Your shoulder is one of the most flexible – and complex – joints in your body. Whether you’re getting dressed, combing your hair or playing tennis, its bones, muscles and supporting joints work together to give you the all-round flexibility and reach you need.
At its centre is the ball and socket joint with your upper arm bone, which is kept in place and linked to your shoulder blade by a group of muscles and tendons. As these muscles and tendons surround your shoulder like the cuff of a shirt around your wrist, they’re called the rotator cuff.
As well as providing control and strength, they play a key role in keeping the joint stable by preventing it from dislocating when you move.
Our renowned medical team provides a range of treatments, from the traditional to the innovative:
This is an effective and well-researched procedure that’s a potential alternative to surgery. It takes advantage of the blood’s natural healing properties to reduce pain and improve joint function. It uses a specially concentrated dosage of platelets prepared from your own blood to repair damaged cartilage, tendons, ligaments, muscle and bone. Treatment is administered via an injection and, depending on the injury, two to six injections may be required, performed at weekly intervals. Patients usually see their symptoms improve within four to six weeks of having the injections. PRP is a safe treatment option which, because your own blood is used, carries no risk of allergic reaction. Read more clinical evidence supporting PRP here.
This day case treatment is exclusively offered to our patients. It combines the benefits of Platelet-Rich Plasma (PRP) therapy with Lipogems®, a pioneering procedure that uses your body’s own adipose (fat) cells to treat pain and inflammation. AMPP injections are minimally invasive and are carried out under ultrasound guidance. Altogether the procedure takes about an hour to perform with a minimal recovery time of around three hours. As well as being a potential alternative to surgery, AMPP can also aid post-surgery recovery.
The most common injuries are tears when the rotator cuff’s tendons and muscles come away from the humerus bone and impingement, where one of the rotator cuff’s tendons rubs against another part of the shoulder joint (usually the underside of the acromion bone) and becomes inflamed.
Rotator cuff tears, can be partial thickness or full thickness (i.e when the tendon is detached from the bone). They can be small or large and can happen for several reasons:
Wear and tear, a natural part of the aging process, is a very common cause. More than half of everyone over 60 will have a rotator cuff tear without knowing it as they have no symptoms. However, sometimes a degenerative, age-related tear can become painful and affect your movement. Often, patients with rotator cuff injuries in their 50s or 60s had a small past injury that weakened a tendon and has gone on to develop into a full tear. Genetics can also play a part. If someone in your family has suffered with a tear, then you may be more likely to experience one.
Playing contact sports, having a fall, being in a road accident or any other significant trauma to your shoulder can cause tears.
Repeated minor injuries – or ‘microtraumas’ – can eventually lead to a rotator cuff tear, for example, from lifting heavy gym weights or doing a manual job that involves carrying out the same action many times. In some cases, the rotator cuff itself may be injured by the tendon attached to your biceps muscle. Sometimes injury can result in the tendon slipping out of place and causing a biceps pulley lesion, which leads to the biceps cutting into the rotator cuff producing a tear.
Mr. Ali Noorani, one of our upper-limb orthopaedic surgeon consultants, says:
“Think of the rotator cuff as like a curtain. The muscles are the cloth with the hooks the tendons attaching it to the rail, which is the bone.
The more hooks you lose, for example from a tendon tear, the less it functions like a curtain – and in the case of the rotator cuff, that can cause pain and weakness. However, just like a curtain, exactly where the hooks come off is important.
If you lose several in the middle, it still works, but if the missing hooks are on the edge, then it won’t run so smoothly – there’s an imbalance and reduced function.”
Though it’s possible to have a rotator cuff tear without any symptoms, many people will find it painful. Other symptoms can include:
– weakness in your arm and difficulty in moving it in certain directions
– instability in your shoulder from dislocation or partial dislocation
Most patients we see have some combination of pain, weakness, instability and stiffness.
A thorough history of the injury and an examination are key for an accurate diagnosis. Though it’s rarely confused with other conditions, we also use diagnostic imaging – including MRI or ultrasound scans – to confirm there is a tear. The scans are also useful in showing its size and exactly where it is. We don’t just rely on the scan itself to give us the diagnosis as a lot of patients may have rotator cuff tears without any pain or other symptoms.
While some small tears may heal on their own, larger ones won’t. If you have shoulder pain, it’s important to find out the cause sooner rather than later. Unlike impingement, osteoarthritis or ‘frozen shoulder’, rotator cuff injuries need to be recognised and treated early so the muscle involved doesn’t have a chance to waste away. If it weakens too much, there’s less chance of a surgical repair being a success.
Over-the-counter painkillers and rehabilitation with a professional who understands your shoulder’s condition can be crucial for improving your symptoms. Rehabilitation is important whether you have surgery or try a non-operative treatment. Most of our patients, though, don’t need surgery as they find relief through our referral for specialist rehabilitation and by following the care advice we give.
If the first-step approaches of pain medication and rehabilitation don’t help, or a specialist has advised your condition requires more in-depth treatment, there are several options that don’t involve surgery.
We also offer a variety of biological therapies that harness your body’s natural ability to repair itself – Platelet Rich Plasma (PRP) treatment and Activated Mesenchymal Pericyte Plasma (AMPP®) injections.
They are minimally invasive, can decrease inflammation, stop the progression of arthritic damage and may repair joint cartilage. The recovery time is also much shorter than with surgery.
Following these treatments, you are often encouraged to move around the same day and quickly return to normal activity without having to go through the risks associated with surgery.
There has been over thirty years of research showing that injecting steroids around rotator cuff tears only gives – at best – temporary relief of symptoms as they don’t promote any healing and can actually make matters worse. There is also good patient evidence that a surgical repair after multiple steroid injections can be less successful.
Although keyhole surgery to repair a rotator cuff tear works for about 90% of patients, there are lots of factors to consider in choosing it and you should discuss the options with a specialist before making a decision.
Before recommending a keyhole repair, also known as an arthroscopic fixation, your upper limb orthopaedic consultant will consider the size and location of your tear as well as how any weakness, pain, stiffness or instability affects your daily activities, recreation or sleep.
The operation involves re-attaching the affected tendon to where it’s been torn away from your upper arm bone.
Your age is not an important issue, though the healing rate of tendons does slow up as we get older. Our expert orthopaedic team have successfully helped patients in their 70’s and 80’s with rotator cuff repairs.
As well as our own experienced upper limb consultant surgeons, we also work with a global group of Orthopaedic Specialists.
If your tendon tear is full thickness or unbalanced, it’s likely keyhole surgery will be the best recommendation. However, if your tear is big and your tendons are weak, your healing may be poor. To give your recuperation a boost, we often recommend Platelet-rich Plasma (PRP) therapy or Activated Mesenchymal Pericyte Plasma (AMPP®) injections. We find patients that have AMPP or PRP after their operation recover more quickly and with less post-operative pain.
Generally, rehabilitation after a rotator cuff repair operation takes six to nine months though, for some patients, it can be more than a year. In some cases, however, we’re able to enhance the healing process by using Platelet-rich Plasma (PRP) therapy or Activated Mesenchymal Pericyte Plasma (AMPP®) injections.
Our experience in complex keyhole surgery, as well as our expertise in regenerative medicine, gives you a unique and comprehensive range of management options for your shoulder.
An expert consultation is essential for an accurate diagnosis and to tailor a treatment plan to your needs. Our innovative range of treatments goes beyond what’s available on the NHS. As well as providing a full opinion on your condition that includes all the traditional non-surgical and surgical options, our experienced consultant will also assess your suitability for our alternative biological therapies, Platelet Rich Plasma (PRP) and Activated Mesenchymal Pericyte Plasma (AMPP).
– discuss your medical history to find out more about your symptoms
– carry out a clinical examination to look at the joint and identify the source of the pain and mobility issues
– arrange for a diagnostic investigation, for example using an x-ray and/or MRI scan to assess the issue
– discuss all the treatment options with you, along with their potential benefits and any risks.
Our experienced team works as part of a collaborative partnership of surgeons, sports medicine doctors and physiotherapists to provide the perfect patient pathway to get you quickly on the road to recovery. Whether you need conventional treatment or if you are a candidate for our regenerative treatments, you can be sure that you will get the best advice.
Autologous means ‘from the same person’ rather than from a donor. Essentially, your own cells are used to encourage healing. With this type of treatment, there’s a dramatic reduction in the risks of the rejection, infection or contamination that come with using material from someone else. The innovative therapies we offer are based on this idea. If you’ve found traditional treatments aren’t helping your pain, or if you’re looking for a possible alternative to surgery, then this approach is one to consider.
Biological treatments are pioneering procedures and we’re continuously monitoring and recording its effectiveness. Patients undertaking these treatments are asked to complete pre-operative and post-operative questionnaires.
The information obtained from these questionnaires allows us to monitor your progress and it also contributes to our evidence-based database and other global studies on biological treatments. All information gathered is anonymised.