/ Shoulder injury, going private?

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Phill Mitch - on 18 Apr 2012
I have an ongoing shoulder injury, did it in the autumn and it got worse as the winter went on. I haven't climbed now since mid Jan and I am getting very tired of it. I have seen a physio who says it is my bicep tendon. Now, I am sure my doctor wants to go with steroid injections, which to me is not an option.
I am thinking I would like it scaned to see exactly what is wrong and why it feels no better now than it did 4 months ago, what type of scan would that be, how much might it cost and is it worth doing yet (as I know these things take time).
I can just see the summer passing me by! Any advice taken.
Thanks Phill.
UppityClimber - on 18 Apr 2012
In reply to Phill Mitch: Hi Phil, having just gin ethrough exactly the same thing, you need to request referral to an orthopaedic surgeon who specialises in upper limb injuries. I was bounced all around with diagnoses from wry neck, torn rotator cuff, labrum tear, parsonage-turner syndrome and infrascapular nerve palsy.

I have had ultrasound, X-ray, MRI, nerve EMG tests and am waiting for an arthrogram. It took two GPs to get refrerred to an orthopaedic and a third to get to one who knew what they were talking about. The first wanted to operate for an injury that did not exist!

You need ultrasound and MRI arthrogram (with contrast dye) at the very least. My suggestion is do some research into upper limb specialists in your area (even better a clinic) and demand referral from your GP. You have the right under patient choice to be seen where you want and any clinic will select the right consultant for your case. No offence to GPs but they really don't generally have clue about specifics like this.

Many local health authorities require an orthopaedic referral for MRI but some will allow the GP to make a request. You need a consultant though as if you have the injury you suggest (or many of the others it could be) you need their expertise. GPs cannot diagnose a bicep tendon tear from visual observation and you describing the pain.

As for private, you have the right to it on NHS and there is the danger that if you begin the journey of private MRI (hundreds of pounds) any surgery would also be private (thousands of pounds).

Just my experience but hope it helps.

Phill Mitch - on 18 Apr 2012
In reply to djangopither: Thanks for you speedy reply, I was thinking of private as I know how long winded it can be getting any sense from the NHS. Your reply has just confirmed that!
Not sure I want to spend thousands but don't mind a few quid to know what's wrong.
I think it sounds like a mine field. Thanks.
UppityClimber - on 18 Apr 2012
In reply to Phill Mitch: The main problem I had Phil was that I didn't hold out to see t he right person in the first place. I let the GP make a lot of decisions for me about whether I got a consultation, when I got one, who with etc. If I had gone in sticking to my guns about what I wanted I probably would have had treatment and be fit again now.

Don't let your desire to climb rush you into your choices. Make sure you know who you want to see and where and just push for it. Honestly you shouldn't have to pay for any scans if you just make your desires heard and acted upon.
Phill Mitch - on 18 Apr 2012
In reply to djangopither:Ok thanks. I will go in all guns fireing and see if I can get somewhere. Thanks again.
RCJ - on 19 Apr 2012
In reply to Phill Mitch:
I went NHS with my knee but was given option of private hospital and jumped!
I get all private services free. 2wk wait for MRI scan, compared to 12wks etc
jobertalot - on 19 Apr 2012
In reply to Phill Mitch:

I'm a GP. I've had a shoulder injury for around 3 years and have also had steroid injections (some benefit) and physio (very little benfit). I recently felt it was finally time to get it sorted and got my own GP to refer me to the local upper limb orthopaedic surgeon. He actually thought it was the AC joint that was causing the problem but requested an ultrasound scan anyway to look at the tendons, an lo! - a 2/3 tear through the supraspinatus tendon.
I'll definitely be requesting more US scans myself in the future - GPs can request these no problem but generally can't access MRIs (depending on area), so it might be worth asking your GP for this as a first step.
I've never really considered going private, but then my injury has never been that bad, never actually stopping me from climbing, just being painful, and occasionally very painful. Having said that, a friend of mine who is also a doctor had a much more serious shoulder injury and saw just how slowly the nhs cogs can turn... she ended up seeing, and being operated on by Len Funk who is mentioned above - the outcome has been good, I think. It is definitely possible to access the very best available care on the NHS but it might be difficult or impossible to choose who you see and things can take time... good luck with it.
Phill Mitch - on 19 Apr 2012
In reply to jobertalot:So the tendon was 2/3 torn and you could still climb?
I think the time is right now for me to go to my GP and try my luck for a US scan. That sounds like my best bet.
I was thinking of private health care to get things moving fast but I am convinced now that it's not going to be a quick fix whatever I do. Thanks for your reply.
jobertalot - on 19 Apr 2012
In reply to Phill Mitch:
It still IS 2/3 torn - I only had the scan this morning, followed by a great afternoon climbing on the Orme. It aches a bit now but I think that's partly psychological! Supraspinatus is just one of four muscles forming the rotator cuff, the function of which is mainly to support the shoulder and direct the forces generated by the larger muscles, so you might be able to do without it altogether.
I'm sure you'll be climbing again soon, and better than ever... i'm convinced that recovery from injury is mainly a function of your psychological makeup and attitude, so chin up! (still worth seeing the professionals, obviously!)
JamesBrowning - on 20 Apr 2012
In reply to jobertalot:
Ah crap, I think I've just been given a bad diagnosis by my GP on my shoulder. After 5 months since it flared up she said that as I have pretty much pain free range of motion that I didn't have a rotator cuff tear and that it was only abrasion and referred me to a physio. How bad is your shoulder in terms of pain with a 2/3rds tear?

Cheers,
James
jobertalot - on 20 Apr 2012
In reply to JamesBrowning: I guess a mild to moderate ache about 50% of the time, I probably take ibuprofen most days. Physio is a good first step anyway - I may well be wrong but I think this is the mainstay of teatment for partial tears in any case. If it's not improving then it would be worth maybe getting a scan.
MattJ753 - on 20 Apr 2012
In reply to jobertalot: I too have a partial tear in my left supraspinatus tendon. This went un-noticed by my gp and 2 physio's until I had an ultrasound scan. Haven't climbed since September, and have been very committed to a new re-hab programme since January. Getting to the point now where I can see it may be possible to return to climbing at some point in the near future. In the end found a very good physio on the nhs who took an interest and I think spoke to a shoulder specialist in his own time. The main things I have found useful are to concentrate on correct biomechanics of the shoulder and scapula stabilisers and proprioception of the shoulder joint. Which is what has helped massively. The generic rotator cuff strengthening exercises helped very little in my case. My advice would be to look into the above exercises, and avoid the steroid injection as it weakens the tissue...albeit providing pain relief, but at what price?
slim - on 20 Apr 2012
In reply to Phill Mitch:

very much similar...

I had a shoulder injury for ages, several poor NHS physios later, and i went private, I came on a long way, but it never got back 100%...
physio told me to get referred to a shoulder specialist orthopedic surgeon, to get a MRI

Did have to wait ages, but after the MRI, that come up inconclusive, I was offered an artheogram(sp) that is surgeon speak for, have a poke about and see what we can see, or steroid injection that was “never” going to work

With that in mind, I opted to let them have a poke about.
They found a SLAP tear, and now I’m 6weeks into recovery, hopefully will be back to 100% by 6mths

its worth seeing thorugh
Phill Mitch - on 20 Apr 2012
In reply to jobertalot:
Being able to do without that muscle may be possible but I am sure it has not stopped it hurting you. Mine felt ok a few weeks ago so decided to try a few easy moves on my climbing wall, it's not stopped hurting since. Including many a sleepless night. When my arm reaches one particular point in rotation I get a searing pain that wakes me instantly. The pain involved is enough to make me shy away from anything that could make it worse, so I think you are right about the psychological effect.
I have made an appointment to see my GP on Monday so I intend to try and be very persuasive!
Phill Mitch - on 20 Apr 2012
In reply to jobertalot: As you are a GP, am I wrong to think taking ibuprofen regularly is bad for you? Or is thatother pain killers?
Trevor Langhorne on 20 Apr 2012
In reply to Phill Mitch:

Agree with your idea that you need to push your GP for more detailed investigation, ultrasound will show more than an X ray (the likely option?) as it shows soft tissue injuries.
I am just starting to get back into easy climbing 10 months after dislocating my shoulder, which led to the supraspinatus and a lump of bone being ripped of the head of the humerus with a 70% tear of the remaining rotator cuff muscles. I only had X ray investigation, luckily the surgeon decided that the supraspinatus needed to be re-attached and when he opened the shoulder up to screw the bone back to the humerus he found and fixed the rest of the damage.
I have learned that you have to be patient as shoulders are very easy to upset and hard to settle down afterwards. Pain is bad but movement with very light resistance (therabands are excellent) is very helpful - you may be surprised just how weak parts of your shoulder are!

Good luck and I hope you get a proper diagnosis and effective treatment asap.
firefighteralex - on 21 Apr 2012
In reply to Phill Mitch: I too had a problem with the bicep tendon. This was not as a climbing injury and was prior to taking up climbing. I did go under NHS and had dye put in and an MRI to confirm that the bicep tendon had partially ripped off. The options were to have keyhole surgery which was a 4 month recovery. The specialist said that as it had been a year since the injury it was unlikely to get worse or better by itself.

I now just live with it as I found with time the pain went and only flares up when doing over hangging bouldering that requires long reach to slopers. I now just avoid certain types of climbs.

UppityClimber - on 21 Apr 2012
In reply to Trevor Langhorne: X-ray will show if there are bone spurs or a fracture of any type. Ultra sound can be very good for muscle, ligaments and tendon damage diagnosis. MRI basically does the same as ultrasound but in a different way. Many good orthopaedics will diagnose from ultrasound as it's cheaper and quicker than MRI. Can be done in he office.
MRI have a low success rate at diagnosing labrum tears like SLAP or Bankart Lesions. You need MRI with contrast dye (arthrogram) to pick up on hose with high rates of success. In addition nerve damage such as damage to the Brachial Plexus or Infrascapular nerves can also present as muscle, tendon or labrum damage symptoms.

Physio's and GPs will tend to diagnose from symptoms in my experience and many shoulder injuries have overlapping symptoms, making diagnosis difficult. There are a bunch of range of motion tests that can help and even scans are not 100%. Sometimes arthroscope (investigative surgery) is the only accurate diagnosis. As I said earlier, find yourself a good orthopaedic consultant and ask for referral to them. Do not go with a general trauma consultant but use an upperlimb and preferably sports injury specialist. Len Funk, who's name crops up in this forum a lot, is great if your in the NW but there are many other very good specialists in the country.

Don't just go for the earliest appointment with Mr General Orthopaedic Surgeon at the local hospital. That will probably make diagnosis less likely to be accurate, cause unnecessary or inefectual treatment and delay recovery. Carry out research and make the right choice from the outset.
UppityClimber - on 21 Apr 2012
In reply to firefighteralex: I'd get he op and wait 4 months to recover. Why limit your climbing for the rest of your life for 4 months rest? I've had 6 off and am now back on grade and probably climbing better than before the rest
Phill Mitch - on 22 Apr 2012
In reply to Phill Mitch: I will take on all these points and make an effort to get the best from my GP tomorrow.It sounds to me like I am not the only one suffering with my shoulders, I just hope it does not spoil any of your summer. Thanks for your interest. Phill.
Phill Mitch - on 23 Apr 2012
In reply to Phill Mitch: Been to see GP today and have got a referal to the muscular and skelital clinic, no idea of time scale yet.
FrJ on 24 Apr 2012
In reply to Phill Mitch:
Just for getting an idea of scale of costs private MRI scan of ankle came in at £300.
plasticclimbingcaver on 24 Apr 2012 - host81-129-155-169.range81-129.btcentralplus.com
In reply to Phill Mitch:
Do keep us posted on how you get on Phill - I am now nearly a year since a labral tear caused by not warming up properly and campusing (yes, I am a girl... literally). I spent 3 months waiting for my GP to refer me for an US which showed inflammation and not much else, then another 3 months waiting to see an Ortho, 5 weeks for an MRI, 4 more weeks to get results of the MRI w/contrast (inconclusive but showed healed fracture and possible/suspicion of labral tear), 4 weeks waiting for physio referral, 3 months of physio (which has helped a bit, but the original pain and dysfunction persist) only to be referred back to the Ortho because surgery is now the only option.

11 months into my frustration, I went to a private physio to see if they could possibly help me. My NHS physio, who is lovely and seemingly competent, is not empowered to do anything more than make sure I'm doing the few exercises she prescribed at the start and give me a bit of acupuncture for pain management...so despite her best efforts I thought I might find out a bit more. The private guy said unequivocally the labral tear tests positive, questioned why if I had the same tests a year ago and they were positive anyone farted around this long, and refused to treat me any further because he said I would be wasting my money when what I need is an operation...

Yes, it will be free on the NHS, but I have been in pain for a year over this, lost countless hours of sleep, most of my climbing fitness, and constant pain can make you very depressed - trust me. Do whatever you can to get a diagnosis and treatment that sorts the problem out!

Good luck to you, and I'll let you know how I get on with the shoulder op. Might stay away from campusing in the future tho...
Phill Mitch - on 24 Apr 2012
In reply to plasticclimbingcaver:
> (In reply to Phill Mitch)
I have been in pain for a year over this, lost countless hours of sleep, most of my climbing fitness, and constant pain can make you very depressed - trust me.
I am with you on that. What a run around you have had. I have a friend who had a similar run around and ended up with a colostomy bag after taking too many pain killers for too long!He ended up going private and getting things sorted right away. That's on my mind.
How long is too long to mess about with hopeless care, the climbing clock is ticking and I have already got too many routes to do to fit into this life!
Let me know how you get on. Thanks
Phill Mitch - on 24 Apr 2012
In reply to FrJ: Thanks, I am considering it if I am not happy with my referal. I am convinced a better standard of care is guaranteed, it's nice to know how much it costs though cheers.
plasticclimbingcaver on 27 Apr 2012 - host81-129-155-169.range81-129.btcentralplus.com
In reply to Phill Mitch:
Good god! I will remember to stay well away from the temptation to keep abusing the anti-inflammatories. After a couple of months of taking half the dose I was prescribed of both Dicolfenac and Tramadol (recreational entertainment, just add alcohol) I got terrible kidney pain and got really sick on a long haul flight. So I voluntarily quit taking just about everything and save it for the night after the day before...or when I dare to climb or do a serious yoga or training session. Otherwise I just whine a lot and beg my husband to rub ibuprofen gel on my aches. Good for bonding :-) Private is sounding better all the time...
This climbing lark, aye? Hazardous!
Simon4 - on 27 Apr 2012
In reply to FrJ:

> private MRI scan of ankle came in at £300.

Private MRI scan of shoulder was £720 (but that was in London).

It was arranged 2 days after seeing the specialist, who is :

http://www.londonbridgehospital.com/LBH/consultant-det/mr-adel-tavakkolizadeh/

Who is very, very good, particularly oriented toward the idea of getting you back climbing. But it does depend on how complete the damage to your tendon is, also this does not seem very convenient for your location (but what is the cost of a train ticket to London compared with getting your arm sorted properly?)

One thing you can do is to get the scans and diagnosis by consultant done privately, then hand them to NHS staff to guide NHS treatment (private scans should always be handed over to you, in physical and electronic form, so you can do whatever you want with them).

There are other issues involved, PM me if you wish.

Phill Mitch - on 29 Apr 2012
In reply to Simon4: Thanks for that Simon. I would check that out if I were close to London. I am sure I can find treatment closer to home. Thanks all the same.
ads.ukclimbing.com
dave frost - on 30 Apr 2012
In reply to Phill Mitch: if you decide to pay for it you matvwant to consider going abroad for the work being done. Save yourself money on the medical stuff could go towards some nice hols.

Loads of stuff about medical tourism these days,vuk is expensive! Evenvfrance is cheaper i think.

Good luck.
Dave

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