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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:

    The Reading Expert Shoulder Course 15-16 April 2019
    Instructional Course

    Smith & Nephew Expert Connect Centre Watford, United Kingdom
    15-16 April 2019
    Course Convener: Prof Ofer Levy (UK)

  • IDO Isometer Shoulder Muscle Strength Gauge.

    Available to buy online in idorth.com - Innovative Design Orthopaedics - [Read more]
  • Shoulder study day for Physiotherapists 26 February 2019 at 18:00 
    at the Royal Berkshire Hoapital.
    Please register your interest by e-mail to: Jonathon.Lee@RoyalBerkshire.NHS.uk [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 
  • Once again we are running the successful Reading Shoulder Arthroplasty Instructional Course on Friday,  30 September 2016
    • Re-Live surgery
    • Lectures
    • Discussions 
    • Clinical session with patients presentations
    • Hand-on workshop on models
    • Workshop for theatre nurses

    CME Points applied (6 CME Points approved by the BOA for the previous course)

      Register early - limited places

     
    [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]
  • The Reading Expert Shoulder Course 15-16 April 2019

    Instructional Course
     
    Smith & Nephew Expert Connect Centre Watford, United Kingdom
    15-16 April 2019
     
    Course Convener: Prof Ofer Levy (UK)

    Description

    The Reading Expert Shoulder Course is a two day advanced shoulder course. All the delegates are experienced shoulder surgeons and “All are Faculty”.

    Day One will cover arthroscopic techniques for treatment of complex instability, arthroscopic bone block, arthroscopic Latarjet, and Biceps procedures. Comparison of different methods of rotator cuff repair, various approaches to manage the massive rotator cuff tear, Suprascapular nerve release and more.

    Day Two will cover advances and innovations in total shoulder replacement, especially reverse TSA and stemless rTSA.
    The course will involve lecture-based discussions but is primarily a cadaver lab course with ample opportunity to practice the techniques taught in the Expert Connect Centre.

    Accreditation - Accredited by the Royal College of Surgeons of England.

    Participant profile

    This course is an advanced shoulder course aimed at experienced shoulder surgeons who want to further discuss and develop advanced arthroscopic and arthroplasty skills. Ideal candidates are Shoulder Consultant in first 3-4 years of practice, and even more experienced Consultants.


    Course Faculty


    International Faculty

    Prof Ettore Taverna - OBV Hospital Mendrisio, Switzerland
    Dr Carlos Torrens Canovas - Parc de Salut Mar, Spain
    Dr Juan Bruguera - Unidad de Hombro y Codo, Spain
    Dr Bernd Hinkenjann - St. Agnes Hospital Bocholt, Germany

    UK Faculty

    Mr Jaime Candal Couto - Northumbria Healthcare NHS Trust, UK
    Mr Roger Hackney - Leeds Teaching Hospitals NHS Trust, UK
    Mr Kapil Kumar - Aberdeen Royal Infirmary, UK
    Mr George Arealis – East Kent HUF Trust, UK
    Mr Amar Malhas - Royal Berkshire Hospital, UK
    Ms Julie McBirnie - Royal Infirmary of Edinburgh, UK
    Mr Hannan Mullett - Sports Surgery Clinic Ireland
    Mr Jai Relwani - William Harvey Hospital, UK
    Mr Sunil Sharma - Queen Margaret Hospital, UK
    Mr Giuseppe Sforza - Berkshire Independent Hospital, UK
    Mr Andreas Leonidou - Royal Berkshire Hospital, UK
    And the Reading Shoulder Unit team 

Tennis Elbow and Golfers Elbow

Tennis Elbow (Lateral Epicondylitis)

This condition is charactersied by pain and tenderness on the outside of the elbow. It occurs as a result of repetitive strain and trauma on the attachment of the extensor tendons of the wrist (these tendons bend the wrist back) and of the fingers,  at the lower and outer portion of the arm (the outer 'bump of the elbow).

Fig 1: Shows the attachment of the extensor muscle at the outer part of the elbow which gets inflammed and painful.

Tennis elbow occurs as a result of repeated bending back of the wrist against resistance that leads to microtrauma and minor lesions and tears on the insertion of the extensor tendons depicted in the figure above.

Who is affected?

Although called Tennis Elbow at the end of the 19th century,   this terms remains despite the fact that most of the people affected are not tennis players; instead other common causes are gardening, brick laying, excessive use of a screwdriver, hammering, computer typing and shaking hands.

What does tennis elbow feel like?

The main clinical symptom is pain centered on the lateral epicondyle (bony prominence on the outer aspect of the elbow) that radiates down into the forearm. The foremarm muscles may feel tight and sore. It is worsened by manouvres like lifting and gripping, especially so when the wrist is bent backwards. Tenderness just below the epicondyle and  weakness of dorsal flexion of the wrist. Simple day to day actions like turning a door handle or picking up a bottle of milk can cause severe pain.

How is the diagnosis confirmed?

The diagnosis is mainly confirmed by clinical examination.

Normally plain X-Rays are not needed at the onset of the disease, but may be requested later on by the orthopaedic specialist to exclude other problems. An ultrasound scan may be performed if acute tendon tears are suspected or to visualize local sign of degeneration like calcific deposit that are associated with worse prognosis.

How is the condition treated?

Non-operative management

90% of the patients heal spontaneously within one year.

Conservative treatment is the treatment of choice for the first phase.

Avoiding repetitive wrist dorsiflexion (bending the wrist backwards) and modification of  sport or offending activities are generally the most important prescriptions.

Pain killers and Non steroidal anti-inflammatory medications

Local corticosteroid injections (up to 3 injections) are effective for short term pain control.

A Counterforce dynamic brace can be used; but there is poor patient compliance.

A physical therapy program (aimed to  stretch and progressively strengthen the extensor muscles with  pain free active and isometric exercise) has been shown to be effective in the long term.

PRP (Platelet Rich Plasma) injection

Platelet rich plasma (PRP) is blood plasma with concentrated platelets (the body’s repairmen for damaged tissue). The concentrated platelets found in PRP contain growth factors that are vital to initiate and accelerate tissue repair and regeneration. These bioactive proteins initiate connective tissue healing and repair, promote development of new blood vessels, and stimulate the healing process. 
 
How does PRP therapy work? 
Blood will be taken from you and then placed in a machine that spins at high speed to separate the different types of blood cells. The surgeon will extract the platelet rich part of the blood, mix it with local anaesthetic and inject this into the area of your injury. The entire process to prepare your blood takes about 15 minutes and increases the concentration of platelets and growth factors at the site of injury by up to 500% (you will have five times the normal number of platelets/growth factors). By having a PRP injection, we aim to stimulate your body’s ability to heal chronic conditions like tennis elbow.
 
What are the potential benefits of treatment? 
The main benefit is that patients can see a significant improvement in symptoms. This treatment may eliminate the need for more aggressive treatments such as long term medication or surgery, as well as a remarkable return of function and a much shorter recovery time. 
A major advantage of this treatment is that no foreign substance is used – we use the patient’s own growth factors from his or her own blood   so there is no risk of any disease transmission.
 
What are the alternatives?
They include:
Surgery
Anti-inflammatory drug therapy
Steroid injections
Physiotherapy
What are the possible risks or complications of this procedure? 
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:
Infection at the site of the injection.
An increase in inflammation and pain at the site of the injection.
Bleeding and/or bruising.
No relief or worsening of symptoms.
Skin discolouration.
Allergic reaction to the local anaesthetic drug.
Failure to achieve successful result. 
Injury to the nerves or blood vessels.
Prolonged stiffness and or pain.
If you require further information about risks or complications, please discuss with the doctors in clinic or on admission.
 
How long will the procedure take?
The procedure usually takes around 30 minutes. Most of this time is separating the platelet-rich plasma from your blood sample.
This procedure is performed with the patient awake. 
The PRP is injected together with local anaesthetic drug. 

PRP Injection Patient information leaflet

PRP Injection Patient information leaflet - Kit cost
 

Operative management

About 10% of cases are not responsive to conservative treatment. These patients could have symptoms more than 1 year of duration, more than 3 steroid injections in the past, constant pain without activity, local calcification or exostosis on XRay. In these cases surgery is a good option.

Patients satisfaction after surgery has been reported very high with more than 90% of good or excellent results.

3 different surgical options are available: open surgery, keyhole surgery, or per-cutaneous techniques.

Minimally invasive techniques like percutaneous or key hole techniques have been described as less harmful with quicker recovery and return to work activities. The key- hole technique also has  the advantage to recognize and treat associated intra-joint abnormalities, if they are present. 


Patient Information Booklet PDF
 

Golfer's Elbow (Medial Epicondilytis)

Is a similar condition charactersied by pain and tenderness on the inside of the elbow. It occurs as a result of 'inflammation' (tendinosis) of the attachment of the flexor tendons of the wrist ( these tendons bend the wrist forward) and of the fingers,  at the lower and inner portion of the arm ( the inner 'bump' of the elbow near the 'funny bone'). 

Medial epicondylitis is less common than Lateral Epicondilytis. Although it may affect Golf players, any other reason of excessive and repetitive wrist flexion may cause the disorder.

Treatment is similar to Tennis elbow.