery.

Key Points — Surgical Treatment

  • Most people go home on the same or next day.
  • You will have a general anaesthetic (you will be asleep).
  • Your shoulder will feel stable and pain free within a few days of surgery in the majority of cases.
  • You will be in a sling for 2–3 weeks.
  • You will not be driving for 4–6 weeks.
  • You cannot do any heavy work or sport for 3 months.
  • This is a safe, reliable and effective operation for 90% of people.
  • You may need removal of the metal plate from your clavicle 6 months after the surgery. This occurs in around half of all cases and recovery after this surgery only takes a number of days.
ACROMIO-CLAVICULAR JOINT (ACJ) INJURY

The acromio-clavicular joint is the point where the collarbone meets the shoulder blade. It is prone to injury if you are involved in a heavy impact to the shoulder area and injury may lead to arthritis. Symptoms include pain and a visible deformity of the shoulder area.

Key Points — Diagnosis and Management

These points will be discussed in more detail when you meet your surgeon.

  • ACJ injuries range from a sprain to a complex dislocation.
  • The majority of people with this problem can be managed without surgery.
  • People with physical jobs, ongoing pain, or concerns regarding the way the shoulder looks are more likely to undergo surgery.

Key Points — Surgical Treatment

  • Most people go home on the same or next day.
  • You will have a general anaesthetic (you will be asleep).
  • You will be in a sling for 2–3 weeks.
  • You will not be driving for 4–6 weeks.
  • You cannot do any heavy work or sport for 3 months.
  • This is a safe, reliable and effective operation for 90% of people.
  • More information can be found at http://lockdownsurgical.com/usa/patients-caregivers/acj-injury/
SHOULDER DISLOCATION

This is a disruption of the joint capsule of the glenohumeral joint (the main shoulder joint) usually caused by a sudden jolt to the shoulder joint, usually in a rugby tackle or heavy fall.

This occurs because the socket of the shoulder joint (glenoid) is quite shallow, and so the shoulder is not as stable as other joints such as the hip.

Key Points — Diagnosis and Management

These points will be discussed in more detail when you meet your surgeon.

  • The treatment for recurrent traumatic dislocation depends on the age of the patient and their sporting involvement. Sportsmen/women under 30 years old frequently require a shoulder stabilization procedure.
  • The following factors affect your chance of re-dislocating your shoulder:
    • Men are more likely than women to suffer from recurrent instability following their first traumatic anterior shoulder dislocation (47.3% and 25.5%, respectively).
    • People 40 years and under are 13.5 times more likely to suffer recurrent instability following a first-time traumatic anterior shoulder dislocation than those over the age of 40 years.
    • People with a greater tuberosity fracture are over seven times less likely to suffer from recurrent instability compared with people without a fracture.
    • People with hyperlaxity are 2.7 times more likely to suffer from recurrent instability following a first-time traumatic anterior shoulder dislocation compared with people without hyperlaxity.
    • Source: British journal sports medicine (http://dx.doi.org/10.1136/bjsports-2014-094342)
  • Of those people who re-dislocate, this occurs in the first month for a quarter of all patients, half by 6 months, three-quarters by a year and the remainder dislocate after a year.
  • More sedentary adults usually choose to modify their sport or lifestyle, which is one option to reduce re-dislocation risk.
  • Older patients frequently have an associated rotator cuff tear that needs to be repaired surgically. Your surgeon will investigate your shoulder to see if your tendons are torn after dislocation.
  • Depending on your exact injury (determined by MRI scanning), your surgeon may use one of a number of different surgical techniques including: keyhole surgery (arthroscopic stabilization) or ‘open’ surgery (capsular shift or Latarjet).

Key Points — Surgical Treatment

  • Nearly all are done as day-case surgery (home the same day).
  • You will have a general anaesthetic (you will be asleep).
  • You will be in a sling for up to 6 weeks.
  • You will not be driving for at least 6 weeks.
  • You will not return to work for 3 months if you are a manual worker, but much sooner if you are not a manual worker.
  • You will have to wait 6 months before returning to collision (contact) sport including football.
  • This is a safe, reliable and effective operation for 90% of people.
  • This is not a quick fix operation. Symptoms may take many months to improve.
  • shoulderdoc.co.uk is a reputable and useful British website for further information.
PROXIMAL HUMERUS FRACTURES (UPPER ARM)

A proximal humerus fracture, also called a broken shoulder, is a common injury affecting the upper part of the arm, which forms the rounded ‘ball’ section of the shoulder joint.

Key Points — Diagnosis and Management

These points will be discussed in more detail when you meet your surgeon.

  • The majority of fractures will heal without surgery. You will be advised to wear a sling for a period of time and then mobilise the shoulder under the direction of your surgeon and physiotherapist.
  • If the bones move out of place (become displaced), then you may need surgery to improve the function of the shoulder.
  • Depending on the type of fracture, this may involve holding the bones in place with screws and plates, or replacing the shoulder with an artificial joint.

Key Points — Surgical Treatment

  • Most people go home one or two nights after surgery.
  • You will have a general anaesthetic (you will be asleep).

Your rehabilitation will be specific to you, your fracture and the treatment you undergo, but in broad terms:

  • You will be in a sling for approximately 6 weeks, but can gently move the elbow.
  • You will not be driving for 8 weeks.
  • You cannot do any heavy work or sport for 3 months.
  • This is a safe, reliable and effective operation for over 90% of people.
  • The physiotherapy you receive after your surgery is very important in determining outcome and we work closely with expert physiotherapists.

REFERRALS & ENQUIRIES

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