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