Clinical Assessment of Shoulder and special shoulder tests may not be so special at all by Professor Jeremy Lewis   what do we know about these special tests ??

EXTRACTS FROM Professor Jeremy Lewis   The Shoulder Clinic London and 2019

Jo Gibson Shoulder Steps to Success   2019

Shoulder pain according to research by Prof Jeremy Lewis and his team at the London shoulder clinic accounts for the second major cause of years of living with disability after low back pain.
Shoulders are the 2nd to 4th most common cause of pain, and shoulder pain is present in 70% of the population at some time during their life.
Up to 34% of the people over the age of 65 years will experience shoulder pain and this becomes a bigger problem as one gets older.
Only 21 to 50% report full recovery of their shoulder pain after six months and 14 to 54% of the people report ongoing symptoms up to 1 to 2 to 3 years later.
There is still a great deal of research to be done into shoulder pain and one of the biggest problems has been whether to operate or not to operate. This is in particular to the older age group because there is a very great relationship between age and the outcome.

Many of the special tests that we are taught are actually not so special in the end this is because when one is doing a particular test one actually is activating over 13 muscles so it is actually impossible for the special tests to be special none of these tests can diagnose any of the structures accurately. For instance there are between 6 to 12 per site around the shoulder and the purse I have the greatest amount of nerve innovation and they are also full of chemicals. If they’re full of chemicals which are not normal chemicals these Bursar then can be very painful and highly irritable. But if the Bursar are full of normal chemicals then their pain free.

 

 

 

 

In the course provided by Prof Jeremy Lewis which lasts two days Prof Lewis explains that nearly half the European population are thought to have difficulties in understanding and using the health information this is a major problem because people believe they understand their condition and go onto the Internet but in fact may read the wrong information or misunderstand it.

SHOULDER PROBLEMS

 

Shoulder Pain or Rotator Cuff Pathology refers to a spectrum of pathology including tendinopathy, tendinosis and bursitis as well as rotator cuff tears..  The reported age range is wide between 35 years and 75 years  It is though well known that in the middle and older age group is where the majority of rotator cuff tears are more prelevant

Fundamentally, other that the presentation of an acute traumatic rotator cuff tear in “a younger patient” which does require an urgent referral for scanning and surgical report the consensus is that initital management  should be CONSERVATIVE

 

 

 

 

A response of lack of respond to previous treatments can be pertinent   A negative response to corticosteriod injections has been linked with poorer outcome with surgery   This is because corticosteriods can in some caases cause rotator cuff tears/ ruptures so which CSI are good pain relief and provide an excellent window box opportunity for exercises corticosteriods has a negative affect on tissue healing and repairing and this would be particularly in the older age group where there is degenerative changes in the tendons and can re tear within 2 years after surgery

Generally due nature of rotator cuff degenation or atrophy in the older age group that is over the age of 65 years and as the older age are more prone to trips and falls massive tears of the rotator cuff in the NHS it has been foudn that these massive tears do not respond to surgery which is why conservative treatments are so important in the older age group

 

 

 

 

 

How to Predict That Rotator Cuff Tendon Repair May or Will Fail part of shared informed consent which you can ask your Shoulder Surgeon  It depends more on age as actual shoulder joint may have wear and tear and if you had had a history of corticosteriodal injections as corticosteriod injections weaken the soft tissues or may even cause ruptures of tendons if is it not ultra sound guided

 

Shoulder Confusion: Common Pitfalls in diagnosis and treatment by Dr Jeremy Lewis

Read more here on this link Surgical Management of Irreparable Rotator Cuff Tears 

What Works and What Does Not and What is Coming  September 2019