Soft Tissue Injury: Shoulder

  • Reference Number: HEY-251/2014
  • Departments: Orthopaedics

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 your doctor, 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 caring for you.

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 General Practitioner (GP) 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

There are many different ways in which ice can be applied. Whichever method you choose it is important that you wrap the ice in a damp towel to prevent the ice burning the skin. Ice should be applied for 20 to 30 minutes every two hours.

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

It is obviously very difficult to elevate the shoulder, however, if you develop swelling in your wrist or hand elevate it above the level of the heart as much as possible by placing your hand on your opposite shoulder.

Consuming alcohol, massaging the injured area and applying heat can all be detrimental in the early stages of healing and therefore should be avoided.

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 dependant
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 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. You should try to practice each exercise 10 times, 3 – 4 times every day.

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:

Rehabilitation and recovery - Step 1
  1. Side to side.
  2. Forward and back.
  3. As if you are drawing a circle on the floor.

2. Whilst in a standing, sitting or lying position, hold a stick with both hands at shoulder width apart.

Rehabilitation and recovery - Step 2

Use the uninjured arm to assist the injured arm to lift the stick out in front of you as high as possible.

Hold at its highest point for 10 seconds.

3. Still holding the stick, bend your elbows to a right angle and tuck the injured arm into your side.

Rehabilitation and recovery - Step 3

Ensure palms are facing upwards and push the stick to the injured side as far as possible keeping the elbow tucked into the side.

Hold for 10 seconds.

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

Rehabilitation and recovery - Step 4 Now lift the stick up sideways by assisting with the other arm.

Ensure as you lift your arm your thumb points towards the ceiling and not down at the floor.

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

Rehabilitation and recovery - Step 5

Take hold of it with your uninjured arm and try to stretch the hand up your back as far as is comfortable.

Hold the stretch for 10 seconds.

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 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.

When to seek further help

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

Should you require further advice on the issues contained in this leaflet, please do not hesitate to contact: Physiotherapy team: (01482) 608939.

If there is no answer, please leave a message, clearly stating your full name, address and telephone number and we will get back to you as soon as possible.

General Advice and Consent

Most of your questions should have been answered by this leaflet, but remember that this is only a starting point for discussion with the healthcare team.

Consent to treatment

Before any doctor, nurse or therapist examines or treats you, they must seek your consent or permission. In order to make a decision, you need to have information from health professionals about the treatment or investigation which is being offered to you. You should always ask them more questions if you do not understand or if you want more information.

The information you receive should be about your condition, the alternatives available to you, and whether it carries risks as well as the benefits. What is important is that your consent is genuine or valid. That means:

  • you must be able to give your consent
  • you must be given enough information to enable you to make a decision
  • you must be acting under your own free will and not under the strong influence of another person

Information about you

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We may pass on relevant information to other health organisations that provide you with care. All information is treated as strictly confidential and is not given to anyone who does not need it. If you have any concerns please ask your doctor, or the person caring for you.

Under the General Data Protection Regulation and the Data Protection Act 2018 we are responsible for maintaining the confidentiality of any information we hold about you. For further information visit the following page: Confidential Information about You.

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