Should we go to A&E? Hive mind advice needed

[Elisheva]

My dd(11) injured her shoulder 10 days ago. We went to the minor injuries unit who sent her to A&E, she had an xray and they said she had sprained the shoulder joint which would resolve with rest and painkillers. All good.
Except she hasn’t moved it since then, she says when she tries it pops and feels like it’s grinding and that it’s too painful to move properly.
I am almost certain that it is muscular and that her muscles have seized from not moving it for so long, so she just needs to work through the pain and get them going again. But she won’t.
We returned to the walk in, who says she should go back to A&E as they can’t see the original x rays.
My dd is autistic (high functioning for the purposes of this discussion), and cannot tolerate another long wait. It took all her resources to cope the first time. We tried to go back and she just walked out when they said it would be 3 hours wait.
I phoned 111 who said that A&E is the appropriate route.
I don’t know what to do. I am as sure as I can be that there is nothing seriously wrong, but a tiny voice says what if there is! I can get her through another long wait, but I think they will just send her away and say she just has to start moving it. Which she won’t. Aaargh!

Would she be able to tolerate the wait in the car or in the cafe instead? If you have two adults one could wait in the waiting room and one could take her elsewhere.

I think you have 3 choices:

A&E, a private appointment with an orthopaedic surgeon or trying a physio.

If it is muscular, a physio could probably help and also know whether another X ray is needed. It could easily be ‘frozen shoulder’, shoulders are tricky.

I can’t see any other options.

I did think of a physio, but a friend told me they wouldn’t treat a child with an uncertain diagnosis unless signed off by a doctor.

It’s just me. I did wonder about signing her in and then going to the cafe for an hour.

A friend who’s a physio who treats children?
Ring around and find one . Or ask the GP for a physio referral, in my area, new injuries are seen quickly.
Does she like medical stuff? My (and) dd loves finding me excersise videos for my aches and pains, maybe she could do some googling and find something that helps

Is there a minor injuries unit that does x-rays? Some areas have them and the wait is far less.

I didn’t answer your question- no, don’t go to a&e, get onto the go about it. 111 love sending children to a&e, it isn’t an emergency and doesn’t sound appropriate for an autistic child.

Of course they will you just need someone who specialises in children. Maybe talk to a medical professional rather than a friend.

I’ve talked to several medical professionals?

I second asking the GP for a physio referral. The GP could also do a scan/x-ray referral if they feel it's warranted. While I don't think you would be like wrong to go to A&E, it sounds likely that it would be really stressful for your daughter, but also they will probably just give her the same advice, which if she isn't ok with moving her shoulder, is useless! The GP is more likely to work through an appropriate course of action given your daughter's needs from her autism as well as the injury.

I suppose the question is whether I keep pushing her to move it, which is what the doctor said she should do, when she is adamant that it is too painful.

About physio - you said a friend said they won’t do it. Not true. Speak to a child friendly physio. I didn’t means doctors or A&E.

@Elisheva ,

That wasn’t my experience with my 11 year old son (at the time). The physio took a good look and said he needs a scan. So, at least I got clarity.

Also, our NHS is really mean with MRIs, which are the gold standard for this kind of thing (you can see partial fractures, swelling, soft tissue injury etc).

If you have insurance or the money, I would refer yourself privately and get an MRI.

Are you giving her regular pain relief?

Make a GP appointment for Monday, and see who they can refer to.

I don’t have the money or the insurance for a private referral.

Yes, ibuprofen and paracetamol.

When my elderly dad was alive he needed an X-Ray and because it wasn't urgent, and because he couldn't physically sit on the hard plastic chairs for hours in A&E, his GP made an appointment for an X-Ray.

Could yours do that if you explain about your DD's autism?

If you do go to A&E as you book inet the receptionist knows that your child has a formal diagnosis of autism and as a reasonable adjustment let them know that your going to wait remotely (in your car or hospital coffee shop etc) and ask to be phoned by the triage nurse when it's your turn.

They should accommodate this seamlessly.

If they struggle to accommodate your request remind them of the Equalities Act 2010 and reasonable adjustments.

Also, you could contact your local MIU and ask for a booked time slot for x-ray as advised by 111.
This would likely be the most appropriate and avoid a highly stretched A&E dept.

She already had an x-ray which showed a sprain.

I think you are wasting everyones time by taking her back to A&E she needs physio and good analgesia now. Have a chat with the GP tomorrow and see how she can be referred and if they will review her pain.

is it her dominant arm? who looked at/reported the original x-ray?... radiologist/orthopaedic surgeon/senior ED doc/someone else? The answer to those two questions might make a difference to a) how urgent it is and b) how much I believed the original diagnosis. Did the ED give an option of getting booked in for a fracture clinic appointment (fracture clinics aren't just for fractures, but just occasionally they do pick up a bony injury in someone originally thought to have a soft tissue only problem)? It may be worth phoning ED to see if that could be an option/ if someone can see the formal report of the original x-ray and advise, but if they can't help with that over the phone (which they probably won't, but it's worth a try), then you're a bit stuck with visiting the ED. I would go to the same place as the first time as they'll be able to review the original pics. Returning children, particularly ones who may have difficulty expressing themselves/ or have unusual sensory perception, are usually taken pretty seriously.

If both walk in and 111 say A&E, I think that's probably where you need to go.

I'd get a GP referral for a NHS physio, OP.

At the age of 13 my daughter had a serious horse riding accident whilst on holiday, no broken bones. She was badly bruised and had whiplash type injuries from being thrown.

When we returned I contacted my chiropractor for help, she was more than happy to see her and sorted her out.