Shoulder pain after a fall
History
A 21 year old male presents with an acute fall of his shoulder on grass during running. He felt immediate pain and he could not move his arm. What can physiotherapy do to help?
Clinical examination
The patient could not move his arm by himself due to pain. In the passive movement examination, his arm was able to be lifted forward and sideway to shoulder height before being stopped by pain. His arm across his body was the most painful and restricted movement. His shoulder internal and external rotation range is good, only mild pain is reported at end of range. His left acromioclavicular (AC) joint was the most painful on palpation. No step deformity was seen, which is a good sign for a lower grade injury.
His mechanism of injury and clinical presentation indicate an AC joint sprain (mild to moderate).
Management
Acute AC joint injury management includes supported immobilisation to allow the sprained joint capsule and ligaments to have time to heal. He was given a sling to wear during the day and his shoulder was strapped. He had trigger point muscular pain in the surrounding area such as upper trapezius and deltoid muscles, which is a common problem because these muscles are trying to compensate for the injured AC joint. This patient responded well with dry needling which helped him to alleviate resting pain and muscular ache.
Over the next two to three weeks, this patient improved well and was able to gradually reduce the usage of sling without symptoms. His horizontal adduction movement range was still restricted compared to the other movement which is common after AC joint injury because this is a stressful position to the AC joint. This would gradually improve with treatment and exercises.
He was given rotator cuff strengthening exercises and scapular stability exercises as a progression at a later stage of his rehabilitation.
In six week post injury, he was able to return to gym and perform his normal workout routine without issues.
If you have any questions regarding your specific problem or are interested in seeing if we can help you, please give us a call at (02) 8411 2050. Here at Thornleigh Performance Physiotherapy, we can give you an accurate diagnosis and treatment, to help you get back in action as soon as possible. We are conveniently located near Beecroft, Cherrybrook, Hornsby, Normanhurst, Pennant Hills, Waitara, Wahroonga, Westleigh, West Pennant Hills, and West Pymble.