• Reference Number: HEY-251/2021
• Departments: Orthopaedics
• Last Updated: 19 January 2021

Introduction

This leaflet has been produced to give you general information about your injury.  Most of your questions should be answered by this leaflet.  It is not intended to replace the discussion between you and the healthcare team, but may act as a starting point for discussion.  If after reading it you have any concerns or require further explanation, please discuss this with a member of the healthcare team.

What is a shoulder soft tissue injury?

The term soft tissue refers to muscles, ligaments and tendons that surround and support our joints. Injuries to the soft tissue around the shoulder can occur due to falling on an outstretched hand, overuse or direct impact.

What are the symptoms?

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

• Pain.
• Heat, redness or bruising.
• Stiffness and loss of function.

Pain relief

To manage your pain it is advised that you regularly take simple pain relief which can be bought over the counter from your pharmacist. If you have allergies or conditions which prevent the use of pain relieving or anti-inflammatory medication, please seek advice from your doctor or a pharmacist.

What should I do in the first 72 hours after the injury?

The most important initial treatment is aimed at controlling the pain and swelling by following the principles of RICE:

R – Rest

Complete rest is not advisable but it is important that you prevent putting the shoulder under strain in the early stages of healing. Ensure you continue to move the elbow, wrist and fingers as normal as it is common to quickly become stiff in these areas.

You may be given a sling but this should be discarded as soon as the pain is under control this is usually within 72 hours unless advised otherwise.

I – Ice

Ice will help reduce the pain in your shoulder and so should be applied for 10 – 15 minutes. This will help to reduce the swelling.

There are many different ways in which ice can be applied however it believed crushed ice, in the form of frozen peas for example, is the most effective.

Whichever method you choose it is important that you wrap the ice in a damp towel, in order to prevent it from ‘burning’ the skin.

Please Note:
Only use an ice pack on areas that have normal skin sensation i.e. where you can feel hot and cold.
Do not apply over an open wound.
Do not apply an ice pack to an area that has poor circulation.
During ice application check the skin every five minutes and discontinue its use if:

• the area becomes white, blue or blotchy.
• the area becomes excessively painful, numb or tingles.

C – Compression

It is not normal to need any form of compression with an acute shoulder injury.

E – Elevation

If you develop swelling in your wrist or hand elevate it above the level of the heart as much as possible. You can do this by placing your hand on your opposite shoulder or, if you are wearing a sling, adjust it so your hand is above the level of your elbow.

What not to do

Consuming alcohol, massaging the injured area and applying heat can all be detrimental in the early stages of healing and therefore should be avoided. It is important to note that smoking may also delay the healing process.

Rehabilitation and recovery

If you follow this basic advice your injury should take around six weeks to heal.  However, everyone recovers from injuries at different rates and it is dependent on the severity of the injury and the presence of any other medical problems.  It is possible that you may be back to normal in two weeks however it is also possible you may suffer symptoms for up to three months.

After 72 hours you can remove your sling, if you were provided with one. It is very important you try to start using your shoulder normally again when doing everyday tasks like washing and dressing. The exercises below will help you to regain full function, flexibility and strength.

1. Rest the hand of your uninjured arm on a table. Step back and lean forward a little so your injured arm is hanging free. In a pendular motion swing your arm:

Side to side. Forward and back. As if you are drawing a circle on the floor.

2. Whilst in a lying position. Hold a stick with both hands at shoulder width apart with your arms straight.

Use the uninjured arm to assist the injured arm to lift the stick out in front of you as high as possible. To begin with this may only be a short distance from your body. Hold at this point for 10 seconds. You can try this in sitting or standing if you are unable to get into a lying position.

3. Still in lying hold the stick and with the palms facing upwards, bend your elbows and tuck the injured arm into your side.

Use the uninjured arm to push the stick to the injured side as far as is possible while elbow is kept tucked into the side Hold for 10 seconds. You can do this exercise in sitting or standing.

4. Stand and grip one end of the stick with the injured arm.

Use the uninjured arm to push the stick up sideways away from your body. Ensure as you lift your arm your thumb points towards the ceiling and not down at the floor. Hold for 10 seconds.

5. Lastly, place the hand of your injured arm behind your back.

Take hold of it with your uninjured arm and try to gently pull the hand up your back as far as is comfortable. Hold the stretch for 10 seconds.

All photos with kind permission of ©Physiotec™

You should try to practice each exercise 10 times, 3 – 4 times every day. You may experience more discomfort when you start the exercises.  However, this is normal and does not mean you should stop.  If your symptoms remain worse for more than two hours after the exercises then you should decrease the number of each exercise that you do and build up again slowly.

Repetitive shoulder movements and lifting objects heavier than a teacup should be avoided to begin with. However, as your movement improves and pain reduces, little by little you can increase the amount of weight that you are able to lift but this should be done sensibly.  Progressing from lifting a tea cup to a heavy shopping bag for example would not be advisable as is likely to result in overloading of the soft tissue and consequently re-injury.

When can I return to normal activities?

If your job involves regular activities using your elbow you must ensure that you practice similar tasks so that you build your strength and function up gradually.

If you participate in an active hobby then it is advised that you do not return to this until you have full strength, full range of movement and you can use your shoulder normally without experiencing pain or swelling.

If you play a sport, practice sports specific activities like throwing to prepare the shoulder and build this up gradually before returning to full training sessions and competition.

Do I require further treatment?

You may be advised that you require physiotherapy following this type of injury, unless your symptoms are minimal on your initial appointment. Your physiotherapy could be at a variety of locations in the Hull and East Riding area.

You can self-refer to physiotherapy by contacting the following number depending on the location of your doctor:

• Hull GP patients self-refer to Healthshare: (01482) 300003
• East Riding GP patients self-refer to East Riding Physiodirect: (01377) 208300 or self-refer online at chcpmsk.org.uk

On occasions the clinician may wish to refer you to the physiotherapy team within the hospital trust. If this is the case they will advise you of this and you should receive an appointment at Hull Royal or Castle Hill Hospitals within 5 to 7 days of your attendance at the Emergency Department. If you have received no contact within this time please call the physiotherapy admin team on (01482) 674880.

When to seek further help

If 10 days following your injury you are unable to use the arm and it remains painful and swollen, despite following the above advice, please contact the physiotherapy team that you were advised to in the section above.