Nuffield Health: Shouldering the Burden

The shoulder is one of the most flexible joints in the body, with a wide range of motion. However, due to this flexibility, it can be unstable, is easily injured, and can deteriorate with constant use over time. Nuffield Health Bristol Hospital offers advice on how to keep shoulders healthy and pain-free, as well as how to spot and avoid common injuries.

The shoulder is made up of three bones: the collar bone (clavicle), the shoulder blade (scapula), and the upper arm bone (humerus). Four tendons – called rotator cuff tendons – hold the shoulder joint in place, but as tendons age, they are less able to tolerate stress, are less elastic, and become easier to tear. It is therefore important to take a patient’s occupation and lifestyle into account, as well as their age, when diagnosing the cause of their shoulder pain.

Shoulder instability happens most often in younger people and athletes. When the muscles and ligaments that hold it together are stretched beyond their normal limits, the shoulder becomes unstable. The acromioclavicular joint, or ACJ, is a joint at the top of the shoulder where the clavicle meets the shoulder blade. Problems occur due to overuse, which causes tenderness of the ACJ. Treatment often involves resting and applying ice to the joint for it to heal. In some cases, injections, anti-inflammatories or arthroscopic surgery may be required.

Osteoarthritis in the shoulder is less common than in the hip or knee, but over time, this can cause pain, stiffness and weakness of the joint. The condition can arise due to degeneration of the joint, or following trauma to the shoulder. Modern advancements in shoulder replacement surgery mean that there are a number of options relating to joint replacement, which can help ease pain and restore function.

Adhesive capsulitis, or ‘frozen shoulder’, is very painful stiffness, caused when the capsule (soft tissue envelope) surrounding the shoulder joint becomes thick and stiff, preventing normal movement. Again, steroid injections are useful in dampening pain and allowing the physiotherapists to work.

Impingement pain is very common in all age groups. This is a sudden pain in the shoulder that comes on when reaching out, up, or behind, and can occur from the shoulder being held in a poor postural position, overuse or sometimes following injury. It can be due to a structural problem with the shoulder joint, related to the tendons of the rotator cuff, which may fray or tear completely. The shoulder bursa (a cushioning sac filled with lubricating fluid located between the tendons and bone) can become inflamed, generating pain. Impingement pain can often be successfully treated with physiotherapy and cortisone injections. If it is more severe, where you are unable to raise your arm, this can be a sign of a rotator cuff tear which may require surgery.

Mr Philip McCann (pictured), a Consultant Orthopaedic Surgeon specialising in upper limb disorders at Nuffield Health Bristol Hospital says: “Shoulder and elbow problems are common yet complex, and can have a significant impact on our ability to work, play sports or enjoy a good quality of life.

In order to move our arms and hands freely, many different joints and muscles must work harmoniously to permit normal, pain-free motion. Symptoms such as pain, stiffness, weakness and instability may be due to a number of different underlying conditions.

“As a surgeon, my primary goals are to provide an accurate diagnosis, and to formulate a treatment strategy to help ease, and wherever possible, eradicate your symptoms, in a patient-centred manner.”

As shoulder pain is so common, many conditions can be easily diagnosed and managed. Sometimes this leads to surgery, but in many cases it can be avoided. In addition to Mr McCann, other Consultants specialising in upper limb disorders at Nuffield Health Bristol Hospital include Mr Iain Packham and Mr Gray Edwards, while our team of physiotherapists are also available to see you.

For more information or to book an appointment, please call 0117 911 6062. You can also book online, by visiting our website.

Nuffield Health Bristol Hospital
3 Clifton Hill, Bristol BS8 1BN