AC Joint Problems
The AC joint, also known as the acromioclavicular joint, is a small joint located at the top of the shoulder where the acromion (a bony projection of the scapula or shoulder blade) and the clavicle (collarbone) meet. It plays a crucial role in the shoulder’s stability and allows for a wide range of motion in the arm.
Problems that can affect the AC joint include:
- AC Joint Sprain
This is the most common issue affecting the AC joint. A sprain occurs when the ligaments that stabilise the joint become stretched or torn, usually due to a fall or direct impact to the shoulder. Most of the time sprains will resolve with pain relief, a sling and a period of rest.
- AC Joint Separation
A more severe injury than a sprain, AC joint separation occurs when the ligaments holding the joint together and those between the clavicle and the scapula are completely torn, leading to a visible or palpable bump at the top of the shoulder. This injury is also commonly caused by a sporting collision, a fall or traumatic impact. Depending on the severity of the separation, the treatment can be conservative (just like an AC joint sprain) or surgery. Surgery usually involves inserting a suture-based implant that brings the AC joint back to its usual position, allowing the ligaments to heal in their natural position.
Over time, the AC joint can be affected by wear and tear, leading to osteoarthritis in the joint. Osteoarthritis is a degenerative condition characterised by the breakdown of cartilage, causing pain, stiffness and reduced range of motion in the shoulder. Very often this can be managed with pain relief and physiotherapy alone, but occasionally a steroid injection can be recommended. In severe cases the AC joint can be removed entirely through a keyhole operation.
A severe impact or trauma to the shoulder can result in a fracture of the clavicle or acromion, which can also affect the AC joint and its stability. Depending on the location and severity of the fracture, the treatment can be conservative with a sling and physiotherapy, or surgery where the fracture is fixed with a plate and screws.
If you suspect an issue with your AC joint or experience persistent shoulder pain, it is essential to seek evaluation from an orthopaedic surgeon or an experienced physiotherapist to facilitate an accurate diagnosis and appropriate treatment.
Calcific tendonitis, also known as calcific tendinosis, is a painful condition characterised by the formation of calcium deposits within a tendon, most commonly affecting the rotator cuff tendons around the shoulder joint. The calcium deposits can cause inflammation, pain and limited range of motion in the affected area.
The condition typically progresses through several stages:
- Pre-calcific Stage
In this stage, the tendon becomes irritated due to repetitive stress or microtrauma, leading to inflammation and swelling.
- Calcific Stage
Calcium crystals start to accumulate within the tendon, forming small deposits. This stage is often the most painful and can cause significant discomfort.
- Post-calcific Stage
The calcium deposits may begin to resorb naturally and the inflammation and pain subside.
The exact cause of calcific tendonitis is not fully understood, but it is believed to be related to repetitive microtrauma, overuse of the affected tendon, or issues with calcium metabolism.
Treatment for calcific tendinitis depends on the stage of the condition and the severity of symptoms. The main approaches to managing calcific tendinitis include:
- Conservative Treatment
Rest: Avoiding activities that exacerbate the pain can help reduce irritation to the affected tendon.
Ice: Applying ice to the affected area can help reduce inflammation and relieve pain. Ice can be applied for about 15-20 minutes several times a day.
Pain Medications: Over-the-counter pain relievers (e.g., NSAIDs) can be used to manage pain and inflammation.
Physiotherapy: Specific exercises and stretches can help improve shoulder mobility and strength, as well as reduce pain.
- Aspiration and Injection
Needle Aspiration: In some cases, a radiologist may use a needle to aspirate (draw out) the calcium deposits from the tendon. This can provide immediate pain relief in certain instances.
Corticosteroid Injection: Injecting corticosteroids into the affected area can help reduce inflammation and alleviate pain.
- Shockwave Therapy
Extracorporeal shockwave therapy (ESWT) involves directing shockwaves to the affected area to help break down the calcium deposits and stimulate healing.
- Surgical Treatment:
In cases where conservative treatments fail to provide relief or if the condition is severe, surgical intervention may be considered. This is usually performed though arthroscopic (keyhole) approach and aims to release the calcium deposits from the affected tendon and promote resolution of symptoms.
If calcific tendonitis is confirmed it is essential to consult with a healthcare professional, such as an orthopaedic specialist or experienced physiotherapist in order to determine the most appropriate treatment plan. Early diagnosis and prompt intervention can help prevent the condition from progressing and improve the chances of successful treatment.
A clavicle fracture, also known as a collarbone fracture, is a common injury that occurs when the clavicle bone, which connects the sternum (breastbone) to the shoulder blade, breaks due to trauma or excessive force. It is often caused by a fall onto an outstretched hand or direct impact to the shoulder area from falling off a bicycle.
Symptoms of a clavicle fracture include pain, swelling, bruising and tenderness over the collarbone. The affected individual may have difficulty moving the arm on the injured side and may notice a visible deformity or bump at the site of the fracture.
Treatment of a clavicle fracture depends on the severity of the injury. Generally, there are two main approaches to managing clavicle fractures:
- Non-Surgical Treatment
Most clavicle fractures can be effectively treated without surgery, especially when the bone fragments remain relatively well-aligned. Non-surgical treatment options may include:
Arm Sling or Brace: Wearing a supportive arm sling or brace helps immobilise the arm and shoulder, reducing strain on the fractured bone and allowing it to heal properly. Regular x-rays are usually required to monitor the healing process.
Pain Management: Over-the-counter pain medications, such as paracetamol or nonsteroidal anti-inflammatory drugs (NSAIDs), may be helpful to manage pain and reduce inflammation. Occasionally stronger medications will be prescribed, particularly in the early stages following injury.
Physical Therapy: Once the initial healing process has begun, physiotherapy exercises are very important to improve shoulder strength and range of motion.
- Surgical Treatment
In some cases, surgery may be recommended, particularly for severe fractures where the bone fragments are significantly displaced or there is a risk of the bone not healing correctly (non-union). Surgical treatment involves realigning the bone fragments and securing them usually with a plate and screws. After surgery, a period of immobilisation and physiotherapy will be necessary to aid in rehabilitation.
The choice between surgical and non-surgical treatment is based on various factors, including the fracture location, displacement and the individual’s age, activity level and overall health.
Recovery time for a clavicle fracture varies depending on the severity of the injury and the chosen treatment approach. In less severe cases, healing may take about 6-8 weeks, while more complex fractures or surgical interventions may require a longer recovery period. It is essential to follow the surgeon’s instructions carefully during this time and attend all follow-up appointments to ensure the fracture heals properly.
Frozen shoulder, also known as adhesive capsulitis, is a condition that affects the shoulder joint, causing pain and limited range of motion. It typically progresses through three stages over time, each characterized by different symptoms:
- Freezing Stage
This is the initial stage and involves the gradual onset of pain in the shoulder. As the pain worsens, the shoulder’s range of motion begins to decrease.
In this stage, the pain may begin to diminish, but the shoulder becomes stiffer, resulting in further limitations in movement. Performing simple tasks, such as reaching for items or dressing, can become difficult and painful.
During this stage, the shoulder gradually starts to regain some range of motion and the pain lessens. This stage can take several months to years.
The exact cause of frozen shoulder is not fully understood, but certain risk factors may contribute to its development, such as diabetes, thyroid disorders, previous shoulder injuries, or prolonged immobilisation of the shoulder.
Treatment for frozen shoulder focuses on reducing pain and improving shoulder mobility. The treatment options may include:
- Physical Therapy
Gentle stretching and strengthening exercises prescribed by a physical therapist can help improve range of motion and reduce pain. However, it’s essential to avoid overexertion, as it can worsen the condition.
- Pain Relief
Over-the-counter non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, may be recommended to manage pain and inflammation.
- Heat and Ice
Applying heat packs or ice packs to the affected shoulder can help reduce pain and inflammation. Heat is generally more helpful during the “thawing” stage, while ice may be more beneficial during the “freezing” stage.
- Corticosteroid Injections
In some cases, corticosteroids may be injected into the shoulder joint to reduce inflammation and alleviate pain.
- Joint Distension
This procedure, also known as hydrodilatation, involves injecting sterile water into the joint capsule to stretch and expand it, potentially improving range of motion.
- Manipulation Under Anesthesia (MUA)
In this procedure, the patient is put under anaesthesia and the arm is carefully manipulated in order to break up the adhesions in the shoulder joint.
- Arthroscopic Capsular Release Surgery
If conservative treatments do not provide relief, arthroscopic surgery may be considered to release the joint capsule and improve the range of shoulder motion.
It’s important to note that treatment for frozen shoulder can be a slow and gradual process and patience is essential. Early diagnosis and prompt treatment can lead to better outcomes and a quicker recovery. If you experience shoulder pain and stiffness that doesn’t improve, it’s crucial to consult an orthopaedic surgeon or experienced physiotherapist for proper evaluation and management.
Proximal Humerus Fracture
A proximal humerus fracture refers to a fracture of the upper part of the humerus bone, which is the long bone of the upper arm. The proximal part of the humerus is the section that connects to the shoulder joint. Proximal humerus fractures are common and can occur due to various reasons but most commonly falls and sports injuries.
The severity of the fracture can vary, ranging from a simple crack in the bone to a more complex fracture involving multiple bone fragments. The treatment for a proximal humerus fracture depends on several factors, including the type and location of the fracture, the age and overall health of the patient and the presence of any other injuries.
Treatment options for proximal humerus fractures include:
- Conservative (Non-Surgical) Treatment
This approach is typically considered for less severe fractures where the bone fragments are still relatively well aligned and/or when fractures occur in elderly patients with lower demands. It involves immobilizing the arm with a sling or brace to allow the fracture to heal naturally over time. Physiotherapy is usually recommended to regain joint flexibility and strength during the healing process.
- Surgical Treatment
Surgery is often required for more complex fractures or if conservative treatment is unlikely to provide satisfactory results. The surgical options include:
Open Reduction Internal Fixation (ORIF): In this procedure an incision is made and the fractured bone fragments are realigned and held in position with a metal plate and screws or a nail.
Joint Replacement: If the fracture is severe and cannot be adequately reconstructed, a shoulder replacement may be necessary. This involves replacing the damaged parts of the humerus and the shoulder joint with artificial components.
Hemiarthroplasty: This is a partial shoulder replacement where only the humeral head (the ball part of the shoulder joint) is replaced with an artificial implant. It is occasionally used for unfixable fractures in the younger aged patient.
Reverse Total Shoulder Arthroplasty: This procedure is considered when the shoulder joint is severely damaged or if the patient has a specific type of fracture. It involves switching the position of the ball and socket components of the shoulder joint to improve function and stability.
The choice of treatment will be made by an orthopaedic surgeon based on a thorough evaluation of the fracture and the patient’s individual circumstances. Rehabilitation and physiotherapy are essential components of the recovery process to regain strength, range of motion and function in the affected arm.
Rotator Cuff Tears
Rotator cuff tears are a common type of injury that affect the muscles and tendons in the shoulder joint. The rotator cuff is a group of four muscles (supraspinatus, infraspinatus, teres minor, and subscapularis) and their associated tendons that surround the head of the humerus (the upper arm bone) and stabilise the shoulder joint. These muscles and tendons work together to allow for a wide range of motion in the shoulder and arm.
A rotator cuff tear occurs when one or more of these tendons become partially or completely torn. This can happen due to various reasons, including repetitive overhead movements, trauma from falls or accidents, degenerative changes with age, or chronic overuse. Rotator cuff tears can range in severity from minor fraying to complete tears
Symptoms of a rotator cuff tear may include pain (particularly when lifting or reaching), weakness in the shoulder and arm and a limited range of motion in the shoulder.
When conservative treatments like rest, physical therapy and anti-inflammatory medications do not effectively improve the condition or when the tear is severe, rotator cuff surgery may be recommended.
Rotator cuff surgery is usually undertaken in a minimally invasive way through small incisions around the shoulder and using a camera called an arthroscope. Here is an overview of the surgical process:
The patient is given general anaesthesia to ensure they are unconscious and do not feel any pain during the surgery.
A few small incisions are made around the shoulder joint and an arthroscope (a thin metal tube with a camera and light at the end) is inserted. This allows visualisation of the inside of the shoulder on a TV monitor in the theatre.
Using specialized surgical instruments, the tear is trimmed and any damaged tissue or debris is removed. The tendon bed is ‘freshened up’ to permit healing, before the torn rotator cuff tendon is fixed back to the bone, usually with small bone anchors.
Once the repair is complete, the incisions are closed with sutures and adhesive dressings and a sling are applied.
After the surgery, the patient will typically need to wear a sling for six weeks to rest the shoulder and promote healing. Physiotherapy is an essential part of the recovery process, helping to regain strength, range of motion and function in the shoulder. The duration of recovery varies depending on the severity of the tear and the individual’s overall health but usually the benefit of surgery will begin to be felt after around 3 to 4 months.
It is essential to follow the post-operative instructions carefully following rotator cuff surgery, in order to achieve the best possible outcome and minimize the risk of complications. While many people experience significant improvement after rotator cuff surgery, full recovery may take several months and some patients may still experience mild residual symptoms even after successful surgery and rehabilitation.
Shoulder arthritis, also known as glenohumeral arthritis, is a condition where the cartilage that covers the surfaces of the shoulder joint bones wears away, leading to pain, stiffness and reduced range of motion in the shoulder. The shoulder joint is a ball-and-socket joint, where the head of the humerus (upper arm bone) articulates with the glenoid cavity of the scapula (shoulder blade). When the cartilage in this joint is damaged or deteriorates, it causes the bones to rub against each other, resulting in the symptoms of arthritis.
There are many different types of shoulder arthritis, with the most common being:
The most common type of arthritis, caused by wear and tear over time.
- Rheumatoid Arthritis
An autoimmune disorder that causes inflammation in the joint lining.
- Post-Traumatic Arthritis
Arthritis that develops after a shoulder injury or fracture.
- Cuff Tear Arthropathy
A specific pattern of arthritis that develops following a loss of rotator cuff function
Treatment for shoulder arthritis aims to alleviate pain, improve function and enhance the patient’s quality of life. The specific treatment options depend on the severity of the arthritis and the patient’s individual circumstances. The main approaches to managing shoulder arthritis include:
- Conservative Treatment
Pain Medications: Over-the-counter non-steroidal anti-inflammatory drugs (NSAIDs) or prescription pain relievers can help reduce pain and inflammation.
Physiotherapy: Gentle exercises and stretches prescribed by a physical therapist can improve shoulder mobility and strength.
Activity Modification: Avoiding or modifying activities that exacerbate shoulder pain can help prevent further joint damage.
Assistive Devices: Using supportive devices such as slings or braces can occasionally help reduce strain on the shoulder joint.
Corticosteroid Injections: Injections of corticosteroids directly into the shoulder joint can provide temporary relief from pain and inflammation.
Hyaluronic Acid Injections: These injections may help lubricate the joint and reduce friction, providing some relief from symptoms.
- Arthroscopic Debridement
In cases where there is loose cartilage or debris in the joint, arthroscopic surgery can be performed to remove the damaged tissue and smooth the joint surfaces and release contractures.
- Shoulder Replacement (Arthroplasty)
This is considered when the joint damage is extensive and other treatments are no longer effective. Shoulder replacement surgery involves replacing the damaged joint surfaces with artificial implants.
There are two main types of shoulder replacement: Anatomic total shoulder replacement (usually performed for osteoarthritis) and Reverse total shoulder replacement (usually performed for end-stage rotator cuff failure and following fractures around the shoulder).
- Joint Fusion (Arthrodesis)
In severe cases and in young patients where other treatments have not been successful, joint fusion may be considered. This involves surgically fixing the joint surfaces together to eliminate pain, but it also restricts joint movement entirely.
The choice of treatment depends on factors such as the patient’s age, activity level, overall health and the extent of joint damage. It is essential for individuals experiencing shoulder pain or reduced shoulder mobility to seek evaluation and advice from a qualified shoulder surgeon or experienced shoulder physiotherapist, to determine the most appropriate treatment plan for their specific condition.
Shoulder impingement, also known as subacromial impingement, is a common condition where the structures in the shoulder joint become compressed or irritated, leading to pain and limited range of motion. It occurs when the space between the acromion (a bony projection of the shoulder blade) and the rotator cuff tendons narrows, causing the tendons to rub against the acromion or the bursa (a fluid-filled sac that reduces friction between the tendons and bones). This repetitive rubbing can result in inflammation, swelling and pain in the shoulder.
Causes of shoulder impingement may include overuse of the shoulder, repetitive overhead activities (common in athletes and people who perform certain jobs), muscle imbalances, poor posture and structural abnormalities in the shoulder joint.
Treatment for shoulder impingement typically involves a combination of conservative measures to alleviate pain, reduce inflammation and improve shoulder function. In some cases, surgical intervention may be considered if conservative treatments are ineffective or the condition is severe. The main treatment options include:
- Rest and Activity Modification
Resting the shoulder and avoiding activities that worsen the pain can help reduce irritation to the affected area.
Specific exercises and stretches prescribed by a physiotherapist can help strengthen the muscles around the shoulder joint, improve shoulder mechanics and increase flexibility.
- Pain Medications
Over-the-counter non-steroidal anti-inflammatory drugs (NSAIDs) can help reduce pain and inflammation.
- Ice and Heat
Applying ice packs or using heat therapy can help reduce inflammation and alleviate pain. Ice is generally more effective in the early stages of impingement when there is acute inflammation, while heat can be beneficial for chronic or persistent pain.
- Corticosteroid Injections
Injections of corticosteroids directly into the subacromial space can help reduce inflammation and provide temporary pain relief.
- Posture Correction
Addressing poor posture can help reduce stress on the shoulder joint and prevent impingement.
- Surgery – Arthroscopic Subacromial Decompression / Acromioplasty
In cases where conservative treatments do not provide relief, or if there is a structural issue causing impingement, arthroscopic surgery may be considered. During surgery any bony spurs or inflamed bursa is removed and the acromion is reshaped to create more space for the tendons.
The specific treatment approach will depend on the severity of the impingement, the individual’s symptoms and the underlying cause. It is essential to seek evaluation and advice from a qualified shoulder surgeon or experienced physiotherapist to determine the most appropriate treatment plan for shoulder impingement. Early diagnosis and proper management can help prevent the condition from worsening and improve the chances of a successful recovery.
Shoulder instability refers to a condition in which the structures that stabilise the shoulder joint, including ligaments, tendons and the joint capsule are injured. This can lead to excessive movement of the shoulder bones, making the joint prone to dislocation or subluxation (partial dislocation). Shoulder instability can be broadly classified into two main types:
- Traumatic Instability
This occurs as a result of a sudden and forceful impact or trauma to the shoulder, such as a fall off a bike or a heavy tackle whilst playing sport. Traumatic instability can lead to a dislocation of the shoulder joint, which may require medical intervention to reposition the joint back in its usual place.
- Atraumatic Instability
This type of instability is not caused by a specific injury but may develop over time due to an underlying joint laxity or hypermobility, due to genetic factors. People with atraumatic instability may experience frequent episodes of subluxation or a feeling that their shoulder is “slipping out of place.”
Treatment for shoulder instability depends on various factors, including the severity of the instability, the patient’s age, activity level and overall health. Here are some common treatment approaches:
- Conservative (Non-Surgical) Treatment
Mild cases of shoulder instability may be managed without surgery. The focus of conservative treatment is to strengthen the muscles around the shoulder joint to provide better support and stability. Physiotherapy exercises are usually prescribed to improve shoulder strength, stability and proprioception (awareness of the joint position). Additionally, the use of a shoulder brace or sling may help support the shoulder during the healing process.
- Surgical Treatment
If conservative measures fail to provide adequate stability or if the instability is severe, surgery may be considered. The type of surgical procedure will depend on the specific instability issue and the patient’s individual circumstances. Common surgical options include:
Arthroscopic Stabilisation: A minimally invasive procedure where small incisions and a camera (arthroscope) are used to repair torn ligaments and stretched capsule.
Latarjet Procedure: This surgery involves transferring a piece of bone from the coracoid process (a bony projection on the scapula) to the front of the glenoid (the shallow socket of the shoulder joint). This can help stabilise the joint and prevent dislocations.
Eden-Hybinette Procedure: Named after the surgeons who originally popularised it, this is similar to the Latarjet procedure, but involves a small piece of bone being taken from the top of the pelvis (through a separate incision) and then placed on the front of the shoulder socket to increase stability.
Following surgery, a structured rehabilitation program is essential to regain shoulder strength, flexibility and function. Physiotherapy plays a crucial role in the recovery process.
It’s crucial to seek medical attention from an experienced orthopaedic surgeon or physiotherapist if you suspect shoulder instability or experience recurrent shoulder dislocations or subluxations. An accurate diagnosis and appropriate treatment plan can help prevent further damage and improve shoulder stability and function, leading to a better long term outcome.