Shoulder Rotator Cuff Injury

[craig1912]

chris7676 said:

But this is how the NHS works, limiting specialist care - I'm surprised most people are still not aware of it. Criminal but true. I'm sure they will get a few billion more next year to continue...

I have been battling with other similar stuff and only after meeting a common-sense GP I'm getting a SPECIALST referral now after a year plus. Physio is NOT a specialist at all usually means 'excercise' and a bit pointless if you are not aware of the actual condition. Obviously it often can lead to worsening.

I wasn't NHS and trusted the Specialist that he knew what he was talking about. After a year and 35 sessions of Physio who knows he might have been right but I will find out next week when I get the results of the scan.

[MurderousCrow]

chris7676 said:

But this is how the NHS works, limiting specialist care - I'm surprised most people are still not aware of it. Criminal but true. I'm sure they will get a few billion more next year to continue...

I have been battling with other similar stuff and only after meeting a common-sense GP I'm getting a SPECIALST referral now after a year plus. Physio is NOT a specialist at all usually means 'excercise' and a bit pointless if you are not aware of the actual condition. Obviously it often can lead to worsening.

craig1912 said:

I wasn't NHS and trusted the Specialist that he knew what he was talking about. After a year and 35 sessions of Physio who knows he might have been right but I will find out next week when I get the results of the scan.

Ok. Specialist referral may or may not be indicated on initial presentation, depending on a wide variety of factors including pain, presence of 'red flag' signs, effect of injury on activities of daily life, patient goals, Trust guidelines etc. etc. Again, most shoulder injuries can be resolved with conservative management and a targeted strengthening regime once pain is controlled. As a result, it is often - but not always - wiser and cheaper to attempt conservative management before seeking specialist review. If such review is required, a scan would usually be performed fairly early in the referral process. There is, of course a limited amount of money in play for any given condition - and this would be true regardless of service provider either public or private. Add to that the fact that MRI can lead to apparent 'abnormalities' being detected which are non-clinical and causing no issues, it makes sense to leave such sensitive and specific tests for cases which warrant it. Such cases may not be immediately apparent! Clients who are failing to respond to applied conservative therapies would fall into this category.

A physio is not a 'specialist'. However, physios can be highly effective clinical practitioners, using a solid evidence-based skill set to reduce pain, restore functional movement, and in many cases avoid the risks of surgery and the (often longer) subsequent rehabilitation process. They work as part of a multi-disciplinary team, and so *if* their interventions are not working they should refer. Clearly, this process can sometimes break down. Assuming full client compliance, following 35+ sessions or a year of therapy with no progress it may be reasonable to assume the applied interventions are not working. Absolutely no aspersions cast against either the above posters or the professionals involved in their management. See my previous post:

MurderousCrow said:

NICE recommends referral to orthopaedics on the basis of a number of different criteria - which you may fulfill. Even so in the absence of red flag signs (including those pointing toward an acute rotator cuff tear as opposed to an impingement syndrome) it is likely your care providers will try conservative management and physiotherapy first. Generally, if this is not making headway within three months or so, further interventions such as surgery may be warranted.

Every case of painful shoulder is different - there's little value in comparing yourself to others, even those with similar symptoms. Be positive and determined in your approach to getting better, and comply as best as you can with the recommendations made. If the therapy prescribed is unsuccessful you are then in a strong position to demand further investigations / interventions - or look elsewhere.

To specifically address Chris7676's post - A targeted rehabilitation program will not exacerbate an injury if the assessment process was thorough, and if client compliance with instructions was good. The process is dynamic, and at any point the client can report pain, lack of improvement etc. while the practitioner can be guided by visual observation, screening processes, clinical tests and the client's observations. It sounds as if this process broke down for you, but that doesn't extrapolate to physiotherapy / rehabilitative strengthening being either pointless, or worsening in any general sense for the vast majority of patients.

[craig1912]

craig1912 said:

I wasn't NHS and trusted the Specialist that he knew what he was talking about. After a year and 35 sessions of Physio who knows he might have been right but I will find out next week when I get the results of the scan.

Well after a year and 30+ sessions of Physio the scan shows that I need an op. He is going to cut a tendon (biceps teno tommy) that leads to the bicep and check out two other tendons that are "angry". May need a small rotator cuff repair but hopefully not. He says should just lose 5/10% of strength and cosmetically bicep will drop (leaving a popeye appearance!) but pain should go.

Edited by craig1912 on Tuesday 30th June 06:35

Edited by craig1912 on Tuesday 30th June 06:46

[craig1912]

Had confirmation I'm having T7982, Right Shoulder ASAD + cuff repair +LHD Tendonotomy. in September.

Any tips as to what exercises I should be doing in the meantime to help post recovery?

Thanks

[Waynester]

Quick update on this thread.

Had my first physio appointment today for my right shoulder/rotator cuff pain. After examination and some basic exercises it seems my shoulder blade/back muscle area are not doing very much work when I lift my arms above my head. Seems that my pec muscles are over compensating and therefore pulling my shoulders forward which is stressing the joint. Apparently.

So I have been given some specific exercises to do 3 x per day, with a follow appointment in 2 weeks time. I'm quite pleased with this as it sounds like something that can be relatively easily corrected through physio.

[hajaba123]

Great news, thanks for the update too many threads like this die away.

[MurderousCrow]

Waynester said:

Quick update on this thread.

Had my first physio appointment today for my right shoulder/rotator cuff pain. After examination and some basic exercises it seems my shoulder blade/back muscle area are not doing very much work when I lift my arms above my head. Seems that my pec muscles are over compensating and therefore pulling my shoulders forward which is stressing the joint. Apparently.

So I have been given some specific exercises to do 3 x per day, with a follow appointment in 2 weeks time. I'm quite pleased with this as it sounds like something that can be relatively easily corrected through physio.

Excellent - it sounds hopeful for you. If not already prescribed, it could be worth asking your physio about specific self-myofascial release techniques and stretches you could use in addition to the exercises. Keep us updated!

[Waynester]

Thanks, I will do.

Will update progress in 2 weeks time.

[andycambo]

Waynester said:

Had my first physio appointment today for my right shoulder/rotator cuff pain. After examination and some basic exercises it seems my shoulder blade/back muscle area are not doing very much work when I lift my arms above my head.

After having 6 weeks worth of aching / pain with my shoulder and back after falling over when spraining my ankle when running I eventually went to see the doctor who told me to go and see another doctor who is more of an expert in joints and muscles...

There was a two week period I had to wait so in the meantime I went to see a Chiropractor to see if they could help. They've been great and told me something very similar to what you've mentioned and now I'm more aware about what my body is actually doing, it's pretty bad!

After getting another appointment last Monday I saw the doctor and gave me a Cortisone injection and told me to continue with the Chiropractor and rest saying it could be months till the pain goes away - gutted.

Anyway, if you get the chance could you share some of the simple exercises? I hope you get better soon!

[Waynester]

andycambo said:

Waynester said:

Had my first physio appointment today for my right shoulder/rotator cuff pain. After examination and some basic exercises it seems my shoulder blade/back muscle area are not doing very much work when I lift my arms above my head.

After having 6 weeks worth of aching / pain with my shoulder and back after falling over when spraining my ankle when running I eventually went to see the doctor who told me to go and see another doctor who is more of an expert in joints and muscles...

There was a two week period I had to wait so in the meantime I went to see a Chiropractor to see if they could help. They've been great and told me something very similar to what you've mentioned and now I'm more aware about what my body is actually doing, it's pretty bad!

After getting another appointment last Monday I saw the doctor and gave me a Cortisone injection and told me to continue with the Chiropractor and rest saying it could be months till the pain goes away - gutted.

Anyway, if you get the chance could you share some of the simple exercises? I hope you get better soon!

Unfortunately it does seem to take time to recover, the physio exercises are helping I think...but the pain seems to fluctuate.
I'm finding it hard to sleep on my right side which is annoying as it's my preferred position.
I also had to reschedule my physio appt as I forgot my car was in for a service/mot yesterday. Appointment is now next week, so I will update with what the Physio therapist suggests next.

Here's the exercise sheet I was given.

[andycambo]

Waynester said:

the pain seems to fluctuate.

Here's the exercise sheet I was given.

Thanks for the exercises, really helpful.

[craig1912]

as stated earlier I'm having my op in 5 weeks, but currently in a bit of pain and going away on holiday in a week for a couple of weeks. Would a steroid injection ease the pain? Would it have any detrimental effect on the op?
Specialist is on holiday and I'm waiting to see if his secretary and speak to one of the other orthopods bout thought I'd ask here too.
Going to go to GP tomorrow in the hope he might consider giving me an injection as I would rather not be in this pain for 5 weeks.
Cheers

[andycambo]

craig1912 said:

Would a steroid injection ease the pain? Would it have any detrimental effect on the op?

Can't say anything regarding the op but the Cortisone injection I received has helped a lot. Before I was in constant pain with a deep ache and the odd sharp pain. I also couldn't move my arm in certain directions meaning putting a shirt on, washing my hair etc. was always uncomfortable.

The injection took around a week to fully work for me and now I'm not as miserable because I'm not in as much pain all the time. I can still tell there is something wrong as the injury is still there and I still get uncomfortable during the day but I'm far happier.

What I've found helped me is to get distracted. For first month or so I was just focusing on the pain because I stopped doing anything. I wasn't going the gym or walking, I was getting up, thinking ouch, going to work, thinking ouch, going home, thinking ouch, and going to bed, thinking ouch...

Now I make plans to get out and walk (haven't plucked up the courage for the gym yet), do little things in the garden and I've started programming a new app for myself to use when I'm better. Basically anything to make me stop thinking about being uncomfortable.

I hope your appointment goes well.

[DMN]

Well my injury has flared back up from a few years ago.

I came off my mountain bike at Dalby and put a slight tear in it on my left shoulder. It took a year of physio before a cortizone injection stopped it hurting constantly. It's been about 95% right since.

However last Sunday I've done something to it and its not stopped hurting. I can't even sleep with it as I can't get comfortable. If I do and move while I'm asleep the pain wakes me back up. I did manage a good nights sleep last night after taking two paracetamol tablets right before bed.

I'm off to see the Dcotor tomorrow, and I hope I don't have to wait another year before this pain goes away.

[craig1912]

Been to Gps and got 500 co-codamol which should keep me going. My op is in four weeks and GP said a cortisone injection could do more harm than good at this stage. Just have to grin and bear it.
I do go to the gym (think it might have been the rowing machine that made it worse) so just cycling now and weight machine for my good arm only.

[AlRaven]

I've had physio a year ago for this and want to build up the muscles a bit now using exercise rather than resistance bands - what sort of machines can I use and which should I avoid?

I've restarted swimming but breast stroke only, as I don't feel confident to do crawl (also it's boring).

For the experts, it's "Subacromial impingement secondary to partial superior cuff tear"

[Challo]

AlRaven said:

I've had physio a year ago for this and want to build up the muscles a bit now using exercise rather than resistance bands - what sort of machines can I use and which should I avoid?

I've restarted swimming but breast stroke only, as I don't feel confident to do crawl (also it's boring).

For the experts, it's "Subacromial impingement secondary to partial superior cuff tear"

I would ask your physio. I dislocated my shoulder last year and when I got the sign off from the physio went back into training and straight into military press which although great for building shoulders caused me to regress as the trap muscle over powered everything else to get the weight up.

I went to another physio and they gave me lots of different exercises to do to warm up and engage all the muscles big/small in my shoulder and also build up the strength.