Trusted orthopaedic information

Expert care for your shoulder & elbow

Clear, evidence-based information to help you understand your diagnosis, prepare for treatment, and feel confident every step of the way.

Person holding shoulder in pain - shoulder condition
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Shoulder & elbow conditions with full guides
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Fracture and trauma guides
Comprehensive information for patients with upper limb fractures
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Specialist orthopaedic care

Our education content is written and reviewed by specialist orthopaedic surgeons specialising in shoulder and elbow conditions - so you can trust what you read.

Evidence-based content
All information is reviewed against current clinical guidelines and kept up to date.
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Whether you are seen on the NHS or privately, this resource is free and open to everyone.
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Access information at any time - before your appointment, late at night, or on the day of surgery.
Surgery pathway

From your first appointment to full recovery

Step-by-step guides for before, during, and after your procedure - including what to bring, how to prepare your home, and what recovery looks like week by week.

1
Pre-operative assessment
2
The day of surgery
3
Immediate recovery (ward)
4
Home recovery & physiotherapy
5
Follow-up & outcome review
✓
Back to full activity
Father carrying child on shoulders - recovery and strength after shoulder surgery
Back to full strength
Surgical team operating in theatre
Surgery preparation

Surgery prep guides

Select your procedure below for a step-by-step guide covering your pre-assessment, the day of surgery, and your recovery - tailored to your specific operation.

Shoulder procedures
Shoulder surgery guides
Elbow procedures
Elbow surgery guides
Fractures and injuries
Fracture and injury guides
General preparation
Applies to all procedures

Whatever your operation, there are steps that apply to everyone - fasting, medication review, arranging transport, and preparing your home. These are covered in every guide.

🚫No food from 2am; clear water until 6am
💊Review blood thinners with your team
🚗Arrange a driver and overnight support
🚭Stop smoking before surgery
Patient reported outcomes

My outcome scores

These validated questionnaires help your surgical team track how your shoulder or elbow is affecting your daily life. Each takes about 2 minutes. Your answers are saved privately in your browser.

OSS

Oxford Shoulder Score

12 questions assessing pain and function for shoulder surgery (excluding instability). Validated since 1996.

OSIS

Oxford Shoulder Instability Score

12 questions specifically designed for patients with shoulder instability. Validated since 1999.

OES

Oxford Elbow Score

12 questions assessing elbow pain, function and social-psychological impact. Validated since 2008.

⚠️
Ethics approval pending
This study has not yet received Research Ethics Committee (REC) approval. No recruitment is currently taking place. This page is for information only.
Active research study

The ASSET-S study

A research study investigating whether a small wearable motion sensor can improve how shoulder movement is measured, led by the shoulder and elbow surgery team at Imperial College Healthcare NHS Trust.

Study status

Study name
ASSET-S
IRAS ID
364440
Target recruitment
50 participants
Ethics approval
In progress - not yet approved
20
Minutes per visit
No extra appointments required
50
Participants
Adults with shoulder conditions at Imperial
1
Single visit
During your normal clinic appointment
Why this study matters

The problem with measuring shoulder movement today

Shoulder disorders are among the most common musculoskeletal conditions worldwide. Current assessment methods - clinical examination and patient questionnaires - are valuable but have limitations. The ASSET-S study asks whether a small wearable sensor can provide reliable, objective kinematic data to complement existing assessment tools.

Complete your Oxford Shoulder Score

The OSS is one of the validated questionnaires used in the ASSET-S study.

What happens during the study
1
First

Read the information sheet and sign a consent form

You will be given time to read this information sheet carefully. You are free to decline or withdraw at any time without affecting your care.

2
Then

A small sensor is placed on your upper arm

The Movella Dot sensor is a small, lightweight device attached using a soft elastic strap. It is non-invasive and can be removed at any time.

3
Then

Simple shoulder movements

You will perform gentle, standardised shoulder movements. The sensor records the range, speed, and smoothness of each movement.

4
Finally

Complete a short questionnaire

You will complete a validated patient questionnaire such as the Oxford Shoulder Score. Your involvement is then complete.

Who can take part?

You may be able to take part if you:

  • Are aged 18 or over
  • Have a shoulder condition being assessed or treated at this clinic
  • Are able to perform simple shoulder movement tasks
  • Are able to give informed consent
  • Can understand written and spoken English

You cannot take part if you:

  • Are under 18 years of age
  • Are unable to give informed consent
  • Have a skin condition or allergy that prevents use of the sensor strap
  • Are pregnant
  • Have an implanted electronic device (such as a pacemaker)
  • Are currently enrolled in another interventional research study
Risks and benefits

Potential benefits

There is no direct clinical benefit to you from taking part in this study. However, the information collected may help the research team understand whether wearable sensors can improve how shoulder conditions are measured and monitored in future patients.

Participation also contributes to the evidence base for orthopaedic research at a national level.

Possible risks

This is a very low-risk study. Some participants may experience:

  • Mild discomfort when performing shoulder movements
  • Mild tiredness
  • Mild skin irritation from the sensor strap

The sensor is non-invasive and can be removed immediately if you experience any discomfort. You may stop participating at any time without giving a reason and without any impact on your clinical care.

Data, privacy and confidentiality

How your data will be used

The data collected in this study - including your shoulder movement measurements and questionnaire responses - will be stored securely and processed in accordance with UK data protection law (the UK General Data Protection Regulation and the Data Protection Act 2018).

All data will be anonymised before analysis. Your name and NHS number will not appear in any publications or presentations arising from this research. Data will be stored securely for a minimum of 5 years after the study ends, in line with NHS and Research Ethics requirements.

Access to identifiable data will be restricted to the direct research team only. Data will not be shared with any commercial organisations or used for purposes other than this study without your explicit consent.

Your rights

You have the right to withdraw from the study at any time without giving a reason. Withdrawal will not affect your standard clinical care. Data collected up to the point of withdrawal may be retained and used in analyses.

Consent

Before taking part you will be given time to read the full participant information sheet and ask any questions. Participation is entirely voluntary. You will sign a consent form before any data is collected.

Beyond ASSET-S

Published research from our team

The clinicians behind this site carry out research on shoulder and elbow surgery, much of it using the National Joint Registry, the largest dataset of its kind in the UK. Recent work has compared types of shoulder replacement, examined how reverse shoulder replacements perform across their growing range of uses, reviewed treatments for rotator cuff tears, explored how patients decide on surgery, and looked at how new technology can support assessment. The ASSET-S study builds directly on this programme. Selected publications are summarised below.

Choosing a shoulder replacement

How patients decide on shoulder replacement

An interview study exploring how patients weigh up whether to have a shoulder replacement, looking at the information they seek and what drives their choice, to help make shared decisions in clinic clearer and better informed.

Davies AR, Sabharwal S, Reilly P, Sankey RA, Griffiths D, Archer S. Factors influencing patient decision-making to undergo shoulder arthroplasty. Bone Jt Open. 2024;5(7):543-549.

Read the paper

Total replacement versus hemiarthroplasty: function over time

Using National Joint Registry data, this study compared Oxford Shoulder Scores after total shoulder replacement and hemiarthroplasty for osteoarthritis. Total replacement gave better function at six months and held up to five years, while hemiarthroplasty scores dipped slightly.

Davies AR, Sabharwal S, Liddle AD, Zamora-Talaya B, Rangan A, Reilly P. Patient-reported outcomes following total shoulder arthroplasty and hemiarthroplasty: an analysis of data from the National Joint Registry. J Shoulder Elbow Surg. 2024;33(11):2411-2420.

Read the paper

Which option has a lower risk of revision?

A matched comparison of 11,556 registry patients with osteoarthritis and an intact rotator cuff found that hemiarthroplasty carried a higher risk of needing revision surgery than total shoulder replacement, including in patients aged 60 or younger.

Davies AR, Sabharwal S, Liddle AD, Zamora B, Rangan A, Reilly P. The risk of revision is higher following shoulder hemiarthroplasty compared with total shoulder arthroplasty for osteoarthritis: a matched cohort study of 11,556 patients from the National Joint Registry, UK. Acta Orthop. 2024;95:73-85.

Read the paper

Which option offers better value for money?

A health-economic model built on registry data found total shoulder replacement to be more cost-effective than hemiarthroplasty across age and sex groups, supporting it as the better-value option for osteoarthritis.

Davies A, Zamora-Talaya B, Sabharwal S, Liddle AD, Vella-Baldacchino M, Rangan A, Reilly P. Cost-effectiveness of total shoulder arthroplasty compared with hemiarthroplasty: a study using data from the National Joint Registry. BMJ Open. 2025;15(3):e086150.

Read the paper
Implant design and younger patients

Metal versus ceramic implant heads

This registry analysis compared metal and ceramic humeral head bearings. For total shoulder replacement in osteoarthritis with an intact cuff, metal heads had a higher all-cause revision rate than ceramic, while there was no difference for hemiarthroplasty.

Davies A, Sabharwal S, Liddle AD, Zamora-Talaya MB, Rangan A, Reilly P. Revision rate in metal compared to ceramic humeral head total shoulder arthroplasty and hemiarthroplasty. Bone Joint J. 2024;106-B(5):482-491.

Read the paper

How long do replacements last in younger patients?

A systematic review and meta-analysis of outcomes in patients under 65 found that more than 80% of anatomical shoulder replacements last beyond ten years and about 75% beyond twenty, with meaningful improvements in shoulder scores at every time point.

Davies A, Lloyd T, Sabharwal S, Liddle AD, Reilly P. Anatomical shoulder replacements in young patients: a systematic review and meta-analysis. Shoulder Elbow. 2023;15(1 Suppl):4-14.

Read the paper
Reverse shoulder replacement

What low revision rates really tell us

Comparing function and revision across implant types, reverse shoulder replacement had the lowest revision rate, but patients with poor function were less likely to be revised. This suggests its low revision rate partly reflects a higher threshold to operate again, rather than simply better implant performance.

O'Malley O, Davies A, Rangan A, Sabharwal S, Reilly P. Is there a difference in thresholds for revision between shoulder arthroplasty types? A National Joint Registry study. PLoS One. 2025;20(8):e0330975.

Read the paper

How reverse replacements perform across different conditions

This registry study examined how reverse shoulder replacement performs across the growing range of reasons it is now used. Revision and further-surgery rates were broadly similar across indications, except for trauma sequelae, where they were higher.

O'Malley O, Davies A, Taghavi Azar Sharabiani M, Rangan A, Sabharwal S, Reilly P. Revision of reverse shoulder arthroplasty by indication: a National Joint Registry study. Bone Jt Open. 2025;6(6):691-699.

Read the paper

Outcomes after a second revision

Among patients whose reverse replacement had already been revised once, the chance of needing yet another operation was high, around 23% by five years. Younger age and instability as the reason for the first revision raised the risk, prompting discussion of concentrating these complex cases in high-volume centres.

O'Malley O, Davies A, Rangan A, Sabharwal S, Reilly P. Re-revision following revision of a failed primary reverse total shoulder arthroplasty: an analysis of the National Joint Registry and Hospital Episode Statistics for England. JSES Int. 2025.

Read the paper

Are outcomes improving over time?

Looking across nine years of registry data, revision rates for reverse shoulder replacement stayed low and steady, while reoperation, mortality, length of stay and shoulder function all improved, pointing to steady gains in the quality of care.

O'Malley O, Davies A, Taghavi Azar Sharabiani M, Rangan A, Sabharwal S, Reilly P. Are we getting better over time? Clinical and patient-reported outcomes for reverse shoulder arthroplasty: a National Joint Registry cohort study. BMJ Open. 2025;15(9):e096084.

Read the paper

Reverse replacement as a day-case operation

Comparing day-case and inpatient reverse replacements, day-case surgery had low revision, reoperation and complication rates and similar patient-reported improvement, supporting it as a safe option for carefully selected patients.

O'Malley O, Davies A, Rangan A, Sabharwal S, Reilly P. Outcomes of reverse shoulder arthroplasty as a day case procedure: a population-based cohort study using the National Joint Registry and Hospital Episode Statistics. Ann R Coll Surg Engl. 2025.

Read the paper

What lengthens a hospital stay after surgery?

A registry and hospital-data study examining which patient and surgical factors are linked to a longer stay after shoulder replacement, with the aim of helping services plan care and improve efficiency as demand rises.

O'Malley O, Davies A, Rangan A, Sabharwal S, Reilly P. Predictors of prolonged length of stay in shoulder arthroplasty: a study using the National Joint Registry and Hospital Episode Statistics for England. Shoulder Elbow. 2026.

Read the paper
Rotator cuff and emerging technology

Options for large, irreparable rotator cuff tears

A large systematic review of non-replacement options for big, irreparable rotator cuff tears, covering 82 studies and 2,790 shoulders. All techniques improved shoulder scores early on, but retear rates were high and benefits often faded after two years, so no single approach stood out as clearly best.

Davies A, Singh P, Reilly P, Sabharwal S, Malhas A. Superior capsule reconstruction, partial cuff repair, graft interposition, arthroscopic debridement or balloon spacers for large and massive irreparable rotator cuff tears: a systematic review and meta-analysis. J Orthop Surg Res. 2022;17(1):552.

Read the paper

Artificial intelligence in fracture clinics

A systematic review of artificial-intelligence tools for virtual fracture clinics. Image-reading tools detected fractures on X-rays with high accuracy, but tools that interpret written clinical notes are still scarce, and developing them is the missing piece for a fully AI-supported clinic. This work sits alongside ASSET-S in exploring how technology can improve assessment.

Sukhbaatar T, Davies A, Koye A, Hashem M, Sivaloganathan S. Artificial intelligence in virtual fracture clinics: a systematic review of imaging and clinical-text tools. J Orthop Surg Res. 2026;21(1):176.

Read the paper
Expression of interest

Study pending ethical approval

The ASSET-S study is currently pending Research Ethics Committee approval. Recruitment has not yet begun. If you are interested in potentially taking part once the study is approved, please contact the research team.

📧 Research team: ardavies85@gmail.com
Physiotherapist guiding a patient through a shoulder exercise
Patient education

Shoulder and elbow physiotherapy

A guide to rehabilitation covering key terms, common exercises, stages of recovery, and when to seek advice from your clinical team.

Important: This page provides general educational information only. Always follow the specific exercise programme given to you by your physiotherapist or surgeon. Do not start new exercises after surgery without clinical guidance.
Recovery, stage by stage

Find the advice and exercises that match the stage you are at. This does not replace the instructions from your surgeon or physiotherapist. If their advice differs from anything here, follow theirs.

Shoulder and elbow exercises

These exercises cover the most commonly prescribed movements in shoulder and elbow rehabilitation. Always follow the programme given by your own physiotherapist, the exercises you need, and when you are ready for them, depend entirely on your specific diagnosis and stage of recovery.

⚠️ Do not start post-operative exercises without explicit guidance from your clinical team. If you are unsure whether an exercise is appropriate for you, ask before starting.
Pendulum exercises, Phase 1 (Week 1 onwards)

Pendulum exercises use gravity and gentle movement to reduce pain and maintain early mobility without stressing healing tissue. They are among the first exercises prescribed after shoulder surgery or injury.

Pendulum side to side exercise diagram
Pendulum circles exercise diagram
Range of motion shoulder exercises, Phase 1–2

Range of motion exercises restore shoulder movement after injury or surgery. They begin passively (someone else or a pulley moves the arm) and progress to active-assisted (you help the arm with your other hand or a stick), then to fully active movement.

Table slides
Wall walk (finger walk)
Stick-assisted forward elevation
Stick-assisted abduction
External rotation with a stick
Rotator cuff exercises, Phase 2–3

The rotator cuff muscles stabilise the ball of the shoulder within its socket. After rotator cuff tear repair, strengthening is delayed until the repaired tendon has healed sufficiently, usually 6–12 weeks. Your physiotherapist will determine when you are ready.

External rotation with resistance band
Internal rotation with resistance band
Isometric external rotation
Full can exercise (supraspinatus)
Scapular exercises, Phase 1–3

The scapula (shoulder blade) must move correctly to allow the shoulder joint to function properly. Scapular exercises can often be started early as they do not stress the shoulder joint itself.

Scapular retraction (shoulder blade squeezes)
Scapular depression
Prone Y, lower trapezius strengthening
Range of motion elbow and forearm exercises, Phase 1–3

Elbow rehabilitation differs from shoulder rehabilitation in one key way: early movement is even more critical. The elbow joint stiffens very quickly and the window to restore movement is relatively narrow.

Active elbow flexion and extension
Forearm pronation and supination
Eccentric wrist extension (Tyler Twist)
Stages of rehabilitation

Rehabilitation after shoulder or elbow injury or surgery follows a predictable sequence of phases. The timing of each phase varies significantly between conditions, these are general principles. Your physiotherapist will tell you exactly where you are in this journey.

1
Acute protection phase

The priority is protecting healing tissue while preventing unnecessary stiffness in adjacent joints. A sling or splint is usually worn. Pain and swelling are managed with ice, elevation, and medication. Movement is restricted to passive or gravity-assisted exercises only.

Goals
✓ Pain management
✓ Swelling reduction
✓ Protect the repair
✓ Prevent stiffness in hand, wrist, and elbow
✓ Maintain circulation
Pendulum exercises · Elbow and wrist flexion · Hand exercises · Scapular setting
2
Early motion phase

Active-assisted and then active range of motion exercises begin. The sling is gradually weaned. The goal is to restore the full range of movement without stressing the healing repair. Muscle activation begins, initially isometric (no movement).

Goals
✓ Full passive range of motion
✓ Active range of motion approaching normal
✓ Early muscle activation
✓ Return to light daily activities
Stick-assisted elevation · Pulleys · Active elevation · Isometric strengthening · Scapular exercises
3
Strengthening phase

Progressive resistance exercises begin, initially with very light resistance and high repetitions. The programme advances based on symptoms, pain should not increase significantly with exercise. Strength, endurance, and proprioception (joint position sense) are all addressed.

Goals
✓ Rotator cuff strength at least 70% of opposite side
✓ Normal scapular movement
✓ Return to driving, light work
✓ Normal daily activities without significant pain
Resistance band rotations · Full can · Rows · Prone Y · Progressive weight training
4
Return to function phase

Sport-specific or work-specific training is introduced. For contact sport, this phase involves progressive exposure to the demands of the sport before full return. For overhead workers, this phase involves graduated return to overhead tasks. Ongoing home programme maintains gains.

Goals
✓ Strength within 10% of opposite side
✓ Sport-specific functional testing passed
✓ Full return to sport or work
✓ Confidence and psychological readiness
Sport-specific drills · Plyometrics · Overhead activity · Heavy resistance training
🎨
Diagram required: Rehabilitation timeline chart
A horizontal timeline graphic showing the four rehabilitation phases across a 12-month axis. Each phase shown as a coloured bar (red → amber → green → blue) with the key milestones (sling off, driving, sport) marked as icons above the line. Separate rows for rotator cuff, shoulder replacement, instability, and fractures to show how timelines differ between conditions.
Physiotherapy terms explained

Understanding the language your physiotherapist uses helps you engage more actively in your rehabilitation.

Range of motion (ROM)
How far a joint can move in each direction, measured in degrees. Your physiotherapist measures ROM at each appointment to track progress. Normal shoulder elevation is 180°. Normal elbow flexion is 140–145°.
Active ROM
Movement you perform using your own muscle strength, without any assistance. This tests how well your muscles are working. It usually lags behind passive ROM in the early stages of recovery.
Passive ROM
Movement performed by someone else (your physiotherapist) or by gravity, without any muscle effort from you. Passive ROM is usually restored before active ROM after surgery.
Isometric exercise
A muscle contraction with no joint movement. Used in the early stages of recovery to activate muscles without stressing healing tissue. You push against a fixed surface, the muscle works but nothing moves.
Eccentric exercise
A muscle contraction while the muscle is lengthening, the lowering phase of a movement. Eccentric loading is the most effective treatment for tendinopathy (tennis elbow, golfers elbow, biceps problems). It stimulates tendon remodelling.
Concentric exercise
A muscle contraction while the muscle is shortening, the lifting phase of a movement. Most gym exercises are primarily concentric. Concentric and eccentric together form a full repetition.
Proprioception
The body's ability to sense the position of a joint in space without looking at it. Proprioception is impaired after shoulder injury and surgery and is specifically targeted in later-phase rehabilitation with balance and perturbation training.
Scapular dyskinesis
Abnormal movement of the shoulder blade. Common after shoulder injury and a contributing factor to impingement, instability, and rotator cuff problems. Correcting scapular movement is a key part of shoulder rehabilitation.
Tendinopathy
A degenerative change in a tendon, the normal collagen fibres become disorganised and unhealthy. It is not simple inflammation. Tennis elbow, golfers elbow, and biceps problems are all tendinopathies. Treatment focuses on graded loading, not rest or anti-inflammatories.
Impingement
Pinching of soft tissue (usually the rotator cuff tendons or bursa) between the bones of the shoulder during movement. Often caused by weakness or poor movement patterns rather than a structural abnormality. Responds well to physiotherapy targeting rotator cuff and scapular muscles.
Shockwave therapy (ESWT)
A non-invasive treatment that delivers acoustic pressure waves to a tendon to stimulate healing. Recommended by NICE for chronic tendinopathy (tennis elbow, golfers elbow) that has not responded to physiotherapy alone. Usually 3–6 sessions, weekly.
VAS (Visual Analogue Scale)
A 0–10 pain scale. 0 = no pain, 10 = worst imaginable pain. Your physiotherapist may ask you to rate pain before and after exercise. Pain of 3–4/10 during exercise is generally acceptable during tendinopathy rehabilitation, pain above 5/10 means you should reduce load.
Getting the most from rehabilitation

The quality of your recovery is significantly influenced by how you engage with rehabilitation. These principles are consistent across all shoulder and elbow conditions.

📅
Consistency beats intensity

Doing your exercises correctly every day produces far better results than occasional intense sessions. Tissue healing follows a biological timeline that cannot be shortened. Missing a day is far better than overdoing it and triggering a setback.

📊
Understand the pain rules

Some discomfort during rehabilitation is normal and expected, tendons, muscles, and scar tissue need to be challenged to remodel. The guideline: pain during exercise up to 4/10 is acceptable. Pain above 5/10, or pain that is significantly worse the next morning, means you have done too much.

📝
Track your exercises

Keep a simple diary, exercises completed, any pain or stiffness noted, and questions for your next appointment. This helps your physiotherapist make better decisions and helps you see progress over weeks and months rather than just day to day.

💤
Sleep and recovery

Tissue healing occurs during sleep. Prioritise 7–9 hours. Shoulder pain at night is common and can severely disrupt sleep, discuss this with your team if it is significantly affecting your rest. Sleeping position, pillow support, and medication timing can all help.

🍎
Nutrition supports healing

Adequate protein intake (1.2–1.6g per kg of body weight daily) supports tendon and muscle repair. Vitamin C is required for collagen synthesis. If you smoke, stopping significantly improves tendon and bone healing, this is one of the most impactful changes you can make.

🧠
Expect non-linear progress

Recovery from shoulder and elbow problems is rarely a steady upward line. Most patients have good days and bad days, with flare-ups that can feel like going backwards. This is normal. A single difficult day does not undo weeks of progress. Look at the trend over weeks, not the experience of a single day.

🤝
Communicate with your team

If an exercise causes the wrong type of pain, produces numbness or tingling, or you are simply unsure, contact your physiotherapist before your next appointment. Modifying the programme is far better than stopping it altogether or pushing through something inappropriate.

🎯
Set specific goals

Talk to your physiotherapist about the specific goals that matter to you, returning to golf, sleeping without pain, going back to work, lifting grandchildren. Goals that are personally meaningful are more motivating than abstract targets, and help your team prioritise the right aspects of rehabilitation.

When to seek help

Most discomfort during rehabilitation is expected and does not require urgent attention. The symptoms below are different, they may indicate a complication that needs prompt assessment by your clinical team.

🚨
Seek urgent medical attention (A&E)
Sudden complete loss of arm movement after surgery, possible re-rupture or re-tear
Rapidly spreading redness, heat, and swelling of the entire limb
Calf pain, swelling, and redness (possible DVT), especially after elbow or shoulder replacement
Sudden onset of chest pain or breathlessness (possible PE)
Any dislocation of the operated shoulder
Wound opening with exposure of deep tissue
⚠️
Contact your surgical team within 24–48 hours
Wound discharge, increasing redness around the wound, or wound not healing
Temperature above 38°C after surgery
Sudden significant increase in pain not explained by activity
New numbness, tingling, or weakness developing after initial improvement
Significant swelling that is not settling with elevation and ice
Any concern about the wound, the repair, or hardware
📞
Contact your physiotherapist
Exercise is causing pain consistently above 5/10 despite modification
Pain is significantly worse the morning after exercise and lasting more than 24 hours
Movement is not improving despite consistent exercise over 2–3 weeks
You are unsure whether a particular exercise is appropriate for your stage
You have had a fall or further injury during recovery
Significant psychological distress, anxiety, or loss of confidence in recovery
ℹ️
Normal and expected, no need to contact the team
Aching or mild discomfort during and after exercise (up to 4/10 pain)
Mild swelling at end of day, settling overnight with elevation
Bruising tracking down the arm, common for 2–4 weeks after surgery
A firm lump at a fracture site, normal callus formation
Night pain and broken sleep, common in first 6–12 weeks
Progress seeming slow, full recovery after shoulder surgery routinely takes 9–12 months
Contact details

If you are unsure whether your symptoms need urgent attention, call NHS 111 (24 hours). For non-urgent concerns about your recovery, contact your surgical team secretary during working hours. If you experience a sudden dislocation or loss of movement after shoulder surgery, attend your nearest A&E department.

Clinical prediction tools

Shoulder & Elbow Club. Validated scores reproduced to support calculation in clinic.

For use by clinicians. These tools reproduce published scoring systems to aid calculation only. They do not provide a diagnosis or a treatment recommendation. The treating clinician interprets each result alongside the full clinical picture and remains responsible for the decision.
Elective
Trauma

Instability Severity Index Score

Estimates recurrence risk after arthroscopic Bankart repair for recurrent anterior instability.

Balg F, Boileau P. J Bone Joint Surg Br. 2007;89-B:1470-1477.

0/ 10 points Lower risk

The original cut favouring a Latarjet was a score over 6, carrying roughly 70% recurrence. Several later studies place raised risk above 3 points, and some cohorts have not reproduced the predictive value. Treat the score as one input, not a rule.

Study critique. Single-centre prospective case-control, 131 patients, derived without a separate validation cohort. The over-6 cutoff has since failed to validate in some series and the threshold has been argued down towards 3. The radiographic items carry inter-rater variability.

Non-operative Instability Severity Index Score

Estimates the risk of failure (recurrence or progression to surgery) when anterior instability is managed non-operatively.

Tokish JM, et al. Sports Health. 2020;12(6):598-602.

0/ 10 points Lower risk

Derived in scholastic athletes, with high risk set at 7 or more. A larger long-term validation could not reproduce a clean cutoff and found it did not predict recurrent instability well, so use it to support a conversation rather than to decide.

Study critique. The weakest evidence base of the set: a retrospective cohort of 57 scholastic athletes (level IV), with return to sport as the endpoint. A larger validation could not reproduce a clean cutoff and it did not predict recurrent instability.

Glenoid track (on-track / off-track)

Assesses whether a Hill-Sachs lesion is likely to engage, which informs adding a remplissage or bone block to a stabilisation. Best measured on 3D CT.

Di Giacomo G, et al. Arthroscopy. 2014. Method per Yamamoto/Itoi (glenoid track = 0.83 × D).

0.0mm track margin (GT − HSI) On-track

Glenoid track = 0.83 × D − d. Hill-Sachs interval = lesion width + bone bridge. Off-track means the interval exceeds the track, the engaging configuration, which carries higher recurrence after an isolated Bankart and supports adding a remplissage or bone block. Three-dimensional CT is the reference standard; the result is only as good as the measurements.

Study critique. A sound biomechanical concept that is widely adopted, but the on-track or off-track call is measurement-dependent (CT versus MRI, best-fit-circle variability) and the binary cutoff simplifies a continuum.

Rotator Cuff Healing Index

Estimates risk of healing failure after rotator cuff repair from pre-operative factors.

Kwon J, Kim SH, Lee YH, Kim TI, Oh JH. Am J Sports Med. 2019;47(1):173-180.

0/ 15 points Low risk

Derived from a single-surgeon Korean cohort. A separate validation found bone mineral density and age were not independent predictors in that population, so external validity is limited. The statistical cut-point is 5, and a score of 7 or more is sometimes used when weighing augmentation.

Study critique. A case-control derivation study (level III) on 603 patients, the large cohort a real strength, but the score was weighted by odds ratios and verified on that single retrospective dataset with no independent validation. Healing was defined by imaging integrity (MRI or CT arthrography) against a 24% overall failure rate, so the endpoint is anatomical retear rather than function.

Clavicle non-union risk

Prognostic index for non-union after non-operative treatment of a diaphyseal (midshaft) fracture.

Robinson CM, Court-Brown CM, McQueen MM, Wakefield AE. J Bone Joint Surg Am. 2004;86-A(7):1359-1365.

1%approx. non-union at 24 weeks Lower risk

Approximation, not an exact figure. The paper shows the risk as a graph rather than a formula, and gives just two precise points at 24 weeks (index −1 about 7%, −2 about 38%). This tool draws a smooth curve through those points to fill in the values between them, and it matches the 1 to 2% the paper suggests near 0. The estimate is least reliable at very high or very low scores and outside the usual range of injuries studied, and it comes from one hospital's patients and has not been checked in other groups, so treat it as a guide.

Study critique. The strongest study of the set, a large prospective cohort of 868 patients, though single-centre. The risk comes from survival curves rather than a closed-form equation, which is why the estimate here is interpolated from the paper's published 24-week values rather than computed exactly.

Humeral head ischaemia risk (Hertel criteria)

Flags risk of head ischaemia and later avascular necrosis after an intracapsular proximal humerus fracture, which informs the fix-versus-replace decision.

Hertel R, et al. J Shoulder Elbow Surg. 2004;13(4):427-433.

0/ 3 high-risk features Lower risk

All three features together reach a positive predictive value up to 97%. The criteria have high sensitivity and negative predictive value but low positive predictive value, so they are stronger at confirming low risk than at confirming high risk. The anatomic neck pattern was the strongest fracture-type predictor in the original series. Head angulation over 45°, tuberosity displacement over 10 mm and four-part patterns add further risk. Ischaemia is one input to the decision, not the decision.

Study critique. A prospective series of 100 intracapsular fractures with intra-operative perfusion assessment, but a selected referral cohort skewed towards complex fractures. It predicts ischaemia rather than clinical avascular necrosis, with high sensitivity and negative predictive value but low positive predictive value.

NJR S-Predict (shoulder replacement)

Estimates the risk of a serious adverse outcome within 90 days of shoulder replacement, to support shared decision-making.

National Joint Registry. Model built on NJR data by the Universities of Oxford, Bristol and Copenhagen.

This one is different from the calculators above. It is an official, maintained NJR tool built on registry data from over 40,000 patients, and it uses age, sex and past medical history to estimate the 90-day risk of a serious complication. We link out to it rather than reproduce it, so it stays current and keeps the registry's own validation and governance.

Open the official NJR S-Predict tool
External official tool, intended for patients to use alongside their surgeon. A static copy hosted here could drift from the registry model and lose recalibration, so a link is the safer and more accurate option. It opens in a new tab and does not affect the self-contained build.

Study critique. The largest evidence base here, registry data from over 40,000 patients, which is its strength. But it is a hosted model rather than an open published equation, so its workings are less transparent than the hand-calculated scores.

Patient education

Patient club

A safe space to get plain-English answers about your shoulder or elbow condition. Watch recorded Q&A videos from our clinical team and use the AI assistant for general questions.

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Patient Club, Coming soon

We are building a dedicated space for patients to connect, share experiences, and access recorded Q&A sessions with our clinical team. Sign up to be notified when it launches.

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Ask anything

Get plain-English answers about your condition, treatment, or recovery - available any time.

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Video Q&A library

Watch recorded sessions where our clinical team answer the most common patient questions. Free to watch.

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Community

Hear from other patients about their experiences with shoulder and elbow conditions and recovery.

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Focus the Q&A conversation

This Q&A assistant provides general patient education only. It cannot give personal medical advice or replace a consultation with your surgeon.
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Shoulder & Elbow Club - Patient Video Q&A
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James M. 10:04
Can a partial rotator cuff tear heal without surgery?
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Clinical team Host 10:06
Great question - yes, many partial tears improve significantly with physiotherapy and time. We generally try non-operative treatment for at least 3-6 months first before considering surgery.
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Patient education
Video Q&A library
New videos added regularly

Patient Q&A videos

Recorded sessions answering the most common patient questions

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Frozen shoulder - the long road and how to shorten it

What is frozen shoulder, how long does it last, and what can patients do to help their recovery?

Available now - 42 min
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Rotator cuff tears - when to operate?

Understanding rotator cuff tears, who needs surgery, and realistic recovery expectations.

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Shoulder replacement - patient questions answered

Total and reverse shoulder replacement - from choosing surgery to life afterwards.

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Elbow conditions - tennis elbow, golfer elbow, and cubital tunnel

The most common elbow conditions, how they are diagnosed, and when non-operative treatment is sufficient.

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Legal information

Privacy policy

Shoulder & Elbow Club patient education

Last updated: May 2026 - Version 1.0

Who we are

This website is operated by the Shoulder & Elbow Club, a patient education service providing information about shoulder and elbow conditions.

For the purposes of UK data protection law (the UK General Data Protection Regulation and the Data Protection Act 2018), the data controller is the Shoulder & Elbow Club.

This website is a patient information resource only. It is not a clinical system and does not form part of your NHS patient record.

What information we collect

Information you provide

This website does not require you to create an account or provide personal information to use it. The following optional features may involve you entering information:

  • Patient outcome scores (PROMs): If you complete the Oxford Shoulder Score or Oxford Shoulder Instability Score, your name (if entered) and score results are stored only in your own browser using localStorage. This information never leaves your device and is not transmitted to us or any third party.
  • Patient Club Q&A: Questions you submit to the AI Q&A assistant are sent to Anthropic's API for processing. Please do not include personal details, NHS numbers, or medical information in your questions. Anthropic's privacy policy applies to this processing.
  • Email results: Using the "Email results" button on the scores page opens your email client with a pre-filled message. We do not receive, store, or process this email.

Information collected automatically

This website does not use cookies, tracking pixels, or analytics tools. We do not collect your IP address, location, device information, or browsing behaviour. No data is transmitted to us when you browse this site.

How we use information

Because we collect no personal data from this website, there is no data processing to describe for standard browsing. The PROMS data you enter remains entirely on your own device.

If you contact us directly by email (for example via the research contact address), your email will be handled in accordance with standard NHS data protection policies and the NHS Records Management Code of Practice.

Third-party services

Anthropic API (Patient Club Q&A)

The Patient Club Q&A assistant uses the Anthropic Claude API. When you submit a question, the text of your question is sent to Anthropic's servers for processing. Anthropic's privacy policy is available at anthropic.com/privacy. We recommend you do not include personal, medical, or identifying information in your questions.

Unsplash (photography)

Some condition page images are loaded from Unsplash (images.unsplash.com). Unsplash's privacy policy applies when these images are loaded by your browser. You can view Unsplash's privacy policy at unsplash.com/privacy.

Google Fonts

This website loads fonts (Fraunces and Plus Jakarta Sans) from Google Fonts. When fonts are loaded, your browser may send a request to Google's servers. Google's privacy policy applies. You can view it at policies.google.com/privacy.

Cookies

This website does not use cookies. The scores page uses localStorage - a browser feature that stores data locally on your device only. localStorage data is not transmitted over the internet and cannot be accessed by us. You can clear localStorage data at any time through your browser settings.

Your rights

Under UK data protection law you have the right to:

  • Access personal data held about you
  • Correct inaccurate personal data
  • Request deletion of personal data
  • Object to processing of your personal data
  • Data portability
  • Lodge a complaint with the Information Commissioner's Office (ICO)

As this website does not collect personal data, most of these rights are not applicable to your use of this site. If you have contacted us by email or have questions about your NHS records, please contact the Trust's Data Protection Officer.

Children

This website is intended for adults aged 18 and over. We do not knowingly collect information from children. If you believe a child has provided information through this website, please contact us.

Links to other websites

This website contains links to external websites including NHS.uk, BESS, ASES, and journal publishers. We are not responsible for the privacy practices of those websites and recommend you review their privacy policies before using them.

Changes to this policy

We may update this privacy policy from time to time. The date at the top of this page will be updated when changes are made. We encourage you to review this policy periodically.

Contact us

Data Protection Officer

Shoulder & Elbow Club
For general enquiries about this website: contact your clinical team

Legal information

Accessibility statement

Shoulder & Elbow Club patient education

Last updated: May 2026 - Version 1.0

Our commitment

The Shoulder & Elbow Club is committed to making this website as accessible as possible for all users, including those with disabilities. We aim to comply with the Web Content Accessibility Guidelines (WCAG) 2.1 at Level AA, as required by the Public Sector Bodies (Websites and Mobile Applications) Accessibility Regulations 2018.

We recognise that accessibility is an ongoing commitment and we continue to improve the experience for all users.

How accessible this website is

We know some parts of this website work well for accessibility and some areas need further improvement.

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Keyboard navigation Partially met
Most interactive elements can be reached by keyboard. Some custom components (the Teams mock meeting interface) have limited keyboard support.
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Screen reader compatibility Partial
Core content pages are readable by screen readers. SVG diagrams include title and desc elements. The AI Q&A interface has basic ARIA labelling.
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Colour contrast Met
Text and background colours have been selected to meet WCAG AA contrast ratios (minimum 4.5:1 for normal text, 3:1 for large text).
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Resizable text Met
The website can be zoomed to 200% without loss of content or functionality. Text scales correctly using relative units.
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Images and media Partial
Informational images include descriptive alt text. The embedded exercise and range-of-motion images have detailed alt text describing all content.
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Mobile and responsive design Met
The website is fully responsive and designed for use on mobile devices. Touch targets meet the recommended 44x44px minimum size.
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Video and audio content Planned
Video Q&A content is planned. Captions and transcripts will be provided when video content is added to the Patient Club section.

Known accessibility issues

We are aware of the following limitations and are working to address them:

  • Teams mock meeting interface: The Patient Club virtual meeting interface is primarily a visual demonstration and has limited screen reader and keyboard support. The Q&A text input and submit button are fully accessible.
  • Complex tables: The journal club results table includes merged cells that may not be fully announced by all screen readers.
  • PDF download: No PDF documents are provided at this time.
  • Focus management: When navigating between pages using the main navigation, focus is returned to the top of the page but a visible focus indicator is not always shown on the main content area.
  • Language attribute: The main page language is declared as English (lang="en"). Content in other languages is not yet available.

Technical information

This website is built as a single HTML file using standard web technologies (HTML5, CSS3, and JavaScript). It does not require any plugins to use.

The following assistive technologies have been used to test this website:

  • VoiceOver on macOS and iOS (Safari)
  • NVDA on Windows (Chrome)
  • Keyboard-only navigation (Chrome)
  • Chrome DevTools accessibility inspector
  • axe accessibility linter

Disproportionate burden

We have not made any claims of disproportionate burden under the accessibility regulations at this time. We are committed to addressing all known issues progressively.

What to do if you cannot access parts of this website

If you need information on this website in a different format such as accessible PDF, large print, Easy Read, audio recording, or in a different language, please contact your clinical team who will arrange this for you.

We will consider your request and get back to you within 10 working days.

Reporting accessibility problems

We welcome feedback on the accessibility of this website. If you find any problems not listed on this page or think we are not meeting accessibility requirements, please let us know.

Contact us about accessibility

Please contact your clinical team who will be happy to assist with any accessibility requirements.

Enforcement procedure

The Equality and Human Rights Commission (EHRC) is responsible for enforcing the Public Sector Bodies Accessibility Regulations 2018. If you are not happy with how we respond to your complaint, contact the Equality Advisory and Support Service (EASS) at equalityadvisoryservice.com.

Preparation of this accessibility statement

This statement was prepared in May 2026. It was reviewed by the Shoulder & Elbow Club development team based on self-assessment against the WCAG 2.1 AA standard. A formal independent accessibility audit is planned as part of the next development phase.