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Shoulder pain

The shoulder can be considered as a set of joints working together to allow controlled arm movement, making it one of the most complex regions of the body.  It is comprised of: the glenohumeral joint, acromioclavicular joint and the scapulothoracic joint. 

Common causes of musculoskeletal related pains tend to originate from bones, ligaments, tendons and muscles. These symptoms tend to settle with time and good self-management.

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Osteoarthritis

What is it? 

Osteoarthritis is the most common type of arthritis, affecting 8.5 million people in the UK. It develops gradually over time, causing joints to become stiff and painful. The good news is that the symptoms of arthritis can be helped with simple exercise. 

Osteoarthritis refers to joint pain with limitation of movement, which can affect daily activities. Contrary to most thoughts, osteoarthritis is not caused by ageing and does not necessarily get worse. 

In osteoarthritis of the shoulder we see changes to the cartilage of the joint as well as other secondary changes such as inflammation. Cartilage helps our joints move freely. Changes to the cartilage can lead to pain, stiffness, and loss of movement. This can in time lead to weakness in the muscles that control the joint. 

For more detailed information on osteoarthritis see: 

https://www.versusarthritis.org/about-arthritis/conditions/osteoarthritis/  

Dealing with shoulder pain 

If you are suffering from osteoarthritis of the shoulder then you should: 

  • Do exercises and stretches to keep the joints healthy and stimulate the natural lubricating fluid, keep it moving through as much of the range of movement that is available to you. 

Some suggested exercises can be found under the additional resources link below. 

  • Maintain good postural habits. If you spend a lot of time sat hunched forward , your shoulders drop forward, your chest muscles get tight and this mayaffect the ability of the shoulder to work properly, causing more pain. 
  • Use Ice or heat therapy 

Heat may be helpful in the form of a hot water bottle, wheat pack or hot shower. This can help to relax the muscles around your shoulder and may allow exercises to be more effective.  

For ice therapy use a damp cloth containing an icepack (or bag of frozen peas) over the top of the painful area to help numb the pain. Leave it on for 10-15 minutes and use up to three times a day.  

  • You should be cautious using these treatments if you have altered skin sensation or circulatory problems.  
  • Check the skin regularly  
  • Stop if there is excessive pain, numbness or tingling  
  • Do not put ice directly on to the skin as this may cause a burn.
  • Physiotherapy can guide you on exercises and long-term management of your shoulder condition. 
  • Simple painkillers 

Painkillers like paracetamol will ease the pain, but need to be taken regularly in order to control the pain. Always follow the instructions on the packet. 

Anti-inflammatories like ibuprofen can help with swelling, and therefore help you move more freely. Follow the instructions on the packet and discuss using them safely with a pharmacist, especially if you have any underlying health conditions

However, you should not take ibuprofen for 48 hours after an initial injury as it may slow down healing.

Up to date guidelines can be found on the NHS website:

https://www.nhs.uk/medicines/ibuprofen-for-adults/

https://www.nhs.uk/medicines/paracetamol-for-adults/

For up to date guidelines on the government about Ibuprofen use and Coronavirus (COVID-19)

https://www.gov.uk/government/news/ibuprofen-use-and-covid19coronavirus

Rotator cuff related pain

What is it?

The ‘Rotator Cuff’ is the name given to the set of muscles and tendons that all have to work together to stabilise the shoulder through movement. 

This condition is extremely common and can happen to anyone. It normally affects people between the ages of 35-75 years. Rotator cuff disorders are often a result of age-related changes however they can also be caused by trauma, overload, or repetitive stress (through sport, leisure activities or work)

What are the symptoms of Rotator cuff disorders 

Pain

Pain occurs in and around the shoulder joint and can spread down the top of the arm. If there has been an injury, the pain may come on suddenly. Pain is usually worse when you use your arm for activities above your shoulder level. This means that combing your hair or trying to dress yourself can be painful but writing and typing may produce little in the way of pain. Pain may also be worse at night and affect sleep. 

Weakness 

Occasionally your arm may also feel weak and you may have reduced movement in your shoulder. Some people feel clicking or catching.  

Factors which can contribute to rotator cuff disorders: 

Posture 

How you hold your head and shoulders is very importantIf the head and shoulder blade are pushed forward (for example, hunched or rounded shoulders), this position forces the shoulder muscles to work in an abnormal way. This can then lead to a reduction in the mechanical efficiency of the shoulder during movement. 

Weak rotator cuff tendons 

The rotator cuff works together to hold the ball on the socket during movement, preventing the structures in the joint space from becoming compressed. If one or more of the tendons are weak they will not be able to do their job properly.  

Stiffness of the shoulder 

If the shoulder is stiffthe mechanics of movement and the way the tendons work to support the joint will be changed. 

How to deal with it 

The aims of treatment are pain relief; to improve range of motion; reduce duration of symptoms and return to normal activities. One or more of the following may help ease your symptoms.  

Medication 

Painkillers like paracetamol will ease the pain, but need to be taken regularly in order to control the pain. Always follow the instructions on the packet. 

Anti-inflammatories like ibuprofen can help with swelling, and therefore help you move more freely. Follow the instructions on the packet and discuss using them safely with a pharmacist, especially if you have any underlying health conditions

However, you should not take ibuprofen for 48 hours after an initial injury as it may slow down healing.

Up to date guidelines can be found on the NHS website:

https://www.nhs.uk/medicines/ibuprofen-for-adults/

https://www.nhs.uk/medicines/paracetamol-for-adults/

For up to date guidelines on the government about Ibuprofen use and Coronavirus (COVID-19)

https://www.gov.uk/government/news/ibuprofen-use-and-covid19coronavirus

Rest or activity modification 

This does not mean you stop moving or using your shoulder altogether. It means avoiding or reducing activities over your head or behind your back as this can help to reduce the irritation in your shoulder. 

Ice therapy 

May be helpful to relieve pain. Place a damp cloth on your shoulder and then place an icepack (or bag of frozen peas) over the top of this. Leave it on for 10-15 minutes use up to 3 times a day. 

  • People should be cautious using these treatments if they have altered skin sensation or circulatory problems.  
  • Check the skin regularly  
  • Stop if there is excessive pain, numbness or tingling  
  • Do not put ice directly on to the skin as this may cause a burn. 

Sling 

Using support to offload the arm can help to make it more comfortable and allow symptoms to settle down. If you don’t have access to a sling you can learn how to make your own by clicking here. Otherwise you can try and use a scarf to give it some support. 

Exercises 

These are commonly advised with the aim of regaining movement in your shoulder and decreasing pain. For most benefit, it is important to do the exercises regularly and theshould be comfortable to perform. Please give the following exercises a try and see if it helps with the management of your shoulder condition. 

Please see the subacromial shoulder pain below for the exercises and the link to the British Shoulder and Elbow Society where you should find videos of the exercises. 

https://www.bess.org.uk/index.php/public-area/shpi-videos 

How to avoid it? 

This is a common condition. As with all MSK conditions try to keep active with regular exercise. Try to follow the advice above and keep to a routine of daily activity. Whenever doing more, whether that is gardening or weight training, remember to gradually build up your load on the shoulder. If you are returning from an injury the same principle of building up to your usual activity applies. If performing repetitive overhead tasks, make sure you are taking breaks and changposition regularly.  

External resources  

https://www.poole.nhs.uk/a-z-services/t/therapy-services/therapy-outpatients/patient-information-leaflets/shoulder-information-leaflets.aspx  

https://www.csp.org.uk/conditions/managing-your-bone-joint-or-muscle-pain/managing-your-shoulder-pain 

https://www.versusarthritis.org/about-arthritis/conditions/shoulder-pain/#exercises-to-manage-shoulder-pain 

https://www.nhs.uk/conditions/shoulder-pain/ 

Large rotator cuff tear

What is it?

The ‘Rotator Cuff’ is the name given to the set of muscles and tendons that all have to work together to stabilise the shoulder through movement.  

Large rotator cuff tears can occur as a result of prolonged overuse, age related change, trauma, or even surgery. This may cause you pain and mean you are no longer able to easily lift your arm. The Deltoid is a powerful muscle on the outside of your arm that can be re-educated to compensate for the rotator cuff. 

How to deal with it? 

The aims of treatment are pain relief; to improve range of motion; reduce duration of symptoms and return to normal activities. One or more of the following may help ease your symptoms.

Medication 

Painkillers like paracetamol will ease the pain, but need to be taken regularly in order to control the pain. Always follow the instructions on the packet.

Anti-inflammatories like ibuprofen can help with swelling, and therefore help you move more freely. Follow the instructions on the packet and discuss using them safely with a pharmacist, especially if you have any underlying health conditions

However, you should not take ibuprofen for 48 hours after an initial injury as it may slow down healing.

Up to date guidelines can be found on the NHS website:

https://www.nhs.uk/medicines/ibuprofen-for-adults/

https://www.nhs.uk/medicines/paracetamol-for-adults/

For up to date guidelines on the government about Ibuprofen use and Coronavirus (COVID-19)

https://www.gov.uk/government/news/ibuprofen-use-and-covid19coronavirus

  

Rest or activity modification 

 This does not mean you stop moving or using your shoulder altogether. It means avoiding or reducing activities over your head or behind your back as this can help to reduce the irritation of your shoulder. 

Ice therapy 

May be helpful to relieve pain. Place a damp cloth on your shoulder and then place an icepack (or bag of frozen peas) over the top of this. Leave it on for 10-15 minutes and use up to 3 times a day.

  • People should be cautious using these treatments that have altered skin sensation or circulatory problems.  
  • Check the skin regularly  
  • Stop if there is excessive pain, numbness or tingling  
  • Do not put ice directly on to the skin as this may cause a burn. 

Sling  

Using support to offload the arm can help to make it more comfortable and allow symptoms to settle down. If you don’t have access to a sling you can learn how to make your own by clicking here. Otherwise you can try and use a scarf to give it some support.

Exercises 

These are commonly advised with the aim of regaining movement in your shoulder and decreasing pain. For most benefit, it is important to do the exercises regularly and theshould be comfortable to perform. Please give the following exercises a try and see if it helps with the management of your shoulder condition.

The following exercises are a 10 stage non-operative programme for the management of large rotator cuff tears.

Exercises should be done two to three times a day to strengthen your deltoid muscle and gain full benefit. Aiming for 10 repetitions. These exercises must be done for at least 12 weeks and must always be performed starting lying down to begin with.

Stage 1:

Lying on your back with your arms by your side, bend your elbow on your affected side to 90 degrees, then lift the elbow off the bed towards the ceiling. When upper arm is vertical straighten your elbow. When you have lifted the arm as high as you can, slowly bend the elbow and return the arm to the bed, as controlled as possible.

Stage 2:

You will need a yellow resistance band. Lying on your back with your arms by your side, bend your elbows to right angles holding the resistance band. Take your hand on the affected side out to the side. Then control back to the middle.

Stage 3:

Start as if you were doing stage 1, once the arm is fully straight add a small swaying movement away from, and towards the head. When finished, bend the elbow and return the arm back to the bed in a slow and controlled manner.

Stage 4:

Repeat stage 3. Holding a bottle with a small amount of water to increase resistance.

Stage 5:

Activities in stages 1 – 4 repeated with head of bed progressively raised.

Stage 6:

Stand facing a wall with a cloth in your affected hand. Keeping as much pressure through your hand, slide it up the wall. At the top, hold for a few seconds and try to increase stretch with unaffected side supporting. Lower arm back down keeping pressure through hand, in a slow and controlled manner.

Stage 7:

Sit down and bend your elbow of the affected arm so that the hand is close to the shoulder. Reach the arm up until the elbow is pointing towards the ceiling, then straighten the arm. Slowly reverse the movement and control the arm back down to your side.

Stage 8:

Repeat as Stage 7. Then lower your hand to touch your head and straighten your elbow again. Repeat 2-3 times before slowly lowering your arm back to your side keeping elbow bent.

Stage 9:

Sitting with your elbows bent and in to your sides holding a yellow resistance band. Take the affected side away from your body as far as you are able. Slowly return to the starting position as controlled as possible.

Stage 10:

In 4 point kneeling transferring weight forwards and backwards.

 

In 4 point kneeling transferring weight side to side

 

In 4 point kneeling progress by either lifting a leg or an arm. Remember to keep your back still.

How to avoid it? 

This is a common condition. As with all MSK conditions try to keep active with regular exercise. Try to follow the advice above and keeping a routine of daily activity. Whenever doing more, whether that is gardening or weight training, remember to gradually build up your loading of the shoulder. If performing repetitive overhead tasks, make sure you are taking breaks and changing position regularly.  

External resources 

https://www.poole.nhs.uk/a-z-services/t/therapy-services/therapy-outpatients/patient-information-leaflets/shoulder-information-leaflets.aspx  

https://www.csp.org.uk/conditions/managing-your-bone-joint-or-muscle-pain/managing-your-shoulder-pain 

https://www.versusarthritis.org/about-arthritis/conditions/shoulder-pain/#exercises-to-manage-shoulder-pain 

https://www.nhs.uk/conditions/shoulder-pain/ 

Frozen shoulder

What is it? 

The shoulder has a capsule that surrounds the ball and socket joint and is usually lax to allow for a large range of movement. Frozen shoulder (also known as adhesive capsulitis) is a gradual tightening of the capsule, accompanied by severe pain in the early stages.

Research is inconclusive as to the cause of frozen shoulder; it affects about 3% of adults at some stage in their lives. It most commonly occurs in people aged between 40 and 65 years. It is more common in people who have diabetes, an overactive thyroid, high cholesterol, a high body mass index, heart disease or a history of trauma. It may start after an injury but can commonly start for no reason at all.

What are the symptoms of Frozen Shoulder?

Typical symptoms are pain, stiffness and limitation in the range of movement of one of your shoulders. There tends to be 3 phases to a frozen shoulder:

Freezing phase can be extremely painful, especially at night. Pain may be felt down the arm as far as the wrist; the pain may be felt all the time and usually becomes worse on movement especially twisting movements as in putting your hand behind your back or behind your head. This phase can last anywhere from 2 to 9 months.

Frozen stage is where pain gradually eases but stiffness and limitation in movement remain and can become worse. All movements of your shoulder can be affected. This phase can last anywhere from 4 to 12 months.

Thawing stage is where the pain and stiffness gradually settle and movement gradually returns to normal, or near normal. This phase can last anywhere from 12 to 42 months.

The time taken to progress through these phases is highly variable from person to person. Untreated, on average the symptoms last from 2 to 4 years, with some cases lasting much less than this, and for a minority of cases symptoms can last for several years. Often some stiffness remains, although most people regain enough movement to carry out everyday activities.

How to deal with it?

Treatment depends on the phase of the condition, severity of symptoms and degree of restriction of work, domestic and leisure activities. The aims of treatment are pain relief; to improve range of motion; reduce duration of symptoms and return to normal activities. One or more of the following may be advised to help ease symptoms.

Medication

Painkillers like paracetamol will ease the pain, but need to be taken regularly in order to control the pain. Always follow the instructions on the packet. 

Anti-inflammatories like ibuprofen can help with swelling, and therefore help you move more freely. Follow the instructions on the packet and discuss using them safely with a pharmacist, especially if you have any underlying health conditions

However, you should not take ibuprofen for 48 hours after an initial injury as it may slow down healing.

Up to date guidelines can be found on the NHS website:

https://www.nhs.uk/medicines/ibuprofen-for-adults/

https://www.nhs.uk/medicines/paracetamol-for-adults/

For up to date guidelines on the government about Ibuprofen use and Coronavirus (COVID-19)

https://www.gov.uk/government/news/ibuprofen-use-and-covid19coronavirus

Ice or heat therapy

Heat may be helpful in the form of a hot water bottle, wheat pack or a warm bath. This can help to relax the muscles around your shoulder and may make stretching exercises more effective.

For ice therapy place a damp cloth on your shoulder and then place an icepack (or bag of frozen peas) over the top of this. Leave it on for 10-15 minutes and use up to 3 times a day.

  • People should be cautious using these treatments that have altered skin sensation or circulatory problems.
  • Check the skin regularly
  • Stop if there is excessive pain, numbness or tingling
  • Do not put ice directly on to the skin as this may cause a burn

Sling

Using a support to offload the arm can help to make it more comfortable and allow symptoms to settle down. If you don’t have access to a sling you can learn how to make your own by clicking here. Otherwise you can try and use a scarf to give it some support.

Exercises

These are commonly advised with the aim of regaining movement in your shoulder and decreasing pain. For most benefit, it is important to do the exercises regularly, the exercises may be uncomfortable to perform but the discomfort should wear off within 30 minutes of stopping. If the discomfort lasts for longer than this or if the pain gets worse, stop exercising and seek advice from your doctor or physiotherapist.

 

Stand leaning on a table supporting your body weight with other hand.

Let your other arm hang relaxed straight down. Swing your arm forwards and backwards. In addition you can swing sideways or take in a circular motion.

 

Pull a rope through a ring located high above your head. Sit with your back against a wall. Hold onto both ends of the rope.

Lift your arm and assist by pulling down with the other hand.

 

 

Place hands on table standing with your legs hip width apart. Gently walk the legs backwards, gradually increasing the range of movement.

Keep arms straight and stretch.

 

 

Stand facing a wall.

‘Walk’ your fingers up the wall as high as posible. Reverse down in the same way.

 

 

Stand and grip one end of a stick with the arm to exercised.

Lift your arm x degrees to the side, assist by pushing with the other hand.

 

 

 

How to avoid it?

Frozen shoulder is a naturally occurring condition and it may occur as a result of injury. It can also occur for no reason at all. After an injury it is therefore important to keep your shoulder moving gently, performing the exercises above and early mobilisation may reduce the chance of developing a frozen shoulder.

 

External resources

https://www.poole.nhs.uk/a-z-services/t/therapy-services/therapy-outpatients/patient-information-leaflets/shoulder-information-leaflets.aspx

https://www.csp.org.uk/conditions/managing-your-bone-joint-or-muscle-pain/managing-your-shoulder-pain

https://www.versusarthritis.org/about-arthritis/conditions/shoulder-pain/#exercises-to-manage-shoulder-pain

https://www.nhs.uk/conditions/shoulder-pain

Shoulder instability

What is it? 

This is a problem that occurs when the structures surrounding the shoulder joint do not effectively keep the ball tightly within its socket. There is a wide variation in the degree of shoulder instability, from the joint slipping (subluxation) to a complete dissociation of the joint surfaces (dislocation) where you may not be able to ‘put it back in joint’ yourself.  

What are the symptoms 

Patients with shoulder instability often complain of an uncomfortable sensation that their shoulder may be about to shift out of place – this is what is known as “apprehension.” It can be either traumatic or non-traumatic in onset. 

In non-traumatic patients the first signs and symptoms of instability can be shoulder pain or an ache during or after certain activities. Patients will often report loss of power or weakness during movement (often overhead activities), as well as clicking, clunking or popping sensations. 

When a patient reports a specific painful injury that caused the problems the shoulder may have dislocated or subluxedConsequently, these patients may experience pain during and after certain activities and usually report the shoulder has never felt the same since. In severe cases recurrent subluxations or dislocations may occur. 

What can contribute instability? 

  1. Shoulder joint hyper-mobility. 
  2. General ligament laxity. 
  3. Inappropriate training or technique 
  4. Muscle imbalance/tightness 
  5. Intensive participation in activities placing the shoulder at risk 

How to deal with it 

The aim of treatment is to ease pain, regain normal alignment of the shoulder and return to normal functional levels. One or more of the following may be advised to help ease symptoms. 

Medication 

Painkillers like paracetamol will ease the pain, but need to be taken regularly in order to control the pain. Always follow the instructions on the packet. 

Anti-inflammatories like ibuprofen can help with swelling, and therefore help you move more freely. Follow the instructions on the packet and discuss using them safely with a pharmacist, especially if you have any underlying health conditions

However, you should not take ibuprofen for 48 hours after an initial injury as it may slow down healing.

Up to date guidelines can be found on the NHS website:

https://www.nhs.uk/medicines/ibuprofen-for-adults/

https://www.nhs.uk/medicines/paracetamol-for-adults/

For up to date guidelines on the government about Ibuprofen use and Coronavirus (COVID-19)

https://www.gov.uk/government/news/ibuprofen-use-and-covid19coronavirus

 

Rest or activity modification 

This does not mean you stop moving or using your shoulder altogether. It means avoiding or reducing overhead activities or reaching behind your back as this can help to reduce the irritation of your shoulder. Following your first dislocation it may help to protect soft tissues to allow healing and reduce inflammation, but it is important to balance this with the need to avoid unwanted stiffness. 

Ice therapy 

May be helpful to decrease swelling and reduce pain. Place a damp cloth on your shoulder and then place an icepack (or bag of frozen peas) over the top of this. Leave it on for 10-15 minutes use up to 3 times a day. 

  • People should be cautious using these treatments that have altered skin sensation or circulatory problems.  
  • Check the skin regularly  
  • Stop if there is excessive pain, numbness or tingling  
  • Do not put ice directly on to the skin as this may cause a burn. 

Exercises 

Strong shoulder muscles remain the best defence against shoulder dislocation, subluxation, and thus, instability. Exercises that build up these muscles around the shoulder are vital. The key is to balance the muscles around the shoulder and ensure not only the ‘mirror’ muscles are exercised (those that you can see when looking in the mirror). Good core stability and posture are also important. It is important to get an individualised physiotherapy programme to fit your needs. 

How to avoid it 

Correctly balanced strengthening exercises are the best way to help avoid further instability. 

External resources 

https://www.poole.nhs.uk/a-z-services/t/therapy-services/therapy-outpatients/patient-information-leaflets.aspx 

https://www.csp.org.uk/conditions/managing-your-bone-joint-or-muscle-pain/managing-your-shoulder-pain 

https://www.versusarthritis.org/about-arthritis/conditions/shoulder-pain/#exercises-to-manage-shoulder-pain 

https://www.nhs.uk/conditions/shoulder-pain/ 

Acromioclavicular joint

What is it? 

Acromioclavicular joint pain occurs where the collar bone meets the shoulder blade. Pain in this joint can occur if you carry out a lot of activities that require you to lift your arms above your head.

Making changes to the amount of overhead activities you do can ease the pain. Painkillers can manage the symptoms, but seek advice from your GP or pharmacist before taking. If the pain is persistent, physiotherapy will also help.

Dealing with acromioclavicular joint pain

  • Pain management
  • Physiotherapy and exercises

Avoiding acromioclavicular joint pain 

Avoid excessive overhead activities

Other causes of shoulder pain

Coming soon – Referred pain.

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Additional resources

Consent form for corticosteroid injection during COVID pandemic

Medical Decision Tool – Coming soon

Shoulder pain exercises

Managing Pain

Subacromial shoulder pain exercises

What is it?

Subacromial pain is very common and causes pain in the shoulder and upper arm. It can spread further down the arm and up towards the neck and shoulder blade. It can feel worse when the arm is moved away from the body such as reaching up or when placing the hand behind the back.

Pain can come on slowly over time or quite quickly if the shoulder has been used for an activity that is much more demanding than it is used to doing each day.

What is the exercise treatment?

Your shoulder should start to feel better within 6-12 weeks if you do the simple exercises on the following pages. These have been recommended by the UK’s leading shoulder physiotherapists and proven to reduce pain and improve your shoulder. This guide will show you how to do them within the comfort of your own home.

You may only be able to move your arm a small amount at the start but this will improve over time. A small increase in pain while exercising is ok as long as it goes away within 30 minutes and is not worse the next day. If this happens, don’t worry, do less repetitions the next time and then gradually build up again.

It may take 6 weeks before you start to see improvement.

If your shoulder does not improve over 6-12 weeks, or gets worse despite the exercises, you will need to visit your doctor again.

Wall slides

Find a smooth wall or wall mirror and a cloth that will slide easily on the wall (or put clean socks on your hands). Stand facing the wall. Place the edges of your hands against the wall with your thumbs facing you.

Now step forward as you gently push into the wall and slide your hands up as far as you can. Relax and return to start position.

– Repeat 8 times

– Rest for a minute

– Repeat 8 times

– Rest for a minute

– Repeat 8 times

When you can do this exercise easily you can progress by doing it without the support of the wall and adding a light weight.

Push-ups against the wall

Now put your hands on the wall as if you are going to do a pushup. Make sure your hands are placed a little wider than the width of your shoulders, your hands are turned out slightly and your elbows are below your shoulders.

Now lower your body towards the wall keeping your body nice and tall.

– Repeat 8 times

– Rest for a minute

– Repeat 8 times

– Rest for a minute

– Repeat 8 times

When you can do this exercise easily you can progress and increase load by moving your feet furher from the wall.

 

 

Shoulder rotation exercises

Sit next to a table with your elbow supported just below shoulder height on a rolled up towel.

Now make a gentle fist, keep your elbow bent and then rotate your forearm to point upwards.

Return to the start position and relax

Make sure you sit up tall whilst you do this.

 

When it is easy for you to do this you can add a light weight – start with half kilo or a small 500ml water bottle.

As the exercise gets easier you can increase the weight:

– First to 1 kilo

– Then to 1 and half kilos

– Then to 2 kilos

Soft tissue injuries

Shoulder injuries

Minor injuries to the shoulder such as a mild sprain or strain are very common and should settle with time. They can often be managed at home.  

A soft tissue injury to the shoulder may result in the following: 

  • Pain 
  • Swelling 
  • Bruising 
  • Stiffness and loss of function 

The pain can be particularly strong in the first three weeks as this is the inflammatory phase of your body healing itself. Typically, these injuries last 4 to 6 weeks depending on the severity.  

Painkillers like paracetamol will ease the pain, but need to be taken regularly in order to control the pain. Always follow the instructions on the packet. 

Anti-inflammatories like ibuprofen can help with swelling, and therefore help you move more freely. Follow the instructions on the packet and discuss using them safely with a pharmacist, especially if you have any underlying health conditions

However, you should not take ibuprofen for 48 hours after an initial injury as it may slow down healing.

Up to date guidelines can be found on the NHS website:

https://www.nhs.uk/medicines/ibuprofen-for-adults/

https://www.nhs.uk/medicines/paracetamol-for-adults/

For up to date guidelines from the government about Ibuprofen use and Coronavirus (COVID-19)

https://www.gov.uk/government/news/ibuprofen-use-and-covid19coronavirus

DAY 1 – Early Management

Protect by minimising use of the affected arm and initially avoiding stretching the area which could cause further injury. 

Rest can be beneficial in the very early stages of the injury (days 1-4). Complete rest, however, is not advisable. In the early stages, gentle active movements and specific exercises can help decrease pain and swelling, they also promote good tissue healing with less unwanted scar tissue and joint stiffness. 

Ice pack/frozen peas wrapped in a damp cloth, placed on the swollen area for up to 20 minutes at a time, 3 times a day. So long as there is swelling you will need to continue ice therapy, often beyond the third week.   

  • Please note only use ice if you have normal skin sensation  
  • Check the skin regularly  
  • Stop if there is excessive pain, numbness or tingling  
  • Do not put ice directly on to the skin as this may cause a burn. 

Compression of the shoulder can be achieved by using a tubigrip or crepe bandage. It should compress firmly but not restrict blood flow and create a tourniquet.  Remove if there are signs of poor circulation, or if you start to experience pins and needles or numbness. 

Elevation. This is difficult for the shoulder. If you have swelling in your arm sit on a chair and place your arm on cushions so it is supported. 

WEEK 1 – Early Mobilisation

After 72 hours is important to start using your shoulder normally again. Start to do normally everyday activities. You should also try doing these exercises 3 – 4 times a day. Repeat each one 10 times. 

1. Pendular exercise – stand leaning on a table supporting your body weight with the other hand. Let your affected arm hang, relaxed, straight down.

a. Swing your arm forwards and backwards 30 seconds 

b. Swing your arm sideways, left and right 

c. Swing your arm in a circle

2. In sitting or standing, roll your shoulders backwards and forwards 

 

 

 

3. Lie on your back, on your bed, with your elbows bent. Hold one wrist with your other hand. Lift the affected arm, assisting with your other hand.

 

 

 

4. Sit or stand. Place your hands on a table. Slide your hands along the table as far as you can without lifting your shoulders. 

 

 

 

 

5. Stand facing a wall. ‘Walk’ your fingers up the wall as high as possible. Reverse down in the same way. 

WEEK 2 – Strengthening Exercises

1. Stand or sit. Hold your upper arm close to your body with your elbow at a right angle.  Try to move your hand outward, resisting the movement with the other hand. There should be no movement. Hold for 10 seconds and repeat 5 times. 

 

 

2. Stand with your arm close to your side and your elbow at a right angle. Push the palm of your hand against the other hand. Hold for 10 secs and repeat 5 times. 

As you start to do these exercises you may feel there is some discomfort, however, this is normal and you should continue. If you have discomfort and pain for more than 2 hours after these exercises, then you should reduce the number and gradually build up again. 

Further shoulder exercises can be found following the link below: 

https://www.poole.nhs.uk/a-z-services/t/therapy-services/therapy-outpatients/patient-information-leaflets.aspx 

Recovery time and returning to activity 

It usually takes 6 weeks to heal from simple soft tissue injuries to the shoulder.  However, everyone recovers from injuries at different rates. Some may be back in 2 weeks however for some it can take up to 3 months.    

Returning to work – Gradually build up your strength and function, practice doing similar tasks that you would do at work before returning. Start doing this little and often ensuring there is minimal pain or swelling. 

Returning to hobbies/sport – it is advised not to return to these activities until you have full strength and range of movement without pain or swelling. Try to practice the specific movements of your hobby / sport in a controlled manner and build up the time and intensity that you do the movements before returning to your activity fully.    

Get advice from 111 now if: 

  • the pain is sudden or very bad 
  • you cannot move your arm 
  • your arm or shoulder has changed shape or is badly swollen 
  • you have pins and needles that do not go away 
  • there’s no feeling in your arm or shoulder 
  • your arm or shoulder is hot or cold to touch 

These can be signs of something serious, like a broken or dislocated bone, or a torn (ruptured) ligament or tendon. 

111 will tell you what to do. They can tell you the right place to get help if you need to see someone. 

Further links

External links for further information on shoulder pain: 

https://www.csp.org.uk/conditions/managing-your-bone-joint-or-muscle-pain/managing-your-shoulder-pain 

https://www.versusarthritis.org/about-arthritis/conditions/shoulder-pain/#exercises-to-manage-shoulder-pain 

https://www.nhs.uk/conditions/shoulder-pain/ 

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