Shoulder soft tissue injury – Royal Sussex County Hospital and Princess Royal Hospital

What is this information about?

This information is about a shoulder soft tissue injury.

It tells you:

• How to look after yourself when you go home from hospital with a shoulder soft tissue injury
• What exercises you can do to help heal and strengthen your arm
• What follow-up treatment you might have
• Who to contact if you need further help and support.

What is a shoulder soft tissue injury?

If you have a ‘shoulder soft tissue injury’ this means that you have sprained some of the structures around your shoulder. These include ligaments (the tough tissue that connects your bones together), muscles, tendons, or the capsule that surrounds the joint. The capsule is a dense connective tissue that surrounds the shoulder joint like a sleeve.

How long is it likely to take for my injury to heal?

It usually takes about 6 weeks to heal. However, you might feel some light aching on heavy or repetitive overhead activities for up to 3 months. Use the sling for the first week and follow the advice in this information to allow the soft tissues to settle.

Will smoking or vaping slow down my healing?

Yes. Smoking slows healing so if you smoke or vape try to stop or cut down. This is most important in the first 2 weeks after your injury. If you would like help to stop smoking talk to your GP or visit Quit smoking for further information.

What should I do if I am in pain after my shoulder soft tissue injury?

If you are in pain, take your usual pain killers or pain killers given to you in the emergency department. Follow the dose instructions on the packet. If you are struggling with pain do speak to your GP or pharmacist.

Put ice or a cold pack over the painful area for short term pain relief.

Will I be fitted with an arm sling?

You may or may not be fitted with an arm sling. If you were fitted with a sling it was done to manage your shoulder symptoms and to help the soft tissue structures around the shoulder begin to heal.

When should I be wearing my arm sling?

Your sling should be worn for comfort only. Take it off to wash, dress, and do the exercises listed below. It does not need to be worn at night. Try to come out of the sling as soon as possible.

What should I do if I am struggling with my sling?

When should I start exercising?

It is important to start gentle exercises straight away to prevent stiffness. You can return to activity when you feel ready. Start with light tasks and be guided by your pain.

Will I have a further (follow up) appointment?

No. We do not usually follow up patients with this type of injury.

Please contact the Virtual Fracture clinic for further advice if you:

• are unable to follow this rehabilitation plan or notice pain other than at your shoulder
• have ongoing issues with pain in your shoulder
• are struggling to regain full range of movement in your shoulder 6 weeks after injury.

What should I do during week 1 after my injury?

• If you were given a sling, use it for comfort only. Take it off to wash, dress and do the exercises listed below.
• Rest your arm for the first 24 to 72 hours (1 to 3 days). However, it is important to keep moving around and start the exercises below.
• Move your fingers, wrist and elbow whilst wearing the sling so they do not get stiff. Do this gently, without causing too much pain.
• Apply cold packs (ice pack or frozen peas wrapped in a damp towel) to the sore area for up to 15 minutes, every few hours. This can provide short-term pain relief. Be aware, the ice must never be in direct contact with the skin.
• Aim to practice all the exercises which are shown below, 5 times a day. These exercises should not cause too much pain.

Hand, wrist and elbow exercises

Finger and wrist bending and straightening

Open and close your hand as shown 10 times. Then move your wrist up and down 10 times.

After a few days, hold a soft ball or a ball of socks. Squeeze the ball as hard as possible without pain. Hold for 5 seconds and repeat 10 times.

Elbow bend to straighten

Bend and straighten your elbow as far as you can without pain. You should not feel more than a mild to moderate stretch. You can use your other arm to help if you need to. Repeat 10 times if there is no increase in pain.

Forearm rotations

Keep your elbow at your side and bent to 90 degrees (a right angle). Slowly turn your palm up and down. You should not feel more than a mild to moderate stretch. You can use your other arm to help if you need to. Repeat 10 times if there is no increase in pain.

Posture exercise

Bring your shoulders back and gently squeeze your shoulder blades together. Hold for 30 seconds. Repeat 5 times.

Shoulder pendulum (swing) exercises

Stand next to a firm surface. Support yourself with your un-injured arm and lean forwards. Let your injured arm relax and hang down to the ground.

Gently swing your arm, making a small movement. Try to do this forward and backward, side to side and in small circles.

Aim to do this for 1 to 2 minutes in total.

Swing your arm gently so is does not cause you too much discomfort. Remember to keep your arm relaxed.

What should I do from week 2 after my injury?

• You should have stopped using your sling.
• Start using your arm more for light activities. Start with gentle movements and be guided by pain or discomfort. Movements above shoulder height are still likely to cause some discomfort.
• Start the exercises as described below. Aim to do them 5 times a day. Repeat each exercise 10 times. These exercises should not cause too much pain. Do fewer if they are making your pain worse.
• You can move through the exercises as soon as you feel ready.

Exercises

Supported arm raising (arm elevation)

Use your other hand to lift your injured arm up in front of you, as shown in these pictures.

Supported arm rotation

With your elbow touching the side of your body, bend your injured arm as shown below.

Hold onto a stick, umbrella, or something similar. Then use your good arm to gently move your forearm outwards away from your body. If you don’t have a stick, hold your injured arm at the wrist and guide it outwards with your other hand. As you do this, keep your elbow bent and tucked into your side.

Arm elevation

Lift your arm forwards in front of you. Try to raise the arm as high as you can. This exercise may cause some discomfort. You do not need to raise your arm so high or for so long that it causes too much pain. If this is too difficult, try the same movement with a bent elbow.

Raising your arm out to the side

With your palm facing forwards, move your arm out to the side in a big arc. Try to raise your arm as high as you can. If this is too difficult, try the same movement with a bent elbow. You do not need to raise your arm so high or for so long that it causes too much pain.

Arm rotation

Start with your elbow bent by your side. Move your forearm out to the side, keeping your elbow bent and near your waist.

What other things can the Virtual Fracture Clinic help me with?

Please contact the Virtual Fracture Clinic if you:

• are concerned about your symptoms
• are unable to follow this rehabilitation plan or notice pain other than at your shoulder
• are struggling with your sling
• are struggling to return to exercise or your usual activities
• would like further information or support after you have read this information.

When can I start driving?

You can return to driving when you:

• are no longer using your arm sling
• can turn the steering wheel as much as you need to without it hurting
• can safely deal with all emergency situations without being in pain or hesitating. For example, you must be able to stop the car quickly and in full control and safely avoid obstacles
• are covered by your insurance company.

How can I get a fit note for work?

You can get a fit note from the Virtual Fracture Clinic team.

If I need further advice about my injury, who can I contact?

If contacting by phone, please leave a message with your date of birth, name and clear contact details, along with a brief message about what problems you are having.

We will contact you back as soon as possible.

We aim to get back to you within 24 hours.

Contacting us by email would be preferable as the phone line can be very busy.