anatomy, exercise therapy

Should I get shoulder surgery?

One of the most common problems reported by visitors to the Move Well Clinic is shoulder pain. In fact, over the course of the year, it is estimated that 1 in 50 of the UK population will visit their local GP to discuss shoulder pain (1). Shoulder pain can have many causes – the shoulder is a complex joint. It can be frustrating for any person to visit their GP to get find out what is causing their shoulder pain and leave without a clear answer. Although many are referred on to a Physiotherapist for a clearer diagnosis, this often involves a waiting list. Some of my clients have informed me that they’ve waited as long as 3 months to see an NHS Physiotherapist – by which time the shoulder pain had resolved itself!

… the right treatment for one person will be different to the best treatment for another.

Other treatment options may be offered to patients including non-steroidal anti-inflammatory drugs, injection-based treatments and referrals to other health services – yet it is estimated that over 13% of people reporting shoulder pain will still be consulting with their GP about the same shoulder pain issue three years later (1).

The effect of persistent shoulder pain can range from being a mild inconvenience to being a debilitating condition. For some it could be the difference between being able to maintain their daily activities (like washing and domestic chores) or not. It can determine whether or not a person can go to work. It’s no light matter.

One of the questions I get asked a lot is whether surgery can help with shoulder pain. The truth is, success rates following shoulder surgery aren’t much better. One of the most commonly reported types of shoulder pain, thought to be caused by impingement of the rotator cuff muscles (between the acromion process and head of the humerus) is known as ‘Sub-acromial Pain Syndrome’ (SAPS).

rotatorcuff.jpg

A recent review of research evidence has shown that is not effective in reducing pain or improving function (2). One of the most important factors impacted by shoulder pain is ‘quality of life’ (i.e.: mental and physical well-being). The same review of evidence highlighted that shoulder surgery to address SAPS was unable to improve patients’ quality of life (2). In fact, the evidence showed that there was an greater risk of health complications associated with shoulder surgery compared to other treatment methods, including pulmonary embolism and thrombosis.

training-828741_1920.jpg

So, by now, you’re probably thinking, “Well, if injections, painkillers and surgery can’t be promised to solve the problem, and physiotherapy referral takes so long… what other options do I have?!”.

The truth is, there is no single solution to all types of shoulder pain. As there are so many different ways to treat different types of shoulder pain, each case of shoulder pain needs to be treated individually. To put it simply – the right treatment for one person will be different to the best treatment for another.

However, the good news is that there growing evidence to support a simple way to address persistent shoulder pain. It costs way less than surgery, is likely to take less time than waiting for a physiotherapy appointment, and can be reused over and over again if the shoulder issue returns….

… exercise therapy.

Evidence for exercise therapy

There is an increasing amount of research evidence published that indicates exercise-based treatments are an effective way of reducing pain and improving function associated with shoulder impingement (i.e.: SAPS) (3) and rotator cuff tendinopathies (4). In fact, data from a small pilot study in the UK has shown that it may be more effective in reducing shoulder pain and disability than standard physiotherapy treatments (5).

massage-2768833_1920.jpg

So, if you’re still experiencing shoulder problem after trying out several methods of ‘hands-on’ treatments (e.g.: physiotherapy, acupuncture, massage), perhaps it’s time to give exercise therapy a shot!

If you’d like to find out more about exercise therapy and how it could help you get away from pain and back to normal functioning, please feel welcome to contact me at the Move Well Clinic!

 

Reference List:

  1. Linsell, L., Dawson, J., Zondervan, K., Rose, P., Randall, T., Fitzpatrick, R. and Carr, A., 2005. Prevalence and incidence of adults consulting for shoulder conditions in UK primary care; patterns of diagnosis and referral. Rheumatology45(2), pp.215-221.
  2. Lähdeoja, T., Karjalainen, T., Jokihaara, J., Salamh, P., Kavaja, L., Agarwal, A., Winters, M., Buchbinder, R., Guyatt, G., Vandvik, P.O. and Ardern, C.L., 2019. Subacromial decompression surgery for adults with shoulder pain: a systematic review with meta-analysis. Br J Sports Med, pp.bjsports-2018.
  3. Kuhn, J.E., 2009. Exercise in the treatment of rotator cuff impingement: a systematic review and a synthesized evidence-based rehabilitation protocol. Journal of shoulder and elbow surgery18(1), pp.138-160.
  4. Littlewood, C., Ashton, J., Chance-Larsen, K., May, S. and Sturrock, B., 2012. Exercise for rotator cuff tendinopathy: a systematic review. Physiotherapy98(2), pp.101-109.
  5. Littlewood, C., Malliaras, P., Mawson, S., May, S. and Walters, S.J., 2014. Self-managed loaded exercise versus usual physiotherapy treatment for rotator cuff tendinopathy: a pilot randomised controlled trial. Physiotherapy100(1), pp.54-60.

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Google photo

You are commenting using your Google account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s