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Pain following surgical procedures can sometimes increase the incidence of complications in the body. It is important to manage this pain effectively. Major shoulder surgery can cause severe pain. Effectively treating this pain will help reduce complications and will promote early mobilization. A wide range of methods are used to treat pain after major shoulder surgery, including administration of opioid (derived from opium) and non‐opioid pain killers and administration of drugs that produce numbness and hence pain relief in and around the shoulder joint or around the nerves supplying the upper limb. We compared the usefulness of a continuous upper limb nerve block performed by injecting local anaesthetic into the neck close to where the nerves originate (interscalene brachial plexus block—ISBPB group) with the administration of opioid pain killers into a vein, into a muscle or under the skin (any route other than by mouth)—the parenteral opioid group.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: February 4, 2014

This summary of a Cochrane review presents what we know from research about the effect of one type of surgery for rheumatoid arthritis (RA) in the shoulder.  Currently, there is a very limited amount of research on the effect of surgical treatments for the shoulder in people with RA.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: January 20, 2010

This summary of a Cochrane review presents what we know from research about the effect of surgery on osteoarthritis of the shoulder.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: October 6, 2010

This summary of a Cochrane review presents what we know from research about the accuracy of imaging tests to detect tears of the rotator cuff tendons in the shoulder.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: September 24, 2013

Doctors can use regional analgesia (injection of local anaesthetics near the nerves or the surgical site) rather than conventional pain control after surgery. Does this choice improve long‐term function after elective major joint (knee, shoulder and hip) replacement? We conducted this systematic review to explore controversy about the use of regional analgesia amidst efforts to limit healthcare costs and demonstrate value for interventions.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: August 13, 2015

Bibliographic details: Tas B, Donatsky AM, Gogenur I.  Techniques to reduce shoulder pain after laparoscopic surgery for benign gynaecological disease: a systematic review. Gynecological Surgery 2013; 10(3): 169-175

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2013

Bibliographic details: Hughes MS, Matava MJ, Wright RW, Brophy RH, Smith MV.  Interscalene brachial plexus block for arthroscopic shoulder surgery: a systematic review. Journal of Bone and Joint Surgery. American volume 2013; 95(14): 1318-132423864181

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2013

The evidence base which supported the National Institute for Health and Clinical Excellence (NICE) published Clinical Guideline 3 was limited and 50% was graded as amber. However, the use of tests as part of pre-operative work-up remains a low-cost but high-volume activity within the NHS, with substantial resource implications. The objective of this study was to identify, evaluate and synthesise the published evidence on the clinical effectiveness and cost-effectiveness of the routine use of three tests, full blood counts (FBCs), urea and electrolytes tests (U&Es) and pulmonary function tests, in the pre-operative work-up of otherwise healthy patients undergoing minor or intermediate surgery in the NHS.

Health Technology Assessment - NIHR Journals Library.

Version: December 2012

Acute anterior shoulder dislocation occurs where the top end of the humerus (the upper arm bone) is pushed out of the joint socket in a forward direction, usually as a result of an accident such as a fall. Initial treatment requires putting the joint back together. Subsequent treatment is either non‐surgical, involving placing the arm in a sling followed by exercises, or surgical, involving repair of damaged structures or cleaning up the joint space.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: January 26, 2004

This study could not identify any randomised controlled trials (RCTs) or high-quality comparative studies assessing collagenase versus surgical interventions for the treatment of patients with Dupuytren’s contracture (DC). Collagenase has demonstrated to be superior to placebo in short-term RCTs, with better results for metacarphophalangeal than proximal interphalangeal joints. It is unclear whether or not collagenase can be used as a second-line treatment for DC. Based on the current evidence, collagenase does not appear to be the most cost-effective option to treat moderate to severe DC in people considered to be suitable candidates for surgery. Other surgical treatments appear more cost-effective, with limited fasciectomy (a type of surgery) being the most cost-effective choice. However, there are uncertainties in the data used for the economic evaluation. There is a need for sound clinical studies to compare the effects and costs of collagenase injections with those of surgical treatments.

Health Technology Assessment - NIHR Journals Library.

Version: October 2015

Winging of the scapula (shoulder blade) in muscular dystrophy is caused by weakness of the muscles which attach the scapula to the chest and help raise the arms. Non‐surgical interventions involve casts or slings to support the shoulders. Surgical operations involve fixing the scapulae to the ribs using screws or wire. No randomised controlled trials were found. Small case series suggest that surgical operations might produce significant benefits in some people. These need to be balanced against loss of mobility, need for physiotherapy and possible complications including failure of the fixing material or reduced breathing capacity.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: January 20, 2010

The acromioclavicular joint is located at the top of the shoulder. It is the joint between the lateral (outer) end of the clavicle (collar bone) and the acromion (a projection from the scapula, or shoulder blade, which is located at the point of the shoulder). Acromioclavicular dislocation is one of the most common shoulder problems treated in general orthopaedic practice.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: August 4, 2010

Shoulder instability represents a spectrum from micro‐instability through subluxation (partial dislocation) to frank dislocation and may occur as a result of different underlying pathologies. Anterior shoulder instability occurs when the humeral head moves out of its shallow joint socket in forward direction, usually following an injury such as a fall on the outstretched hand. Dislocation occurs when the head of the humerus moves completely out of the socket. As it does so, various ligaments around the joint may be torn and the bone of the humeral head or of the socket may be damaged. Recurrent episodes of dislocation are common unless complete healing of the damaged structures occurs. A 'Bankart lesion' is a type of tear involving the lining of the socket part of the shoulder joint. Such a tear predisposes the shoulder dislocate easily and in a recurrent manner. If recurrent episodes are troublesome, surgical repair using an open or minimally invasive (keyhole) technique may be advised and this principally involves the repair of 'Bankart lesion'.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: October 7, 2009

Work‐related complaints of the arm, neck or shoulder are also called repetitive strain injury or occupational overuse syndrome. They are a burden for individual workers, for their employers and for society at large because they impair functioning both in daily life and at work.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: December 12, 2013

Venous thromboembolism (VTE) is a term used to include the formation of a blood clot (a thrombus) in a vein which may dislodge from its site of origin to travel in the blood, a phenomenon called embolism. A thrombus most commonly occurs in the deep veins of the legs; this is called deep vein thrombosis. A dislodged thrombus that travels to the lungs is known as a pulmonary embolism.

NICE Clinical Guidelines - National Clinical Guideline Centre – Acute and Chronic Conditions (UK).

Version: 2010

Frozen shoulder starts out very gradually. The pain is usually only mild at first, but becomes more severe over the course of a few months and often makes it hard to sleep. Over time the shoulder can become so stiff that it is nearly impossible to move, as if “frozen” in place. At what age are people most commonly affected by frozen shoulder? And what can help relieve the symptoms until it gets better on its own?

Informed Health Online [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: November 5, 2015

Fracture of the top end of the upper arm bone (proximal humerus) is a common injury in older people. It is often called a shoulder fracture. The bone typically fractures (breaks) just below the shoulder, usually after a fall. Most of these fractures occur without breaking the skin lying over the fracture. The injured arm is often supported in a sling until the fracture heals sufficiently to allow shoulder movement. More severe (displaced) fractures may be treated surgically. This may involve fixing the fracture fragments together by various means. Alternatively, the top of the fractured bone may be replaced (half 'shoulder' replacement: hemiarthroplasty). More rarely, the whole joint, thus including the joint socket, is replaced (total 'shoulder' replacement). Physiotherapy is often used to help restore function.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: November 11, 2015

Surgical site infections are caused by bacteria that get in through incisions made during surgery. They threaten the lives of millions of patients each year and contribute to the spread of antibiotic resistance. In low- and middle-income countries, 11% of patients who undergo surgery are infected in the process. In Africa, up to 20% of women who have a caesarean section contract a wound infection, compromising their own health and their ability to care for their babies. But surgical site infections are not just a problem for poor countries. In the United States, they contribute to patients spending more than 400 000 extra days in hospital at a cost of an additional US$ 10 billion per year.

World Health Organization.

Version: 2016

Impingement (or pinching) of soft‐tissues in or around the shoulder is a common cause of pain and is often linked to tissue damage in and around the joint. If doctors and therapists could identify impingement and associated damage using simple, physical tests, it would help them to inform on the best treatment approach at an early stage. We were particularly interested in the primary (community) care setting, because this is where most shoulder pain is diagnosed and managed. We reviewed original research papers for evidence on the accuracy of physical tests for shoulder impingement or associated damage, in people whose symptoms and/or history suggest any of these disorders. To find the research papers, we searched the main electronic databases of medical and allied literature up to 2010. Two review authors screened assessed the quality of each research paper and extracted important information. If multiple research papers reported using the same test for the same condition, we intended to combine their results to gain a more precise estimate of the test's accuracy. We included 33 research papers. These related to studies of 4002 shoulders in 3852 patients. None of the studies exclusively looked at patients from primary care, though two recruited some of their patients from primary care. The majority of studies used arthroscopic surgery as the reference standard. There were 170 different target condition/index test combinations but only six instances where the same test was used in the same way, and for the same reason, in two studies. For this reason combining results was not appropriate. We concluded that there is insufficient evidence upon which to base selection of physical tests for shoulder impingement, and potentially related conditions, in primary care.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: April 30, 2013

People who are preparing to have surgery usually have a lot of questions: What are the chances of success? What risks are associated with it? What can help relieve anxiety before surgery? What can you do about pain afterwards? We have put together useful information surrounding this topic here.

Informed Health Online [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: February 8, 2018

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