Why you should try and see a doctor the same day if you have a shoulder injury

A friend of mine recently came off his bike and “made a mess of his shoulder”. He was in intense pain and couldn’t raise his arm 90 degrees. He went to A&E where X-rays showed no damage had been done, but even after three months of physio he was still in pain and couldn’t lift his arm.

Fortunately, his doctor referred him to a special shoulder clinic where an ultrasound scan revealed yes, you’ve guessed it, a rotator cuff tear, which is a common and debilitating shoulder injury. But what is your rotator cuff?

Basically, it’s four ­important muscles that surround the back of your shoulder joint and attach to the top of your arm bone via tendons.

They’re critically involved in the stability and function of the shoulder.

A rotator cuff tear is when one or more of these tendons tears or detaches from the bone. These tears can vary in size and be short or long term. The tears themselves can also be partial or full thickness.

A direct or indirect shoulder injury from ­something like falling off a bike can result in an acute full thickness tear. This is a serious injury that means you should see a surgeon urgently. If you don’t, a rotator cuff tear becomes chronic and more difficult to treat.

But a survey of 104 patients aged 19 to 75 years has shown that 60 of them had some degree of cuff tear on ­ultrasound assessment within six weeks of injury, including 33 with a full thickness tear.

In a second survey of 259 patients aged 18-75, 60 had full thickness acute rotator cuff tears. And rotator cuff tear after shoulder dislocation is particularly common in older patients, with around 50% suffering this.

In a perfect world, this means such patients should be examined for cuff tears on the same day. And any patient with persistent symptoms two weeks after injury should have an ultrasound scan or MRI to look for a torn rotator cuff at a specialist shoulder clinic.

Because of the high frequency of rotator cuff tear after shoulder ­dislocation in patients aged over 40, they should have either urgent ­ultrasound scanning or MRI. These are both reliable tests for assessing full thickness tears, with an accuracy of 98% and 91% respectively.

So if you ever develop shoulder pain with an inability to raise your arm above 90 degrees after an accident, seek assessment and treatment the same day. Get referred to a specialist clinic for ultrasound or MRI scans.

And if you find you have a rotator cuff tear, ask to see a specialist surgeon to have it repaired. Don’t wait!