When it comes to persistent shoulder problems, surgery is often the only option: true or false?
If you’re new to orthopaedics, the answer might surprise you. Essential surgery is actually very rare for shoulders. Perhaps only one percent of the issues we see at Chris Bailey Orthopaedics is an unavoidable case for the operating theatre.
The main reason for this is that shoulder injuries rarely threaten life and limb – thankfully! Which means that shoulder surgery is usually elective. We lay out the options. You choose the one that feels best for you.
Now, sometimes surgery may actually be the best option. Or we may highly recommend it. But the good news is that there are usually conservative alternatives.
So what are they?
The first port of call for shoulder treatment is activity modification. Many shoulder issues are caused by repeated actions – particularly overhead movements. If you’re a pace bowler for the England cricket team, this will be obvious. But the same applies to more prosaic tasks like painting and decorating, or even that weekly session at the tennis club. Pressing pause on repetitive strains – without giving up movement entirely – gives your shoulder respite while we assess the next steps.
Since shoulders are generally more about movement than weight-bearing (unlike knees [insert link to “When surgery isn’t the answer: a guide to conservative knee treatment”]), physiotherapy can be particularly effective. What we’re looking for is a good balance of movement between the ball-and-socket joint and shoulder blade; the correct ratio is two-thirds ball-and-socket to one third shoulder blade. A physiotherapist can help you with exercises that strengthen your muscles and improve your range of movement.
Pain-relieving medication (analgesics) makes life more comfortable while your body attempts to heal itself. This can give us time to see whether your issue will settle, or require intervention. There’s a ‘ladder’ of pain relief. At the low-strength end are over-the-counter drugs like paracetamol and ibuprofen. Next come codeine-based products like Cocodamol, followed by stronger opiate-based drugs. Depending on the issue, we may refer you to a Pain Team for specialist treatment.
Injections can be very helpful for shoulder pain. In fact sometimes we find that they are all that’s required to resolve an issue entirely. There are two major forms: corticosteroids and hyaluronic acid. Steroids target inflammation, reducing the swelling that causes rubbing within the shoulder. Hyaluronic acid is a lubricant that occurs naturally in the body; injecting it into the shoulder can help to reduce pain and inflammation.
Slings and braces are more effective in healing certain injuries than we used to think. One recent trial on patients with proximal humerus fractures – one of the most commonly-broken bones in the body – found that wearing a sling was just as effective as surgery in terms of outcome. Mobility is important, in order to avoid ‘stiffening up’ through lack of activity. But providing a little protection in the early stages of a shoulder injury can be beneficial to the healing process.
Keen to find out more about non-surgical options for your shoulder treatment? This blog is just a small part of the picture! If you’d like to discuss the alternatives in more detail, we would be very happy to help.