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  • Applications for the shoulder fellowship starting in 2017 is now open.
    Please apply by visiting the Unit and sending your CV to Jan Barker
    Visits to the Reading shoulder unit are welcome - Please liaise with Jan Barker [Read more]
  • RSU is advertising for shoulder fellowship to start in July 2017
    a post-CCT shoulder fellowship for One year. please send CV to Mrs Jan Barker and arrange a visit to meet Prof Levy and Mr Sforza. [Read more]
  • Coming up courses:
    we invite you to join us:

    1. Reading Shoulder Arthroplasty Instructional course,  3-4 november 2017. Poznan, Poland.
      With UK and International faculty

      Limited places - Register early
  • New, New, New: Innovative Design Orthopaedics -
    IDO Isometer Shoulder Muscle Strength Gauge. [Read more]
  • Verso Stemless TSA with a new company Innovative Design Orthopaedics (IDO)
  • Shoulder study day for Physiotherapists
    Will be available soon.
    Please register your interest by e-mail to: course@readingshoulderunit.com [Read more]
  • For GPs - New!!! NHS Choose & Book
    The Unit at Berkshire Independent Hospital is open for NHS patients through Choose & Book (Extended Choice Network).
    Book online
    or contact the secretaries. [Read more]
  • Groundbreaking research from the Reading Shoulder Unit by Prof. Ofer Levy and his team regarding Propionibacterium Acnes and shoulder arthritis. 
    Propionibacterium acnes: an underestimated etiology in the pathogenesis of osteoarthritis?

    This is a very important article in that it suggests the presence of propionibacterium in previously unoperated shoulders with arthritis and furthermore that 'aseptic' failures of shoulder arthroplasty may, in fact, be related to indolent infections with this slow growing organism.
    Read comments by Dr Frederick A. Matsen III, M.D.
    [Read more]
  • New Survey on usage of shoulder replacement prostheses.
    Take the survey [Read more]
  • Listen to the BBC Radio4 programme - a day in the operating theatre at the Reading Shoulder Unit at the Royal Berkshire Hospital - Case Notes with Dr Mark Porter on Regional anaesthesia for shoulder surgery [Read more]
  • The least complications with the Verso shoulder compared with other reverse shoulder systems
    From the Royal National Orthopaedic Hospital, Birmingham, UK

    Bone Joint J 2013 vol. 95-B no. SUPP 27 25

    COMPLICATION RATES FROM THREE
    COMMONLY USED REVERSE POLARITY TOTAL
    SHOULDER REPLACEMENTS: A MINIMUM TWOYEAR
    FOLLOW-UP OF 64 CASES
    S. Robati, M.K. Shahid, J. Allport, A. Ray and G. Sforza 
  • Art at the Reading Shoulder and Elbow Centre
    Original fine art prints all dealing with human body in different situations by four artists are exhibited in the Reading Shoulder and Elbow centre 

    The prints on display are available to buy, with the artist contributing a donation to research. For more information please contact the secretaries in the unit.

    [Read more]
  • The Verso stemless rTSA is approved in Australia & New Zealand by the TGA.
    Its use is launched soon in Australia & New Zealand. 

  • Excellent clinical results over more than 11 years with the Verso rTSA.
    Very high patient satisfaction and return to full activities including sports. [Read more]
Frozen Shoulder

Manipulation under Anaesthetic (MUA) for release of shoulder contracture
with/without Arthroscopic release of shoulder contracture and Injection of Steroid


This technique is used in the treatment of frozen shoulders. A shoulder becomes frozen when the soft tissues around the joint become tight and short (i.e. contracted). This prevents the shoulder from moving and leads to the pain and stiffness with which you are familiar.

The problem may resolve over time but it can take up to two years.


The Operation


The aim of the manipulation is to reduce the recovery time by stretching the joint by the surgeon in a controlled maner, to gain full range of movement. This is combine with an injection of local anaesthetic and steroid to reduce inflammation and pain.

There may be need to proceed and perform further arthroscopic release of the contracture, if the manipulation is not successful. This operation is done by key hole surgery; usually through two or three 5mm puncture wounds. It involves examination of the shoulder joint using a tiny telescope with television camera introduced through a key hole. It involves cutting of the tight (contracted) tissues in the shoulder with a special electro-cutting/radiofrequency device to release the contracture.

The operation is performed under general anaesthetic and a nerve block (injection in your neck or upper chest) that will make your arm feel numb for 8-12 hours after surgery. This is to allow you to mobilise your shoulder immediately after surgery without pain. When this wears off, the shoulder may well be sore and you will be given painkillers to relieve the pain.


General Advice


You will usually only be in hospital for a day. A doctor/physiotherapist will see you before you go home. You will be given exercises to do immediately after the procedure. These exercises are an essential part of your recovery.

Outpatient physiotherapy should be arranged for the day after your procedure. This should be organised before you are admitted to hospital.

It is essential that you attend regular physiotherapy in the first few weeks following your procedure. Please ensure that your employers are aware of this commitment.

You will be given a sling. This is provided purely to keep your arm comfortable. It may be taken off as much as you wish and discarded as soon as possible. You will be encouraged to use your arm. Your symptoms should be approximately 80% better after three months but may take a year to totally settle.


Complications


As with all surgery there is a risk of some complications. These are rare, but you should be aware of them before your operation.

They include:

Complications relating to the anaesthetic.

Infection.

Injury to the nerves or blood vessels around the shoulder. Sometimes, the nerves become irritable resulting in pain and stiffness in the upper limb,a condition called reflex sympathetic dystrophy (RSD).

Fracture: The upper arm bone (humerus) breaking. This is extremely rare.

Failure of the operation in improving pain or movement in your shoulder. There should be about 75% improvement in symptoms in the first four to six weeks.

Prolonged stiffness and or pain.

A need to redo the surgery.


If you require further information please discuss with the doctors either in clinic or on admission.


What to expect after surgery


Pain
The shoulder will be sore when the nerve block wears off and this may last for the first few weeks. It is important that you continue to take the painkillers prescribed in hospital. Ice packs may also help reduce pain. Wrap frozen peas/crushed ice in a damp, cold towel and place on the shoulder for up to 15 minutes.

Movement
It is of the utmost importance that you begin moving and exercising the arm on the day of the procedure. The sling should be discarded as soon as possible. Adequate pain relief will enable you to perform the exercises demonstrated by the physiotherapist. Try to use the arm for normal daytime activities where possible.

The Wound:
If the keyhole operation is necessary, it is usually done through two or three 5mm puncture wounds. There will be no stitches only small sticking plaster strips over the wounds. These should be kept dry until healed. This usually takes 5 to 7 days.

Driving:
You may drive after one week.

Returning to work:
If you have a desk job you will probably be able to return after one week. You may need slightly longer if your job involves lifting or manual work.

Leisure activities:
These will depend on the range of movement and strength in your shoulder. It is possible to do most things as long as your shoulder feels comfortable. Please discuss specific activities with your physiotherapist.

Follow up appointments:
You will have a follow up appointment at The Shoulder Unit about three weeks following your procedure. You will be reviewed by the surgeon/specialist physiotherapist who will check your progress.

Progress:
This is variable. In the first few weeks your shoulder will be sore although your movements will have improved. Do not be surprised if the soreness affects your daily activities. You should continue to move and use your arm normally. Over the weeks following your surgery you will notice a gradual improvement in movement and pain.

Exercises:
It is essential that you carry out the exercises regularly following your procedure, ideally four to five times per day increasing as able. It is quite normal for you to experience aching, discomfort and stretching when doing the exercises but decrease the exercises if you experience intense or lasting pain.

Stand. Lean forwards. Let your arm hang down. Swing your arm forwards and backwards. Repeat 10 times. (Shown for the right shoulder).

Stand.
Lean forwards.
Let your arm hang down.
Circle your arm clockwise & anti-clockwise.
Repeat 10 times.
(Shown for right shoulder).

Lying on your back.
Support your operated arm with the other arm and lift it up overhead.
Repeat 10 times.
(Shown for right shoulder)

Lying or sitting. Put your hands behind your head, and gently stretch the elbows towards the floor/ backwards to feel a gentle stretch on the front of your shoulders. Repeat 5 times.

Take your affected arm across your body to rest the hand on the opposite shoulder. Grasp the elbow with your good hand and gently stretch the arm across your body. Repeat 5 times.

Standing with elbow flexed to 90 degrees. Hold the elbow close to your body, gently push the hand against a door frame, hold for 5 seconds. Repeat 10 times

Standing with your arms behind your back. Grasp the wrist of your operated arm and gently stretch the hand on your affected arm towards the opposite buttock. Then slide your hands up your back. Repeat 5 times

Lying on your back. Grasp a stick in both your hands. Lift the stick up and gently take overhead until you feel a gentle stretch in your shoulder. Repeat 10 times.

 

Lying on your back, keeping the elbow to your side. Hold a stick in your hands. Move the stick sideways, gently pushing the hand on your operated arm outwards. Repeat 5 times

 

 

Standing with your arms behind your back and grasp a stick between them. Gently lift the stick up away from your body. Repeat 5 times


Patient Information Booklet ( pdf)
Consent forms MUA / Arthroscopic release