Shoulder Injury Recovery Best Practice

I tore my acromioclavicular ligament a few years ago in a nice OTB.

I knew it was buggered as I could feel bone on bone scraping.

Trip to A&E and a follow-up from Orthopaedics and I was in a sling for a month full time. Basically keeping it held up. Now officially have slopy shoulders.

I'd say go to a&E or an MIUN and get it looked at.

Either do go and see the NHS or go and see a Physio and actually do what they tell you to do and do follow up with them.

Long story short.

Rode into a tree, seemed ok after a week or so. Next 6 months a small amount of pain at certain points but nothing to worry about. Then got to the point where I couldn't sleep in certain positions etc. Physio said suspected Bursitis which confirmed via scans etc. Easy goes with exercises but range of movement was getting worse. They decided I needed painful manipulation to get movement back to avoid surgery. In the meantime it morphed into a frozen shoulder but pain (bursitis) was going away so then about 9 months of physio and exercises and I'm not seeing them anymore and have approx 90 to 95% range of movement back. Will do a follow up soon.

What I learnt from this process was I should have booked in at the Physio the day after the crash to get it assessed and get an exercise regime plus follow up. Preemptive would have at least shortened the whole thing by 6 months and may have avoided both the main issues that came up.

Yep. (private) Physio if you don't want to bother the NHS. I'm paying about £60 for an initial consultation, £50 for follow ups, so its a solid lump of cash, but not unbearable, and most physios understand that if you're paying out of your own pocket, they need to be cost effective in the sessions and not set you up for endless appointments needlessly.

Its worth it as they should be able to tell you at the bare minimum what you've done and how best to manage it while it heals. The correct exercises done during healing can then speed the process and/or negate the side-effects of the enforced immobility.

(Fairly buggered shoulder, here too. Its a complex joint, lots going on, so worth taking the time to get it sorted earlier rather than later)

Mid frozen shoulder here, I'm 6 months in to a potential 2 year recovery, and obviously it is really slow going. I now seems to be making some small progress, due to regular physio & keeping at the exercises. I would definitely suggest some professional guidance from the NHS or a Physio, even if they end up saying it's nothing to worry about, it could stop you taking longer to recover than needed.

Sounds like potentially you have brachial nerve symptoms, does the pain spread down arm? Any numbness in arm down into hand?

But as above, private physio. NHS are great, but it needs a diagnosis, and NHS physio appointments are often very brief and you're just sent away with exercises to do.

Also, as long as it isn't painful, try to keep movement in the shoulder, stop it freezing.

The NHS doesn’t need me bothering them

I thought this too. However, after a couple of months of seeing a sports rehab therapist (at £40 an appointment) and seeing minimal progress (I was doing all the exercises etc.), they told me to go get a scan, so of I went to my doctor and asked him to refer me. First thing my doctor asked, why didn't I go to see him before? It turned out I had an impingement and needed more focused treatment.

Two years later, I'm still not 100%. But that is down to me. Once the pain had gone away in normal everyday use, I forget to do the specific exercises and only revisit them when I get a niggle.

So, my advice is go to your doctor and then regularly do the prescribed exercises even if you feel you don't need to.

I ended up with surgery to reduce impingement after two years of landing on my shoulder.  I'm currently on crutches from a silly slip on ice (on the bike with ice tyres) - torn hamstrings etc where they anchor to my pelvis.  Went to A&E for a 12 hour wait, no broken bones. Given strong pain killers and crutches and sent on my way. Two weeks on, still incredibly painful, need crutches, can't hobble far. Private physio booked for next week. NHS discharged as nothing broken.

I’d say go to a&E or an MIUN and get it looked at.

it not an emergency nor recent so I think you would be entering the system in the wrong place there, at best it gets referred after a looooong wait at worst you get sent to see your GP after the same looooong wait.  My GP can arrange same day (usually next day) X-ray appointment with virtually no queue at the hospital.

call your gp surgery, probably not at 0800 when they are chaos and explain you injured it a month ago and it’s not healing depending how your surgery works you’ll get directed to physio, a non urgent gp appointment, etc.  worst case you are told to join the 0800 chaos - but then you are absolved of guilt because that’s how the like to operate.

Another vote for a private physio first - you'll get a much longer and more in-depth consultation.

If you then want to go down doctors route I find a good way to avoid the morning phone call scrum is to fill in a e-consult form via your doctors website. They can't ignore it and generally someone gets back to you.

My recent experience - I should have seen the NHS about my shoulder sooner. I got an x-ray as there were other things going on at the time, nothing showed uyp there so it was all soft tissue stuff. Took a while to get an NHS physio appt from there. I saw a private physio in the meantime, the 2 physios had quite different approaches but all in all it's on the mend a few months later. I'd say the NHS physio got it more right and the treatment exercises they gave me were most effective but that's just 2 differing opinions not a private vs NHS point.

What started as a twinge became about 50% reduced range of movement and it got quite painful so get it looked at asap.

Some good advice above. I think the NHS is getting better with things like muscle and ligament / tendon damage.

I've always been of the opinion that GPs just say 'oh it's a slight strain, give it a rest for two weeks and see how you are', and repeat until you get bored.

However, the last few times I have had problems, they generally have a phone consultation with the GP and refer to a physio pretty much straight away. Once the physio was utter garbage and most unhelpful but by and large they know the problem well and give good rehab instructions.

That said, I too have shoulder issues at the moment that I should have got looked at some time ago. It is quite painful and limiting now I am back in the gym 3 times a week, so have gone privately through work medical cover. Currently waiting for scan results to see what I've done!

Go and see a physio and do what they tell you no matter how boring and repetitive the exercises are. And then get the opinion of a doctor as well in case you need surgery.

For this sort of thing at my Drs surgery the receptionists (on minimum wage 🙁 ) take some details and then talk to one of the in-house physios and either offer you physio or Drs appt, or suggest take it easy for a week or two and then call back. I've not had the latter.

Most times I have been offered a physio appt and the physios have been v good indeed. Excellent diagnosis, good rehab exercises and an agreement after X weeks to come back if minimal progress. Last time she told me I was old (true) and the early morning clicks from my shoulder were arthritis and I needed to get back to pilates, yoga and circuits to push back against. I had basically stopped for 9 months, so a good prompt to get back to it.

I have used private physios in the past where ongoing treatment is required. The trick is finding one of the better  physios who can accurately diagnose the root cause, though this can take more than one visit.

In summary, if your Drs has a physio service, get in there, or its Drs appt/private physio.

Personally, my experience is that it is best to nip these sort of problems in the bud early, before something more serious develops.

Ask if your GP has a FCP working there, these are usually senior physios and their role is getting people on the right care pathway quickly. They will be able to see you for advice and exercises, give you expected timescales for recovery and what to do if it doesn't improve

The shoulder is complex, but the most likely cause in this case is rotator cuff related shoulder pain. If you are keen to not bother the NHS then you can try these exercises first, at a level of resistance that is comfortable for you, and if after 6-12 weeks you’re not getting anywhere try a physio. Check your local hospital website, many MSK services are self referral now, or you can contact your GP digitally (I use the NHS app)

https://youtube.com/shorts/NQv57c5bgAo?si=_MIrG3EPYcxxCeRh

The NHS doesn’t need me bothering them with this at the moment and so any experiences of similar? Thoughts on… Full rest or light exercise?

Private Physio on this basis, I picked up Adhesive Capsulitis a few years back and resolved it through the private Physio route. In part because of how much quicker the private route is.

Kinda depends on exactly how you're feeling, but from the brief description given it's what id do.

As above. Get yourself to a decent physio, I can recommend one in Leeds if that's any help, and do what they say!

I’ve always been of the opinion that GPs just say ‘oh it’s a slight strain, give it a rest for two weeks and see how you are’, and repeat until you get bored.

My assigned GP is exactly like this. I came off my bike riding down the Herepath from the Ridgeway into Avebury one December, full weight onto my left elbow, shoulder into the side of my head, ears ringing, little birds, stars and planets around my head, etc. After a couple of weeks of my shoulder hurting whenever I picked something up I went to see my doctor, who wiggled my arm and shoulder around, said I’d done something, but I was getting older so what do I expect. Last year, about 15-20 years later, I noticed a lump on my collarbone - I’d broken it, my doctor never even noticed.
Same thing when I landed hard on my left knee on tarmac, another appointment with a different trainee doctor a year or two later got me an ex-ray, which diagnosed osteoarthritis in two places under the impact point under my kneecap. I always try to ask for a different doctor these days.

You need a diagnosis before you do anything.   GP is the gatekeeper.   You need to go thru them.

The wrong exercises could do more damage

GP first to arrange scan, then private Physio.

What they all said. ^

I won't bore you with the mechanism and nature of my injuries as they may or may not be relevant, but my old career and bikes has taken its toll and I've had significant surgery on one and currently managing an issue with the other.

The two experiences couldn't be anymore different, one was diagnosed by military physios, treated by an NHS surgeon, then back to rehab with military physios. Healed a treat.

This time around the progress has been much slower, I'm now under the care of a private physio and things are improving a a good rate.

Do whatever you need to do to get a diagnosis, if you can have a scan of any sort to back that up the better, then find a good physio and follow their plan to the letter and that will see you right.