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Any experience with shoulder / rotator cuff injury from a fall?

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Any experience with shoulder / rotator cuff injury from a fall?

Old 08-26-14, 07:53 AM
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Gramercy
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Any experience with shoulder / rotator cuff injury from a fall?

I fell off my bike 5 weeks ago, hurting my shoulders and back. All X rays came back negative and everything healed but my left shoulder has still been sore. I saw an orthopedist today and declined X rays as I didn't think I needed them - he did an ultrasound on my shoulder and he showed me the inflamed areas. He said I should go to physical therapy twice a week for 6 weeks and then come back and if it's not better, to get an MRI. He said it could also be tendinitis; not sure if the fall could have caused that or not.

My shoulder hurts and he said not to sleep on it or to do pullups, pushups, etc which is fine. But 12 sessions of physical therapy? He said he couldn't tell if it was torn and he wouldn't be able to tell without an MRI. Then why have me wait 6 weeks for an MRI? I thought it seemed odd.

Anyway, has anyone done PT for a shoulder injury? Can I try the exercises at home without committing to going somewhere? Is it worth going to? Apparently you need a prescription for PT, which he gave me - but I think going 12 times seems excessive.
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Old 08-26-14, 08:08 AM
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So you go to an expert who went to college for 13 years (14 if he's fellowship trained) to become an orthopedic surgeon, he gives you advice and a treatment plan to help you get better, and you write off his advice and come to a message board full of a bunch of non-orthopedic surgeons to get a second opinion? You're not starting off on the right foot. If you want to get better, do what your doctor says. If you think your doctor is an idiot, find another doctor.
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Old 08-26-14, 08:18 AM
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Yes, I've tried to rehab a shoulder injury, and eventually had it 'scoped. The surgical outcome (after post-surgery PT) was only a tiny bit better than pre-surgery. Do everything you possibly can to not have surgery.

Do the PT. Waiting for an MRI makes sense, since it's pretty likely that whatever they find with the MRI, the first pass at treatment is the same PT anyway - gradually and conservatively strengthening the muscles that support your shoulder joint. And it's already been 5 weeks, anything that would have mattered to treat immediately, it's already too late.

If the PT is too expensive or too hard to get to, you could do a few sessions and then built on it yourself, but the therapists actually know stuff, and use exam findings to fine-tune your program so you progress with exercises that are appropriate for your condition. 6 weeks/12 sessions is not too much - it takes time for that stuff to work, and you have to do your homework if you are assigned any. And don't haff-ass it either, if you are supposed to do something twice a day, do it twice a day.

But, why are you asking on the internet when you have a doctor? The doc knows better than any of us, even if he's telling you something that you don't want to hear. Get your questions answered directly. Call his office, and ask your questions to him or his nurse, who can relay questions/answers.

Good luck with your recovery - shoulders are super complicated and hard to rehab. IF you do the PT work, though, you will be a lot better off.
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Old 08-26-14, 09:25 AM
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I self-diagnosed my shoulder injury after a hard fall. I went on the internet and developed a PT plan for recovery. No MRI, no X-rays, who needs all that?
Oh yeah, I also talked to a bunch of my buddies that had shoulder injuries and got their advice.
Now, more than one year later, I still suffer significant pain and weakness in my shoulder.

You wento to an Orthopedist and have a treatment plan beginning with PT. Follow it.
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Old 08-26-14, 09:34 AM
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Originally Posted by redcon1 View Post
I self-diagnosed my shoulder injury after a hard fall. I went on the internet and developed a PT plan for recovery. No MRI, no X-rays, who needs all that?
Oh yeah, I also talked to a bunch of my buddies that had shoulder injuries and got their advice.
Now, more than one year later, I still suffer significant pain and weakness in my shoulder.

You wento to an Orthopedist and have a treatment plan beginning with PT. Follow it.
Yikes. Only temp though right?
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Old 08-26-14, 09:40 AM
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"Anyway, has anyone done PT for a shoulder injury? Can I try the exercises at home without committing to going somewhere? Is it worth going to? Apparently you need a prescription for PT, which he gave me - but I think going 12 times seems excessive."

Can you try the exercises at home? Yes - you will have to. The PT is just the two times a week you will go to see the physical therapist. They will find your current range of motion, strength etc and set a baseline. They will likely also give you exercises to do on the days you are not with them. As your strength and range of motion gets better they will up your workload. In six weeks they will have a great idea where you are at.

Can you do this stuff on your own? Sure, but you will lose those other benefits. If I were you I would spend an hour or two on the phone finding out exactly how much your insurance covers and what you will end up spending. If you can afford it - do it. If you can't - go for as much as you can afford.
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Old 08-26-14, 09:42 AM
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I crashed in September of '09 and hit my right shoulder hard. I did several months of PT and developed lot of muscle that took away most of the soreness. A year later I had a Orthopedist look at it thinking there may be some minor clean up work to be done. The doc had me rotate my arm in various directions and did pull ups off my arm and declared I didn't have a rotator cuff tear but sent me off for an MRI. To his shock I had a terrible rotator cuff tear which was disguised due to muscles I had built with PT. When I woke from surgery the doc was apologizing for doing the surgery as he thought it wouldn't heal. It was the worse tear he has seen and this is his primary practice. The tendon had pulled back two inches because I had waited a year to get the surgery. It healed. I'm lucky. I'm also very careful. Get an MRI and find out how bad of a problem, if any, you have. If you need surgery the sooner the better. I almost waited too long.
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Old 08-26-14, 09:52 AM
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Listen to your PT people.

They are not out to steal your partner or your car. They are trying to help you and actually know ****. Ask them what you can do at home and they will tell you.

Do that.
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Old 08-26-14, 10:03 AM
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I just wish they did the MRI today, but apparently they're a few thousand bucks. I'll have to find out if my insurance can cover the whole thing. I was surprised to hear the PT is 35 bucks each time. $420 for PT seems like a lot - hopefully I can go a few times and finish on my own.
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Old 08-26-14, 10:05 AM
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Although my injury was different, my doc gave a similar diagnosis & plan of action. I looked at him & asked "Based on your experience, are the chances high that after PT, I'm going to be back here with the same issue & getting the MRI? If so, lets skip that part & get the MRI now". I got the MRI. It showed a torn rotator cuff tendon. Had surgery (where he severed damaged tendon & reattached it) - then post-surgery PT.

My shoulder is now fine but do not underestimate the amount of lost biking time, hours spent in PT (both with physical therapist & at home) & high levels of pain.
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Old 08-26-14, 10:10 AM
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I'm with the others - listen to your doctor and stop trying to second-guess him/her so much. It is customary, especially when a client expresses sensitivity to costs, to take a progressive approach to an injury like this: If the x-rays and symptoms don't indicate something requiring immediate intervention, first, try PT and anti-inflammatory drugs to see if you can get the condition to improve, then escalate to more diagnostic tools like an MRI, and finally start going to things like injections and even surgery. Yes, you can do the PT on your own and at home, but you'll likely get better results going to a professional, especially at the beginning as they'll show you the right techniques and have specialized equipment. Once you know what you're after, it is easy to replicate on your own. 12 sessions sounds about right initially. And MRI's are wonderful diagnostic tools - if you really want to get to the bottom of soft-tissue injuries, it is the weapon of choice.

Shoulders are finicky. I fell hard on my right side four years ago (classic low-side cornering on wet leaves) and it seemed to heal and be Okay for a couple months, then I developed a bad cause of "frozen shoulder" on my left side, probably related to favoring the right. It took 9-months of working with this with my doctor before it slowly went away. Two years ago, I crashed on a motorcycle and broke my right collarbone. I had it plated and it healed fine, but nine-months after the injury I started experiencing shoulder pain, especially sleeping at night or with any period of inactivity. I managed the pain for nearly a year, treating it with drugs, PT, x-rays, injections, and finally shoulder AND neck MRIs that indicated the problem was actually nerve impingement in my neck even though my pain was in the shoulder. I was about to get a neck injection when things slowly started getting better and over the course of a couple months of intensive PT, the pain went away all-together. My takeaway is that you need to be very patient with these things. That being said, if the pain is bad, getting the MRI right away makes a lot of sense.... I would if it is covered by insurance. I recall my MRIs were more on the order of $800 each, but I could be wrong. This is something you CAN "shop around" for.

- Mark

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Old 08-26-14, 11:31 AM
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Originally Posted by isuckatbiking View Post
Yikes. Only temp though right?
Well after 13 months I'm starting to think not. I am going to take the advice of bowzette and get an Ortho referral. What I thought was a separation must be more, possibly a RC tear.
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Old 08-26-14, 01:14 PM
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I hurt my shoulder in my Aug 2009 crash. I could do a lot of stuff, push ups, curls, etc. I could even ride, if I could pedal, but pulling up hurt a bit. I couldn't put anything on a shelf over about shoulder height though. Ends up one of the four rotator cuffs was badly injured. The other three were fine but since they operate in different planes the injured cuff only showed up in specific situations. It wasn't until about Feb/Mar before it was healed, meaning I didn't have pain in general. It was Mar/Apr before I didn't have pain during most efforts on the bike, and another month or two before I realized I hadn't felt pain in a while.

I did PT. When I first went there I saw a weight stack thing that started at 2 lbs and I thought that was ridiculous. It was so ridiculous I couldn't lift it with my bad arm and in fact I started with zero pounds (no weights) and I was struggling mightily, I think I did 2 reps and the PT person (a cyclist, ironically) stopped me. At the end of the PT I wasn't much better, I don't remember but it was maybe 6 lbs. I'm used to doing similar exercises with 60-90 lbs (using two arms). They did a bunch of other things that helped, gave me exercises that I did diligently, etc. I could see progress from week to week.

I spent about $8k out of pocket on my recovery from my crash. I didn't take any short cuts because, frankly, I don't know about medical/physiological stuff. It's a worthwhile investment, to recover properly from an injury. I don't know if you get to work with anyone that complains about a bum knee or whatever but it's not a great way to go through life if you have an option to avoid it.
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Old 08-26-14, 01:27 PM
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Originally Posted by Gramercy View Post
My shoulder hurts and he said not to sleep on it or to do pullups, pushups, etc which is fine. But 12 sessions of physical therapy? He said he couldn't tell if it was torn and he wouldn't be able to tell without an MRI. Then why have me wait 6 weeks for an MRI? I thought it seemed odd.

Anyway, has anyone done PT for a shoulder injury? Can I try the exercises at home without committing to going somewhere? Is it worth going to? Apparently you need a prescription for PT, which he gave me - but I think going 12 times seems excessive.
Go to the PT!! 12 times is not excessive.

I've damaged my left shoulder twice ... started going to PT but moved halfway through the sessions and didn't pick them up again. I'm still struggling with that shoulder years later.
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Old 08-26-14, 01:32 PM
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Originally Posted by slowgo View Post
So you go to an expert who went to college for 13 years (14 if he's fellowship trained) to become an orthopedic surgeon, he gives you advice and a treatment plan to help you get better, and you write off his advice and come to a message board full of a bunch of non-orthopedic surgeons to get a second opinion? You're not starting off on the right foot. If you want to get better, do what your doctor says. If you think your doctor is an idiot, find another doctor.
+1. Got to wonder if he's worried about the cost. If so, he should see what an MRI costs. If he does have insurance, it may not cover an MRI unless PT is tried first. Also, PT sessions may include things like a cold "cuff" and manipulation by the therapist. I had those when I fractured my collar bone in a bad crash.
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Old 08-26-14, 01:39 PM
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Originally Posted by Gramercy View Post
I just wish they did the MRI today, but apparently they're a few thousand bucks. I'll have to find out if my insurance can cover the whole thing. I was surprised to hear the PT is 35 bucks each time. $420 for PT seems like a lot - hopefully I can go a few times and finish on my own.
It likely will not cover the entire cost. Moreover, your insurance carrier may not authorize it unless you first do PT. Such restrictions are not uncommon and are desined to prevent the overuse of MRI scans.

As I pointed out in my other response, PT usually involves more than simply exercises. When I fractured my collar bone, my therapists performed manipulations designed to increase range of motion. I also had a special cold "cuff" put around my shoulder at the end of each session. Much more elaborate than a bag of frozen peas. And you will not be shown every potentially helpful excerise the first session so if you want to get the full effect, suck it up and go.
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Old 08-26-14, 02:05 PM
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I crashed my MTB last October. X-Ray showed my left shoulder blade was fractured. MRI showed no rotator cuff damage. Arm was in a sling for a couple months. To this day its still stiff. When lift my arm above my head...it still feels stiff. I feel some pain when lifting heavy items.

Shoulder injuries suck.
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Old 08-26-14, 03:20 PM
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Originally Posted by Gramercy View Post
I fell off my bike 5 weeks ago, hurting my shoulders and back. All X rays came back negative and everything healed but my left shoulder has still been sore. I saw an orthopedist today and declined X rays as I didn't think I needed them - he did an ultrasound on my shoulder and he showed me the inflamed areas. He said I should go to physical therapy twice a week for 6 weeks and then come back and if it's not better, to get an MRI. He said it could also be tendinitis; not sure if the fall could have caused that or not.

My shoulder hurts and he said not to sleep on it or to do pullups, pushups, etc which is fine. But 12 sessions of physical therapy? He said he couldn't tell if it was torn and he wouldn't be able to tell without an MRI. Then why have me wait 6 weeks for an MRI? I thought it seemed odd.

Anyway, has anyone done PT for a shoulder injury? Can I try the exercises at home without committing to going somewhere? Is it worth going to? Apparently you need a prescription for PT, which he gave me - but I think going 12 times seems excessive.
Do the PT. I had a fall and landed on my right hand last July but the problems didn't show up in the shoulder for some time. The X Ray showed a shoulder impingement caused by trauma, and the only trauma was the crash. I did PT 2x a week for 6 weeks and regained most of my range of motion, pain went away etc. The only problem the injury caused me with riding was not being able to reach the right rear jersey pocket of a race cut jersey.

Good Luck!
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Old 08-26-14, 03:34 PM
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i didn't read all the posts...

about a year and a half ago i took a fall and permanently dislocated my left clavicle at the breastbone. there was co-lateral damage to the shoulder too. there is still some occasional pain, but i was back on the bike within two weeks, no PT, just one x-ray and a few consultations with orthopedic surgeons as regards surgery. their responses were pretty much "live with it".

about nine months later i fell on my other shoulder and permanently dislocated my clavicle at the shoulder (aka separated shoulder). this time i didn't go anywhere or talk to anyone. just ibuprofen. was back on the bike in two and half weeks. still hurts now and then. probably a little more trauma to the rotator cuff than the first fall. both are a bit unsightly, but i don't habitually take my shirt off in public anyway, so's not a problem.

i ride about 10,000 miles a year and remarkably, can still do pushups, even though there is really no skeletal connection between my arms and the rest of my body!

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Old 08-26-14, 06:08 PM
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Originally Posted by Gramercy View Post
Anyway, has anyone done PT for a shoulder injury? Can I try the exercises at home without committing to going somewhere? Is it worth going to? Apparently you need a prescription for PT, which he gave me - but I think going 12 times seems excessive.
There are a variety of exercises on Youtube and elsewhere that are worth trying, many are surprisingly difficult if you have a shoulder injury...like walking your fingers up a wall. Regardless, I think you are looking at many months of work. I rehab-ed my rotator cuff tear, took more than a year and what finally open things up was taking boxing lessons and working the bag.

In other words, not easy, not fast, not foolproof. PT is the smart bet.
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Old 08-26-14, 06:11 PM
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Originally Posted by Gramercy View Post
I just wish they did the MRI today, but apparently they're a few thousand bucks. I'll have to find out if my insurance can cover the whole thing. I was surprised to hear the PT is 35 bucks each time. $420 for PT seems like a lot - hopefully I can go a few times and finish on my own.
Cheap as!! Lucky you.

My PT usually runs $50+.
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Old 08-26-14, 06:29 PM
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Originally Posted by Machka View Post
Go to the PT!! 12 times is not excessive.

I've damaged my left shoulder twice ... started going to PT but moved halfway through the sessions and didn't pick them up again. I'm still struggling with that shoulder years later.
Further to this ...

My first injury was tearing my rotator cuff while getting dressed one morning ... halfway into a tight sweater there was a loud POP and blinding pain. I ignored it because I figured there was no way I could have possibly hurt myself getting dressed. 2 weeks later I couldn't use my left arm anymore. I continued to ignore it until a week later I ended up in hospital with severe chest pain and a completely numb left arm.

I had torn my rotator cuff, it wasn't healing properly, and the surrounding muscles supporting it had suddenly cramped. Off I went to PT, and that time I went through the whole process and the shoulder and arm felt much better.

Several years later, I was coming down a very steep, slick hill with a 4-way stop at the bottom, cars pulled up at the stop, so instead of flying throught the intersection, I hit the brakes. Bad move. Concussion, brusing from hips to toes, sprained wrist ... and a separated shoulder. My whole left arm felt loose and floppy. Again, it took me a couple weeks to go to the Dr, but when I did, he did a number of tests. We discovered that I can raise and lower the arm just fine in front of me, but not off to the side. I was sent for PT and put on the MRI waiting list. A few weeks later, the MRI confirmed the separation ... and the suggestion was that I continue PT. I did for another couple weeks, but then moved before healing could fully take place.

Years later I still have difficulty raising my arm out to the side, and the shoulder partially dislocates now and then. It still hurts to move the shoulder, especially when it is partially dislocated (like ... right now, for example). It also gives me pain when I'm trying to sleep ... and lying on that side often causes it to dislocate. Now I regret not continuing with PT.
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Old 08-27-14, 06:13 PM
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Good god. Listen to a professional.

I've had multiple shoulder dislocations from contact sports. It is fixable if you have the right care plan, and you follow it religiously. Anyone who tries to self diagnose on YouTube is a moron.

Do the MRI even if you have to pay for it. You may need surgery, which sucks beyond belief, but you won't spend the rest of your life not able to reach for your coffee.

I had the surgey, and take 20 minutes when I wake up doing exercises to make sure it doesn't happen again.

The choice between that and a Colnago c59? Easy.

My USE .002
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Old 08-28-14, 07:46 AM
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Separated my left shoulder twice in bike related accidents. The first time I went the full xray route, was told to wear a sling for a month or two, etc. Wore the sling for a day, couldn't stand it. Basically stayed off the bike for any long rides(still did my short commute ride)for about a month. Shoulder definitely hurt bad for a month(couldn't wash hair all that well, hard putting on a T shirt)but the shoulder eventually heals on its' own and was nearly 100%. Second time, no xrays. I knew how the sequence was going to go. The separation was not as bad the 2nd time so less healing time. That was 4 years ago. I have no residual pain, though push ups are not an option.
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Old 08-28-14, 08:26 AM
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That is an impossible question for anybody to answer. I tore my labrum in my right shoulder. Insurance requires you to go to PT first. It did nothing for me. Then I went and had 3 injections, which also did nothing. Eventually, I had surgery to repair the labrum. The PT's were awesome for after surgery work though. I did everything that they asked everyday. Do your PT.
On a side note, I did return to running and did not realize that I was protecting my shoulder so much when I ran. This created an imbalance elsewhere in my body which has wreaked back pain upon me. You really do not realize how much your body protects things when they are injured. Do your PT and pay attention as it will impact you down the road if you do not.
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