Back to minor injuries or see GP?

[owthathurts]

I fell over on the weekend and really hurt my arm/top of the shoulder, TBH I really thought I had broken it as it was so painful. I went to MI and they x-rayed it. Nothing showed up on x-ray so was sent home with a collar and cuff and told to take regular paracetamol/ibrufen. My arm is still really painful and a little bit swollen - as in really painful, I can't move it very far, cant use a spoon, fork, brush my teeth, put underwear on, wash my hair, drive, use a cup with that hand,sorting myself out after going to the toilet, takes ages to get dressed/undressed and its very very painful.

I am now a few days on and I can use my hand more than I could originally but the pain is pretty much as bad in mu upper arm/shoulder. I have googled and with my self diagnosis have come up with rotator cuff injury. MI did say that after a couple of days if no better go back and see them - is going back to them the right thing or should I go and see my GP? The MI department is nurse led, they were lovely and very sympathetic but I am not sue which is the quickest route in getting a firm diagnosis and hopefully some treatment.

My arm/shoulder really hurts!

I agree it does sound like a rotator cuff injury, these can be hideously painful & annoyingly slow to heal. I am surprised they gave you a collar & cuff as immobilising these injuries tend to make them worse & delays healing.
You need to see a physio, it depends in your area how the service is accessed - either via the walk in centre, GP or self referral. Sorry I can't help you with that.

I'd go back to minors if you can't get a GP appointment quickly. Not ideal, but you cannot be in pain / without further examination by another pair of eyes for any longer.

Keep taking the anti-inflammatories though.

It sounds like a rotator cuff injury, I'm recovering from one just now. I was advised by MI the best thing I could do would be to see a Physio ASAP. However there is a fair wait for one on the NHS in my area and the nurse said if I could afford to pay privately then to do so, as the sooner Physio was started the better.

I've paid to see a private Physio and it's made a huge difference.

Good luck

I am taking paracetamol every 4 hours with Ibrufen in between, its still really painful. Night times are awful as its disturbing every time I move.

What type of things did the physio do? The thought of them moving my am feels me with dread - the x-rays were just awful!

Sounds really obvious but are you icing it? As in, multiple times a day?

Also if you have any pain-free range of motion then gently keep moving it through that range.

Ha! I have just googled some exercises - there is no way I can do them!

I was told to ice it so have used an ice pack several times over the day.

Initially I had my shoulder taped up and started off with small movements. The Physio said it was important to get it moving even a little or it could freeze up and then you have a much bigger problem.

Honestly if you can afford to see a Physio I would really recommend it. I was in a lot of pain too but he supported my shoulder when doing the initial assessment etc and it wasn't as bad as I thought it would be.

Swift - how long has it been?

I find I am holding my arm very close to my body.

About 4 weeks. I was the same, I was holding myself really tense and my arm close to me.

For me by far the worst pain came from a backwards movement, like pulling up trousers, that kind of movement, I genuinely felt like I could have been sick with the pain.

On my first visit the Physio strapped my shoulder up, so it was supported but held in the correct position and still allowed movement. Honestly there was an improvement right away (although still really painful) I had to keep the strapping on for 6 days.

I damaged my rotator cuff a couple of years ago. Took me 6 months or so to be pain free. I should have gone to a physio sooner than I did, but when I did the exercises given were really helpful, and worked with whatever pain free/ low pain movement I had.

Sorry for the questioning but did you only have paracetamol/ibrofen or something stronger? I'm still in lots of pain while still taking paracetamol/ibrofen.

Was it through an injury/fall?

What was the mechanism of your fall?
If you fell directly into it i.e. a direct impact trauma I'd go back for further imaging. How quickly afterwards were the first films taken? Soft tissue swelling can mask fractures. And if you weren't using your arm as you injuries it I'd be more concerned about that than a RC tear.

I tripped over a bag, flew across the room, banged my head on the wall (just above my eyebrow), not sure if my hands hit the laminate floor before my head hit the wall or after ( I think my arms were straight as I hit the floor). My other arm just feels a little jarred. The x-rays were taken about 9 hours after the fall. It all happened so quickly.

I fell down a whole flight of stairs with my arm twisted up awkwardly behind me. Incredibly painful, you have my sympathy. Just ibuprofen and paracetamol yes, at max strength.

It's hard to say from that description. I'd have guessed at fracture or a labrum tear rather than RC- I am a medic but I hate shoulders!

I think if Minors have said you can go back, go back. You'll never have that open door later down the line. Maybe they will take pity on you and get some better imaging done. Your GP is more likely to send you away with anti inflammatories at this stage.

The Nurse did say that they wern't great images but they would be looked over by somebody higher in the next couple of days.

If the MIU said go back to them in a few days if things aren't improving, why not do that? They will at least have the benefit of the x-ray and the notes from last time, which might not yet have been sent on to your GP.

Rotator cuff injuries range from minor sprains to massive tears that sometimes require an operation. If you have very little movement around the shoulder after a few days and a normal x-ray, the next step might be a trip to fracture clinic via an ultrasound scan.

The MIU advice ("return if not improving") was given for a reason!

The nurses at MI are unlikely to be able to give you a diagnosis, they are too generalised in their knowledge. Soft tissue injuries won't be visible on the x-ray either.

Go and see a physio either via your GP if the wait isn't too bad or pay to go privately if you can. I'm a physio and there's about a 6 week wait in my area which is too long to wait.

Go and see a pharmacist for alternative pain relieve - the codeine and paracetamol combination might work for you, we advise to avoid ibuprofen for the first few days after a soft issue injury. A collar and cuff may also not be the best treatment.

I'm just wanting the quickest route to getting some relief from pain and help! I can cope with normal painkillers during the day, but night time is proving very difficult.

I've just got over a nasty shoulder injury. Padding pillows around it, arranging my arm carefully within a he pile, and taking codeine at nighttime helped me get a bit of sleep.

"The nurses at MI are unlikely to be able to give you a diagnosis, they are too generalised in their knowledge"

Minor Injuries Unit nurses tend to be reasonably good at diagnosing minor injuries and, if they're struggling, should know where to refer. If I suspected a significant rotator cuff injury in A&E, I could arrange an ultrasound (by an MSK consultant), fracture clinic appointment, and initial physio consultation the following day during the week. The nurses working at our peripheral MIUs could do the same.

There would be a much longer wait to see a physio if this was arranged as an outpatient, e.g. through the patient's GP.

Thanks Johnhunter. I will go back to Mi tomorrow.