Rotator Cuff Tear (Supraspinatus Muscle) - Private Physiotherapy Sessions (Session 1 Initial Consultation)

As NHS waiting lists are known for being notoriously lengthy I decided to book into a private physiotherapy session in order to take a look at my left shoulder pain which is a suspected tear in the supraspinatus muscle.

SESSION 1 - INITIAL CONSULTATION

I had visited this physiotherapist (Debbie) previously as I was experiencing tightness in my neck and right shoulder and she gave me a sports massage which had been helpful. One of the things I liked about Debbie in particular is that no matter how many questions I bombarded her with she seemed very knowledgeable and was able and willing to answer them all.

Upon meeting with her I explained how I  injured my shoulder and also the current problem I was having i.e  pain in the top end of the range of movement as I lifted my arm directly up in the air above my head.  Unlike the NHS fracture doctor Debbie did not seem dismissive because I had a good range of movement and acknowledged that I was still having pain  which to me is a BIG problem.

One thing that did cause a bit of concern is that Debbie asked for the exact location of the tear and how big it was following the ultrasound results.  I told her that the woman at the fracture clinic that was supposed to give me my ultrasound results could offer no other information other than my shoulder was injured and she thought that it was a tear in the supraspinatus. When I questioned the woman at the fracture clinic she told me that she could not tell how big the tear was as all she had seen on the notes from the ultrasound technician is that there was a tear and it did not provide any other information .  Debbie was perplexed by this but not surprised but stated it was very important to know for any physiotherapist that treats me. All she hoped is that the NHS physiotherapist gets more detailed information than the fracture clinic doctor.

She continued her examination of me using various tests involving the movement of my arm in different positions and hearing my feedback on where I was experiencing pain.  Interestingly upon completion of her tests she said that there are actually two issues , Not just the one that the NHS has identified .

 1.  Pectoral strain -  I had expressed from day one that I had had pain across my collarbone and this was dismissed by the NHS however the private physio believes that when I injured my shoulder I also experienced ligament strain at the point where the pectoral muscle attaches to the chest.

 2. Supraspinatus tear -  she can see from the problems that I'm having that I do have a tear somewhere in the supraspinatous however without the ultrasound she could not tell if it is from the tendon or muscle itself .

Another observation she made is that all of the muscles around my left neck and shoulder were extremely tight,  which is probably a protective measure following injury so she also wanted to work on alleviating this issue aswell.

TREATMENT

In my hour long session the physio performed the following :

Acupuncture -  to increase bloodflow to this shoulder area
Sports massage -  to work on the tightness in the shoulder
Infrared device -  as above

Towards the end of the  session we went through a number of exercises to help the shoulder area and stretch the left pectoral muscle.  I was given a therapy band and had to perform several exercises using resistance in several directions.  As my main pain and weakness is it the top of the range i.e with my arms straight up in the air I was told to only exercise up to shoulder level with the band.  The non-band exercises I was given involved place my arm on the door frame and twisting away from my arm to provide a stretch in the pictorial muscle.

I was told to try the exercises for 10 days but always stop when I experienced pain. Interestingly the fracture clinic doctor had told me to 'push through a little bit'. Once the 10 days was over I should return for follow-up appointment and give my feedback.  The cost of this private physiotherapy session was £45 and the follow up will be £37.

SESSION 2 - FOLLOW UP

Click here for details of my follow up session

Shoulder and collar bone pain - Rotator cuff tear investigation and treatment NHS (Part 2)

Physiotherapy Appointment Arrangement Letter (17th November)

A letter arrived to book an appointment, so I called the number shown. I received the inevitable voicemail and left my details. I received a call back by a very rude sounding woman who barked that they only had one appointment available and it was 12th December. Having been to the physio a few times I asked who it was with and I was told it was a 'new physio'. I hate to be cynical but I fear I'm going to be stuck with a young inexperienced 'deer in the headlights' type character again who panics whenever I ask a question.

Private Physiotherapy Appointments

Given the important function of my shoulder and the ineptness I have experienced on the NHS so many times I decided to take the matter into my own hands and book a private physiotherapy session in addition  to whatever the NHS decide to do. Click here to read about these private sessions.

NHS Physiotherapy Appointment (12th December)

After a short wait in some form filling got to meet my new NHS physio who was called it Tanvir.   Having previously been told that my physio was new I had imagined an inexperienced and  therefore and unhelpful individual.  However Tanvir would prove to be quite the opposite.

 He asked what the issues were and where things were today so I gave him a full rundown of everything that had happened.  Although I didn't hold out much hope I asked him if he could tell me whether or not the tail was serious or not from any information provided from Ultrasound report.  I expected the same result that I had at the fracture clinic where he would turn round and say that there wasn't any information provided by the ultrasound person as to where the table was exactly for it severity however I was really blown away by him telling me that he had already looked at the ultrasound before I had arrived and he could tell me exactly what the issue was.  He then asked me to wait while he got a model of a shoulder for him to show me in more detail.  He returned and gave me a full rundown of the problem in which he showed me that the actual tendon which attaches to my arm had been torn.  The size of the tail on the ultrasound indicated that it was what he would call and medium tear.

 I explained that my private physio has said that there was an issue with the pictorial muscle and that's why I was getting paid over my collarbone but he dismissed this as a possibility and insisted that it was referred pain from my initial injury.

 He explained that as a raw they normally wait 12 weeks for any healing to take place before they start strengthening exercises.  Thankfully for me it had been 12 weeks so we could get started with the rehabilitation.

 I showed him the exercises the private physio have given me and he said that those were okay but he wanted me to do some additional ones.  Some using my own hand as resistance, some with a weight, and some with a Thera band.

Overall he seems knowledgeable, really Enthusiastic  and taught me a lot about the injury. He was also a big guy  Who obviously worked out a lot so he was into strength and conditioning which helped him understand that I was keen to get back to the gym. 

I was with him for about 45 mins which I was very surprised at given my previous experience with the NHS, he also asked if I had any questions and then genuinely and completely answered them. Since that appointment I have tried to do the exercises every day so I'm hoping for some improvement.

MRI appointment (15th Dec)

Details to follow

NHS Physiotherapy Appointment Follow Up (3rd Jan)

Details to follow

Shoulder and collar bone pain - Rotator cuff tear investigation and treatment NHS (Part 1)

Shoulder injury

On September 14 of this year (2016) I was in the garden trying to remove a large hedge. I had sawed through the main stump and and as I had a hoe close to hand I put the stump (part that as not in the ground) through the middle of it and began pulling. This was to pull it free from the fence which it had partially grown through.

The hedge had started to move  backwards and forwards as i'd hoped but the hoe slipped free and violently jarred shoulder.  Immediately it happened I felt something go in my shoulder but it didn't give me a huge amount of initial pain especially since I had been to the gym before. I had been working on my shoulders in the gym and they were already very sore so the pain of the injury must have blended into it.

It didn't really bother me that night but when I woke up in the morning I had a pain all the way across my left shoulder and across my collarbone.  Again I thought it was just because I have been in the gym or maybe is just muscle pain caused from the work that I carried out in the garden as it was quite strenuous.  As I got out of bed the pain was excruciating as if the weight of my arm and gravity was causing more of an issue, it was at this stage that I thought that I have actually broken my collarbone and the fact I was standing up was putting more downward pressure on it.  As I moved around a bit more, the pain started to ease and by the end of the day it felt a bit more comfortable  but was still painful .

Trying to see my local doctor always takes at least a week to get an appointment so I just wanted to see how if it would recover naturally before I had to go and see anyone.  Three weeks passed and I was still having some pain so I decided rather than going in seeing a GP which would take more time I would go to Accident & Emergency (A & E) and see if they would be able to get me an X-ray.

Accident & Emergency (A & E)

I went down to A & E at 11 AM and  booked myself in at the reception with a suspected broken collarbone .  I had to wait until 3 PM before I was seen which was a total of five waiting hours .  This is a very long time but whilst I was there I saw a lot of people that required medical attention a lot more than I did including one young lad who ended up putting one of his teeth into a small vile that the nurse brought him !!.  When I was finally seen I went straight to a doctor who conducted a short examination on me .  She said that I may possibly have a torn rotator cuff and she wanted me to have an x-ray .  I went down to have an X-ray and returned and waited for the outcome.  After a relatively short period of time the doctor reviewed the X-ray and said that it appeared normal however she wanted to refer me to the fracture clinic the next day as a matter of urgency to look at the possibility of having a torn rotator cuff, which is something that would not show up on the x-ray .

 Fracture clinic

I attended the fracture clinic and saw a doctor who did a more thorough examination on my shoulder. This involved doing some mobility tests i.e. lifting my arm up to the front and side and saying when I had pain.  I also gave him a run down of all of my symptoms and also how the injury had occurred. He also believed that issue may be a tear in the rotator cuff so he wanted to get me booked in urgently for an ultrasound scan.  He asked me to book an appointment for two weeks and said that he would arrange for an ultrasound scan appointment to be arranged as a matter of urgency see and confirmation would be sent to me in the post.

 Ultrasound appointment  arrangement

 A week had passed and I had not heard from the ultra sound department so I called them up to find out when my appointment will be and also to let them know that I have been booked in with a doctor the following week to review the scan results.  When I did this I was informed by the ultrasound department that and urgent ultrasound on the NHS has a waiting time of at least six weeks so the appointment that had been made for me to re-attend the fracture clinic to go over the results of the ultrasound scan should never have been made.  I've booked an appointment for my ultrasound on 5 November and then called the fracture clinic to cancel my initial appointment and then rearrange it for 8 November.

Ultrasound scan (5th November)

Shoulder Ultrasound

I attended my ultrasound appointment and after a 30 minute wait I was lead into the room where the doctor asked me questions about the injury and then asked me to point out where I was having the pain and what symptoms were. Having had private health care for quite a few years I was actually quite surprised at how thorough the NHS doctor was as he monitored my shoulder and manipulated my arm to try and get the best angles for the scans.  He completed my scan and then said that I could put my T-shirt back on and carried on taking notes.  The nurse then passed me some paper to wipe away the gel that was still on my arm from the scan and it was at that point that I thought I would ask the person that carried out the scan whether he had seen anything as I didn't feel that he was going to offer this  information.  It was at this stage that he confirmed that he had seen a tear in my rotator cuff specifically the muscle (Supraspinatus) that runs across the back of the shoulder that links onto the front.  This muscle is responsible for the raising of the arm above shoulder height and this is where I have had the pain previously so everything made sense.  Although this is quite serious news I did feel a slight sense of relief that something had been seen in the scan especially since I have so many mysterious illnesses in the past they have just been investigated with no conclusion.

Fracture clinic-ultrasound scan results (8th November)

After waiting 45 mins I was shown into a room/cubicle and asked to take a seat. A few minutes later a young slightly flustered looking woman appeared and told me asked how my shoulder was. I told her that it was still painful much like how it had been at my last visit. She then informed me that the ultrasound results were back and wait for it.............."I had injured my shoulder". I looked at her slightly perplexed as that part was pretty obvious at this point !!!. Thankfully I had asked the Ultrasound guy a few questions about the tear so I could then ask the woman now some further questions which unfortunately she seemed unwilling/unable to fully answer.

At a point in the conversation she asked me to wait and disappeared out of the room. I then heard her discussing my case with two men who said "Range of movement" Her response "Fairly good" to which he said "Yeh just send him to physio". She then returned to give me the news.

I asked further questions regarding how bad the tear was, how big it was, will it totally heal, should i do anything special before physio, should i protect the shoulder in any way and she was unable to offer anything other than "Just use it as normal".

This is a typical encounter I have experienced on the NHS not only do they provide little information to the patient but they also make them feel really uncomfortable by acting like they need to wrap things up with you instantly because they need to run off and do something more important. I know they are busy but nobody likes to feel worthless in a situation especially when they are injured/sick.

To read more - Continue to part 2