In this episode, Dr Anna Mullins speaks with Dr Chris Conyard, an orthopaedic surgeon with a fellowship in upper limb surgery, about the management of rotator cuff tears and frozen shoulders.

Dr Conyard sheds light on the natural history of shoulder conditions, particularly the prevalence and progression of rotator cuff tears. He highlights the significance of various risk factors, including hand dominance, manual labour, diabetes, and smoking. Dr Conyard also discusses the impact of muscle atrophy and fatty infiltration on surgical outcomes.

Providing a detailed overview of the shoulder examination for rotator cuff tears, covering essential tests such as the supraspinatus test, external rotation test, and subscapularis tests. Dr Conyard emphasises the role of functional assessment and the importance of early intervention in acute tears.

They also covered imaging and first-line treatments, including the use of steroid injections. Dr Conyard explains when to consider steroid injections and the implications of repeat injections. He offers guidance on when GPs should refer patients to specialists, particularly in cases of acute tears, symptomatic progression, and failed non-operative interventions.

Dr Conyard addresses the management of frozen shoulder, highlighting the usefulness of steroid injections and hydrodilatation, particularly in the initial phases of the condition. He also discusses when to consider referral for surgical interventions such as manipulation under anaesthesia (MUA) and arthroscopic release, backed by evidence from the UK Frost Trial.

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