03 February 2022
Visit our eLearning platform this month to benefit from a range of resources on shoulder pain. This month we’re also offering access to eLearning materials free of charge to all non-member allied health professionals. To take advantage of this offer, email Daisy Southam, Head of Education. Here we speak to Prof Lennard Funk, a consultant orthopaedic surgeon and shoulder and upper limb specialist at Wrightington Hospital.
What led you to medicine?
As a child I wasn’t very academic. I scraped through school and didn’t get the best grades until right at the end. What did interest me was sports and hobbies that were mechanically orientated. I went and did a degree in sports physiotherapy and biochemistry. While I did that I worked as a physio assistant in a neuro rehabilitation unit, and I absolutely loved it. I went into physiotherapy and then transferred across to medicine.
When did you become interested in the shoulder?
I’d been injured and fractured my spine playing rugby and a friend of mine dislocated his shoulder, and I think these things got me heading towards orthopaedics. In my training, shoulders interested me because there’s a strong link to physiotherapy. It was a Cinderella specialty, and my aptitude surgically was towards arthroscopy and soft tissue. It’s a combination of all these things that has led me to where I am.
Do you have any tips for assessing the shoulder?
Listen to the patient. With shoulders, for two-thirds of patients you probably know the diagnosis before you’ve even examined the shoulder. You learn so much just by talking to them, from their history and by looking at them.
Don’t get obsessed with tests. Focus on the pathology but remember what the patient is there for and consciously think about that rather than focusing only on making a diagnosis.
Do you see many rheumatology patients?
I regularly see them and because so many now have arthritis which is well-controlled, they often heal and do just as well as anyone else. I tend to see patients with frozen shoulder symptoms or rotator cuff problems which are resistant to the usual treatments. I’m more aware of picking up rheumatological problems through subtle signs on MRI scans and getting them to a rheumatologist earlier.
About 15-20 years ago, it was completely different. I used to see patients with massive erosive arthropathy of their shoulders and hugely worn rotator cuff tendons. I just don’t see them at all anymore.
How do you work with physiotherapists?
With shoulders there’s only two reasons you need surgery – that’s cancer or infection – and even those you don’t always need surgery. My conversion to surgery rate is less than 20%. Most patients I treat are non-surgical and physiotherapists have a huge part to play in that.
In every clinic we have shoulder therapists next door. They provide their expert assessment and opinion and oversee the management of those patients.
Do you have any advice about the role of steroid injection in patients?
Steroids reduce inflammation but don’t treat the cause, so it depends on what you’re trying to achieve. If you have an obviously inflamed bursa and your aim is to reduce this inflammation to aid rehab or give the tendons time to recover, steroid injections can be helpful.
I would highly recommend that you should always do a guided injection where you can see what you’re doing if there are any tendon tears as it’s ultimately safer. As a rheumatologist you might also want to seek advice from a shoulder specialist first.
Many thanks to Prof Funk for sharing his expertise. You can find out more about him and his work on his website. Log onto our eLearning platform to improve your skills and knowledge around treating shoulders.
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