Emergency and Urgent Care - Shoulder Injury Advice

What is a shoulder injury?

Shoulder injuries can occur at any age and affect the soft tissues surrounding the shoulder joint. They usually get better by looking after them yourself. Common shoulder injuries include sprains – over stretching of the ligaments, and strains – overstretching of the muscles and tendons.

What symptoms will I have?

• Pain
• Swelling
• Bruising

All of these can last for several weeks, but are usually worse over the first 3 days.

How is it treated?

P - Painkillers: it is important that you take regular painkillers to reduce the pain and help you keep moving around. Paracetamol and ibuprofen are effective painkillers if they are taken regularly, and can be taken at the same time. These medications can be easily purchased over-the-counter at supermarkets and pharmacies. Please carefully read the instruction leaflet with the medication and only take the recommended dose; there may be reasons why you cannot take these medications, a pharmacist will be able to help you with this.

R - Rest: will help prevent further injury and allow the healing process to begin. For the first 2 days reduce the amount of use of your shoulder; gently exercise your shoulder to prevent stiffness.  Avoid forceful and strenuous activity, such as lifting and gripping until you can do this without it causing pain.

I - Ice: can help reduce swelling and reduce pain. Make an ice pack by wrapping a small bag of frozen peas or some crushed ice cubes in a damp towel – DO NOT put ice pack directly onto skin. Put the ice pack on the shoulder for up to 20 minutes every 2 hours for the first 3 days after the injury. Then use the ice pack 3 times a day until the swelling has gone down. DO NOT eat food that has been thawed and refrozen.

M - Mobilisation: early movement has been shown to help shoulder injuries to heal more quickly.. Using the exercises in this leaflet will help you to regain movement in your injured shoulder.

E - Elevation: keeping your injured arm raised for the first 2 days after your injury. This will help to decrease the swelling and pain. Try resting your affected arm on one or two pillows.

Compression: We no longer offer compression bandages for sprains, because they appear to have no beneficial effect on how quickly or fully you recover.

What to avoid:

H - Heat: hot baths, saunas and heat packs will increase swelling and bleeding.
A - Alcohol/Smoking: reduces healing and increases swelling and bleeding.
L - Lifting: lifting heavy objects too soon can worsen pain and prolong healing.
M - Massage: may increase swelling and bleeding.

Recovery

Healing of the ligaments normally takes about 6 weeks, although everyone recovers from injuries at different rates. Healing time is related to how severe your injury is and any other medical problems you may have.

As healing gets underway, it is important that you begin a series of exercises to help you get back the full use of your wrist by improving its flexibility and strength. This will help to reduce the risk of further sprains.

Returning to physical activity:

• Returning to sport and work will depend on the demands of your job or chosen sport
• Recovery is faster if you stay at work, or go back to work as early as possible
• If you are on your feet all day you may need to gradually return to work, do light duties initially, or have regular breaks
• Once you have regained movement, strength and balance you can slowly start to increase your activity back to your previous level

Driving

It is important that you contact your insurance company to let them know about your injury. You may be able to drive once you are able to perform an emergency stop safely and fully operate your vehicle.

Exercises:

• Exercising your shoulder will help reduce any swelling and help ease the pain from stiff joints. These exercises will be most effective if completed “little and often”, and can help speed up your recovery
• They can be done every 2 hours
• Start exercising slowly and smoothly, build up the repetitions and range of movement gradually until you have reached full range of movement
• Try to carry out 10 repetitions of each exercise
• Pain can increase initially but will soon settle down within a few days of starting the exercises

Pendulum Exercise

• Lean over with your good arm supported on a table or chair
• Relax the arm on the painful side, letting it hand straight down
• Slowly begin to swing the painful arm backwards and forwards 10 times
• Now move the arm side to side 10 times
• Now move the arm in a clockwise circular motion 10 times
• Finally move the arm in an anti-clockwise circular motion 10 times

Table Slides

• Sitting or standing in front of a table or level surface, place you painful arm on the table, palm facing down
• You can use a towel to help your hand slide
• Slide your arm forwards as far as you comfortably can, and then come back
• Repeat 10 times

Shoulder Rotations

• Sit or stand up tall with your arms by your side
• Keep your shoulders relaxed and down, not shrugged
• Squeeze your shoulder blades together and hold for a few seconds then relax
• Repeat 10 times

Physiotherapy

If you are unsure about what to do and feel you need support with your rehabilitation, then you can always go to see a Physiotherapist.

If you live in the Heywood, Middleton and Rochdale area, you can refer yourself by using the following link:
www.physiodirect.northerncarealliance.nhs.uk

Things to watch out for:

If you experience any of the following you should return to the Urgent Care Centre or attend an Emergency Department:

• You develop a sudden, sharp increase in pain that is not relieved by painkillers
• You develop a sudden loss of movement to the shoulder
• Your shoulder becomes hot, red and swollen
• You begin to feel generally unwell with any of the above symptoms

If you shoulder does not seem to be improving after 2 weeks, or is not significantly better by 6-8 weeks after your injury, you need to be re-assessed. You should visit your GP for this.

Work

If you do not feel capable of working either due to pain or reduced movement/mobility, you are able to self-certify sickness for the first 7 days.

You must complete a self-certification form found on the government website and give this to your employer. This entitles you to statutory sick pay from your employer for up to 7 days.

To access the self-certification form follow this link:
https://www.gov.uk/government/publications/statutory-sickpay- employees-statement-of-sickness-sc2

If you feel you need longer than 7 days off work, you must contact your GP for a sick note. The Urgent Treatment Centre does not issue sick notes.

Possible complications

If follow up has been arranged you should attend this.

If your injury does not require follow up you will have been given an approximate recovery time during your visit to the Urgent Treatment Centre.

• If the pain is ongoing despite treatment and analgesia
• You experience tingling/change in sensation to the arm
• You develop chest pain

Please contact Rochdale Urgent Treatment Centre on 01706 517023 or return to the department.