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Q. Can I try physiotherapy for my shoulder pain?

Answered by
Dr. Atul Prakash
and medically reviewed by iCliniq medical review team.
This is a premium question & answer published on Sep 06, 2017

Hello doctor,

After I fell from my bike, sometimes, I have a little pain in my shoulder. I feel my shoulder is loose. I got an MRI of the shoulder done, and I am attaching the reports. Can I try physiotherapy for the pain? Or do I need to get a surgery? Please help.

Dr. Atul Prakash

Fitness Expert Orthopedics And Traumatology Physiotherapy Spine Health
#

Hello,

Welcome to icliniq.com.

I have seen the attached report (attachment removed to protect patient identity). The MRI film is more helpful than a report on its own.

  • You reported a fall from the bike a few months ago, but you describe little as to what happened immediately after the injury. I need the following details:
  1. Did the shoulder dislocate? Did you have any x-rays?
  2. What was the period of rest? Was a sling needed?
  3. What was your range of movements then? How does it compare with movements now?
  4. Do you have pain at rest or with certain movements?
  5. What physiotherapy have you had? What was the physiotherapist's impression?
  • Going by the MRI report, which I must say is very ordinary, there is a tear in your rotator cuff, especially the supraspinatus muscle. But, there is no mention of the size of the tear, in addition, a slap tear is present, but I am not sure without seeing the films.
  • Please upload the films, and answer the above questions for me to help you better.

Revert with more information to a fitness expert online --> https://www.icliniq.com/ask-a-doctor-online/fitness-expert


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Thank you doctor,

I have attached the MRI film. Two months back, I fell from my bike, I met a doctor after a month, and took an MRI. I cannot lift my hand up or sideways, and I cannot lift it up to my face straight. If I try hard to raise my hand, it feels weak. I can lift my hand up and sideways with the help of someone else, and at that time, there is no pain. But when my hand is down, I have little pain. While sleeping at night, the pain starts after half an hour. I am using sling belt from a month and a half. I did some light physiotherapy exercise like lifting the arm up and down using a wall with first and second fingers.

Dr. Atul Prakash

Fitness Expert Orthopedics And Traumatology Physiotherapy Spine Health
#

Hello,

Welcome back to icliniq.com.

  • I have seen your MRI films (attachment removed to protect patient identity) myself, and I feel that you have a small articular surface tear of the supraspinatus tension and not a full thickness tear as reported.
  • The implication of this is that you need an arthroscopic assessment and if need be, debridement or repair of the tear of the shoulder if the pain and feeling of weakness do not settle in three months from injury.
  • You also need to send me the x-rays of your left shoulder to assess the cyst reported in the x-ray. If this is a fracture instead of a cyst, then we may have to reassess the situation.
  • Keep the arm in the sling and do pendulum exercises only. Avoid anti-gravity exercise of the arm that you move the arm in front of your body unprotected.

Revert with more information to a fitness expert online --> https://www.icliniq.com/ask-a-doctor-online/fitness-expert


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Hi doctor,

Thank you for replying. I have sent you the latest MRI scans, x-rays, and all the reports taken so far. I do not know how to upload the CD version of it. I do not have the latest x-ray, but if you want, I can get it done for the assessment of the cyst. Thank you.

Dr. Atul Prakash

Fitness Expert Orthopedics And Traumatology Physiotherapy Spine Health
#

Hello,

Welcome back to icliniq.com.

  • The new MRI (attachment removed to protect patient identity) showed a slight displacement of the bone at the site of the cyst. I will request you to arrange for an x-ray of the shoulder. Get a Grashey AP (anteroposterior) and Y view of the shoulder.
  • This is to see any displacement of the fragments. Ideally, the x-ray is the first investigation done before an MRI, as these small diagnostic dilemmas are more easy to address. Please update the x-ray. Thanks.

Revert with more information to a fitness expert online --> https://www.icliniq.com/ask-a-doctor-online/fitness-expert


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Hi doctor,

Thank you for the advice. I have taken the x-ray today, please find the attached files for investigation. The x-ray report will be received tomorrow.

Dr. Atul Prakash

Fitness Expert Orthopedics And Traumatology Physiotherapy Spine Health
#

Hi,

Welcome back to icliniq.com.

I have seen the attached x-ray (attachment removed to protect patient identity).

  • As I had suspected, there is a fracture of the greater tuberosity and that has been the source of your symptoms as the fracture has dislodged from its place, and I feel that you are better off having it fixed surgically.
  • What a shame that an MRI was asked before a plain x-ray, otherwise the fracture would have been picked up earlier and treatment would be to immobilize the shoulder and not have physiotherapy till the fracture heals.
  • Note that now the fracture is unlikely to heal as it is out of place.

For more information consult a fitness expert online --> https://www.icliniq.com/ask-a-doctor-online/fitness-expert


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Thank you doctor,

As per my understanding, I need surgical fixation, right? How long do I need to be in the hospital? What is the period of bed rest and belt post operation? Will the surgery be done with biodegradable elements? Please let me know which hospital is best. Can I get it operated by you?

Dr. Atul Prakash

Fitness Expert Orthopedics And Traumatology Physiotherapy Spine Health
#

Hello,

Welcome back to icliniq.com.

  • The fragment is small and may not hold a screw, I feel that a simple figure of eight with an orthocord around a distal screw should be enough for the repair of the rotator cuff.
  • You will need to keep your arm in a sling for three weeks till the fixation is sound. Pendulum exercise is allowed during this period. No active or overhead movements are allowed till six weeks.
  • At three months, start resistive and strengthening exercises with full strength.

For further queries consult a fitness expert online --> https://www.icliniq.com/ask-a-doctor-online/fitness-expert


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Hi doctor,

Thank you. Is it required to do an open fixation? Or can it be done arthroscopically? I am poor In medical terms, is the screw suggested by you available in biodegradable calcium? Can the fixation be done with biodegradable items?

Dr. Atul Prakash

Fitness Expert Orthopedics And Traumatology Physiotherapy Spine Health
#

Hello,

Welcome back to icliniq.com.

  • I think when you talk about biodegradable screws, it will require you to have a larger fragment, in your case, no such thing is needed. Only a small area needs freshening up and then the metal screw can be placed distally with a figure of eight suture in the rotator cuff.
  • You will need a diagnostic arthroscopy, this is to confirm the MRI findings followed by an open procedure with a small 5 cm incision.

For more information consult a fitness expert online --> https://www.icliniq.com/ask-a-doctor-online/fitness-expert


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Hi doctor,

Thank you so much. Can we remove the metallic screws from the body after the fracture is healed? Or these screws will be there permanently? Thank you.

Dr. Atul Prakash

Fitness Expert Orthopedics And Traumatology Physiotherapy Spine Health
#

Hi,

Welcome to icliniq.com.

  • The screws can be removed after the fracture has healed. It usually takes 4 to 6 months.

For further queries consult a fitness expert online --> https://www.icliniq.com/ask-a-doctor-online/fitness-expert


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Thank you doctor,

Can we confirm the healing status by an x-ray? To remove the screws, does it require open surgery or arthroscopy is enough? Thank you.

Dr. Atul Prakash

Fitness Expert Orthopedics And Traumatology Physiotherapy Spine Health
#

Hi,

Welcome back to icliniq.com.

  • The screw need not be removed as it should not cause problems, but if you do so wish the screw can be removed by a small open procedure.
  • More important than x-rays, clinical healing will be taken into account while progress will be monitored, an x-ray will show healing but the fragment is small. The lack of clinical symptoms and satisfactory progress at three months will be our guide to healing.

For further queries consult a fitness expert online --> https://www.icliniq.com/ask-a-doctor-online/fitness-expert


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