All about shoulder injuries

Shoulder injuries are very common musculoskeletal problems that can cause pain, stiffness, and weakness.

Here, Mr Dimitrios Karadaglis, renowned consultant orthopaedic surgeon with expertise in upper limb conditions, provides a comprehensive insight into shoulder injuries, including causes and treatment.

What causes shoulder injuries, and how can I prevent them?

Shoulder injuries are quite common in adults. They can be:

• high-energy shoulder injuries or low-energy shoulder injuries
• shoulder injuries related to day-to-day activities as a result of an accident, for example, or shoulder injuries specific to sports activities

Often, we see high-energy injuries from car accidents and injuries from heavy falls down the stairs. Usually, the result of these injuries are joint dislocations, fractures, or ruptured tendons.

Not infrequently, we see low-energy injuries which result from repetitive activities or from inappropriate techniques during exercises at the gym. The result of these injuries are partial tears of ligaments, instability of the joint, or partial tendon tears. Usually, these run for a long time before people seek medical assistance because the shoulder is still functional - albeit painful with limitations in activities - so, sometimes people have the belief that their shoulder problems will improve in the future.

How can I tell if my shoulder injury needs medical attention?

Usually, there is a history of a type of injury, which can be either high-energy or low-energy. However, this isn’t always the case because sometimes people can’t recall a trauma that could have started their symptoms.

In general, people should seek medical assistance, with or without an injury:

• if their shoulder becomes painful or stiff;
• if their symptoms are mechanical (reproducible with certain activities) or painful even at rest;
• if their symptoms don’t respond to simple remedies, such as rest or simple anti-inflammatory tablets

Initially, a physiotherapist can help by assessing the shoulder and narrowing down the problem to certain structures. If symptoms persist despite non-surgical treatment, the physiotherapist will then refer the patient to an orthopaedic specialist.

What can I do at home to help my shoulder heal?

We strongly advise to rest for a few days, to slow down, and to avoid any strenuous activities to the shoulder. Instead, people should mainly focus on lower limb activities or modify activities such as swimming, for example, by changing their swimming style. Above all, it is important to avoid aggravating symptoms.

People are also recommended to take simple anti-inflammatory tablets, which are easily available. We strongly advise to avoid medications such as opiates or much stronger analgesics at first instance because almost all these medications have a certain degree of addiction. There are multiple research studies showing how some addictions have started with simple problems like an orthopaedic injury.

Resting the shoulder in a sling isn’t advised unless this is indicated by a physiotherapist or an orthopaedic specialist. The use of slings should always be limited to a short period of time, after we have established a diagnosis, and as part of a definitive treatment.

What treatments are available for shoulder injuries?

There are multiple treatments available at multiple levels according to the type of injury and the type of patient.

Non-surgical treatments

We start, of course, with non-surgical treatments in the form of anti-inflammatory tablets. These tablets are prescribed after we have established a diagnosis, which is usually after a clinical examination and a form of imaging in the form of a simple X-ray, an ultrasound, or an MRI or CT scan if necessary.

Not infrequently, we offer injections of local anaesthetic and steroid. We also advise physiotherapy if this hasn’t been started already.

In some cases, we may provide slings to rest the shoulder in order to enhance the healing of a fracture, for example.

Treatment is always tailored to each patient. Some patients may require fast-acting treatments because of their day-to-day activities or their commitments in certain sports, while others may only require a specific type of treatment because of pre-existing medical conditions.

Surgical treatments

If non-surgical treatments are insufficient, due to the type of injury or the individual wishes of the patient, we then consider surgical treatments. Surgical measures, of course, are invasive and the last line of treatment.

We offer various surgical procedures, including:

• Arthroscopy: For multiple shoulder conditions. Nowadays, for example, almost all tendon injuries are treated arthroscopically.
• Cartilage repair: We intervene if there is cartilage damage.
• Minimally invasive surgery: For certain types of fractures.
• Major surgery: Sometimes, major surgery is necessary if we are dealing with multiple comminuted fractures. Joint replacement, for example, is the only available treatment for certain type of fractures.

Are there risks to ignoring a shoulder injury?

Yes, and unfortunately it’s not infrequent to see delayed cases with long presentations - even years - after a shoulder injury.

The shoulder is the most mobile joint in the body and thus, any type of injury can result in some degree of loss of function. Given that the joint is naturally very mobile, losing some degree of movement isn’t usually detrimental and people can easily adapt to the change. However, this can also cause people to ignore an injury which could have been treated easily should they have sought medical assistance early. After a few months or years, it may not be possible for some injured tissues to be repaired anymore.

A very common example are neglected rotator cuff tears, which are unfortunately commonly seen months or years after the injury. At this point, it’s not possible to restore the anatomy directly because the tendons have retracted and moved away from their initial position. Major surgery is then required, and the results aren’t as favourable should treatment have been provided early.

Sometimes, ligament instabilities occur, with people having an unstable shoulder. People may manage to control their shoulder instability for some years, but when symptoms gradually deteriorate, people must seek medical assistance.

Sometimes, we find that there are also established arthritic changes or other problems as a result of the initial shoulder injury. Treatment is then much more complex and much less favourable for the patient.

For these reasons, we strongly recommend people who have shoulder problems that last for more than a few months to always seek specialist assistance. This isn’t necessarily to have an operation, but to know if they will face certain risks in the future. Of course, then it’s the patients’ own decision if they wish to undergo surgery, but the difference is that this is an informed decision as opposed to it being a surprise after a few years.

If you wish to consult your options with an expert, don’t hesitate to book an appointment with Mr Dimitrios Karadaglis via his Top Doctors profile today.