Physiotherapists in Marylebone treat many different conditions including the issues profiled below.

Total Shoulder Replacement

Shoulder replacement is less commonly performed than replacement of the hip or knee but remains a very useful treatment for a variety of shoulder conditions. Osteoarthritis is much less common in the shoulder than in the knee or hip so replacement is more frequently performed for arthritic diseases such as rheumatoid arthritis and for painful conditions secondary to trauma such as fractures or rotator cuff dysfunction. Replacing the shoulder is a different matter from the main weight bearing joints of the lower limbs which can be thought of as .hard tissue joints.

The shoulder is more of a .soft tissue joint. in that the orientation and sufficiency of the soft tissues are what allows the joint to function properly. Typically the socket is replaced by a plastic socket component and the humeral head by a metal component which has a stem down the humeral shaft. The correct positioning of the humeral head in relation to the soft tissues such as the rotator cuff tendons is vital as if this is not correct then the joint surfaces may be fine but the shoulder will not function correctly. Patients are routinely referred to physiotherapy, initially for range of motion and later for strengthening and functional work.

Trochanteric Bursitis

Pain on the side of the hip is a common complaint and often diagnosed as trochanteric bursitis, even though this diagnosis may not be verifiable. Lateral hip pain can be referred from the lumbar spine or the hip joint but in many cases the pain is located over the large bony prominence at the side of the hip, the greater trochanter. The tendons of several of the large buttock muscles come round and insert into the greater trochanter. On examination a physiotherapist might find great tenderness over the greater trochanter and over the nearby tendon, with pain on resisted hip abduction which stresses the tendons.

Symptoms are aggravated by walking, running or any activity which demands significant power from the buttock muscles. Initially the pain was thought to be inflammation in one of the lubricating sacs positioned between moving structures, known as bursae. Present ideas indicate that degenerative changes may occur within the tendon structures, causing a tendinosis which can be painful. Treatments can include physiotherapy to teach patients eccentric exercises to stress the tendons and force it to repair, steroid injections into the tendon areas which are painful or in severe cases a surgical release.