UKC

Pulled my shoulder again in November bouldering at the Roaches. Gave it the typical month or two off and it's steadily got worse, to the extent I can't sleep and it's spread to neck, upper back and pectoral. I went to Bannerdale osteopaths in Nether Edge in January and early February, and he thought it was a labral tear. SLAP tear in other words. Pain is shit: currently taking 120mg codeine per day.

Question is this: I have a physio appt on Fri. Nhs. Any advice on how to get it into their skulls that I would rather remain active rather than 'avoid physical activity'?

I'm a 43 year old, generally fit bloke.

Any advice would be welcomed. Particularly the nhs route.

PS. I have read most of the shoulder injury threads on here, and depressingly it seems that private is the norm, which I cannot afford.

In reply to David Alcock:

I will take a look in Dave Macleods book and see if there is any helpful advice in there, can't remember if he mentions SLAP tears or not. Have you tried googling 'slap tear physio exercises/advice' and other similar terms? Might be a page out there on the net that can help you

In reply to David Alcock:

Could you just ask the NHS physio to refer you for a scan and then possibly surgery? I had a labrum tear caused by 5 dislocations and so got it operated on, i've never looked back.
It was never as uncomfortable or painful as yours appears to be, aside from the actual moment of dislocation it never caused me any pain, but obviously I couldn't continue to climb hard so I opted for the surgery.
The whole process from seeing my GP to going under the knife only took a couple of months and that was all on the NHS.
5 months of rehab later, the shoulder was great, it's now been 18 months and i've not had a single issue with it and i'm climbing as hard as ever.
I was never urged to 'avoid physical activity' and was told 9/10 people who have the surgery never experience a recurrence of the dislocation, despite a large number of patients being sportsmen, especially rugby players.
Overall I had a pretty decent experience with the NHS, (although their rehab physio was useless so I did seek out my own physio) if you are in pain I think they should be understanding of that and get you the right treatment as quickly as possible.
Best of luck getting sorted!

In reply to David Alcock:

I'm sitting at home in a sling having had my SLAP tear fixed last Thursday. I first injured my shoulder in 2003, and have subluxed and dislocated it maybe once a year from then on. In the beginning it didn't bother me so much, but at the end of last summer (I climbed a lot!) it went rapidly downhill - pain throughout my shoulder, neck, and arm, problems sleeping, had to use strategic pillows in bed to come close to comfort.

Nothing showed up on my MRI scans (not unusual I understand) and a good physio worked on some of my overtaxed mucles (pressure point massage) which helped with the pain. Meantime I was scheduled for an operation to investigate and fix whatever they found. Turns out my labrum (cartiage rim) was 2/3 not attached to my glenoid (bony shoulder socket), but they pinned it in place with 6 anchors.

I have a month in a sling, at least 3 months without weight bearing exercise (if I flex my bicep hard I can potentially rip it all out), then beginning to rehab back to sports-health after that. Long term prognosis is good, but I have mentally written off climbing this year, though I think Lucy Creamer had a SLAP repair and was climbing again a few months later.

Sling is *ing annoying but the pain I had before is completely gone

In reply to David Alcock:

I am not sure who else you have seen via the NHS, but the physio should be able to get you a referral to a consultant where you can get some specialist advice and a better diagnosis. You should let the physio know you can't sleep and it has got worse. In my experience a physio will give you exercises appropriate to the best chances of recovery. I have never been told not to exercise.

In reply to David Alcock:

Hi David,
I feel your pain and frustration. I am currently 10 days post op having just had my LHS AC joint resected. I realise not the same as your problem, but similar journey in terms of constant pain, over reliance on pain killers etc and just general frustration. I too am 43.
My advice is get determined and get it sorted.
Go see your GP and ask for / demand an orthopaedic referral. Tell them you are max ed out on paracetamol etc and are worried about the long term side effects this may be having on your liver. Be nice but persistent.
The surgeons are generally the same people, regardless if you go private or NHS, but you may have to wait a little longer via the NHS.
Check out "shoulder doc.co.uk" if yo have not done so already, I have found it one of the better websites.
SLAP lesions sound tricky to diagnose, so do your homework and try and find somebody that you trust / feel comfortable with that does NHS work and request a referral to them. GPs generally want to help you and if you can do a bit of homework and go to them with a suggestion of who you want to see, then they I'll generally oblige.
Good luck and us know how you get on.
Paul

In reply to David Alcock:

Thank you all. Some hope in your tales. I'll just stage a sit in at the physios' till I get a result. Fingers crossed.

In reply to David Alcock:

You might as well use the appointment to get a second opinion. Otherwise maybe request a referral to an orthopaedic consultant, get a proper diagnosis, and find out if you have a SLAP tear. You likely won't be able to get a referral from an NHS physio to an NHS consultant so your planned staged sit in might be futile. It depends on the funding agreements. Most of the funding pathways are via the GP, meaning the GP will need to refer. Sometimes GPs can request an MRI scan directly.

In reply to David Alcock:

if you are in Sheffield there is a integrated physio/orthopaedic referral process. The extended scope physio wil assess and then refer onward to shoulder orthopaedics. Mr David Stanley is a world class opinion. Probably need a initial MRI then arthroscopy and repair.

In reply to David Alcock:
Again, thanks for the detailed and helpful advice. Saw a physio in my local area today. Unfortunately he was a callow student who kept leaving the room for advice. We all have to learn. He hesitantly spoke of steroid injections if no improvement after four months. I've been f*cked for four months and have done no end of stretches and cuff exercises. Now booked into gp to raise hell.

I suppose we're back to the original question: how to wangle a referral for something as counter-preductive as climbing.

Big sigh. It's not a game I want to give up.

Ordered Macleod's book. Cheaper than the osteopath!

In reply to David Alcock:

I can understand that you're primarily worried about being able to climb, and that not being a 'good enough' reason to get a referral. But reading your original post, it sounds like you are in near constant pain and having trouble sleeping, which is presumably affecting your life and your job. Those are definitely grounds for your problem being taken seriously. At this point it's not important how it happened, and if it is a serious slap tear, is unlikely to be fixed without surgery.

In reply to David Alcock:

I'd also say you seem to be basing this totally on climbing (understandable) but this seems a fairly serious injury affecting your normal life and must warrant proper treatment regardless. I'd play up the day to day misery aspect (that's a lot of painkillers) when you see your GP rather than focus on climbing.

As you say, at your age, you should be able to be physically active as part of a normal healthy life. I'd mention the fact you find it depressing not to be active but not state that as a reason for wanting treatment per se.

Just go to your GP and say it's affecting your work - it's usually the buzzword for instant referral.

In reply to Fultonius:

I'm going be honest and disclose here. I've been off work for a while due to a stupid diagnosis of manic depression. There has been a lot of work recently to fight stigma on mental health, but I have found that it becomes exponentially more difficult to be taken seriously for a physical problem. That's basically why I asked for tips. I've ordered Macleod's book. The problem is basically that if you have that label, you have to speak reasonably and meekly to be heard: forthright gets ignored. I apologise if this is too much information, but it was nagging at my conscience.

In reply to David Alcock:

Not “too much information” at all David ... and you seem to have sussed out the most appropriate way forward.
The Dave McLeod book is very good. If you have been searching the internet a lot you may not see anything new but you will have a good insight into what is likely to work and what is not. He clearly separates the protocols that are backed up by detailed scientific studies from those just supported by anecdotal evidence.
I’m not sure about your specific injury but if it’s affecting your sleep, as shoulder injuries can, it certainly warrants immediate intervention, preferably by the NHS.
Good luck.
Mark

In reply to Mark Harding:

Thanks Mark.

In reply to annak:
Hope you're getting better. Can you roll a fag in the sling?

In reply to David Alcock:
''I can understand that you're primarily worried about being able to climb, and that not being a 'good enough' reason to get a referral. But reading your original post, it sounds like you are in near constant pain and having trouble sleeping, which is presumably affecting your life and your job. Those are definitely grounds for your problem being taken seriously. At this point it's not important how it happened, and if it is a serious slap tear, is unlikely to be fixed without surgery.''

What annak said.

Look fed up and tired and tell them it's affecting your ability to work through lack of sleep, and talk about constant nagging pain, tug at their heart strings. Other than your GP nobody will know you're not working, and it's technically still true even if you are not working at the mo, in that if you did have a job it would be affecting how well you could do it because of how you're sleeping. So a sorted shoulder will still help.

In reply to Timmd:

tĹta.tl ALAN!

Soz. It is what an s4 does on this site. Tim md. Just guessing.

0

In reply to David Alcock:

Am on the mend, thank you. I could roll a fag one-handed about ten years ago but as an ex-smoker such skills are useless to me these days

In reply to David Alcock: Shit man, not good. Hope things work out for you. Just go to your GP and tell it like it is.

In reply to David Alcock:




That's pretty high on the randomness scale.

In reply to Timmd:

Yeah apologies. It's something wrong with predictive text in this box. And thanks all for the input.

In reply to David Alcock:

No worries, it was funny.

In reply to David Alcock:

I empathise with you. I am also 43 and since October 2013 have had pain in my back , shoulder neck arms and hands. I have had two different Physio referrals , the first said it was a rotator cuff injury and the second said it was a neck strain. They both gave me programs to work on but after nearly a year and visits to my GP no improvement. I then went to see an Osteopath, who said I had a twisted spine and that had caused all the other muscular/skeletal problems. After 7 sessions with the Osteopath I am no better. The pain is effecting my day to day life and my fitness levels have nose dived. I was hoping to go to the Alps for the first time latter this year, thinking I should be sorted by then. I have asked for an x-ray but the doctor said they would not do this for a muscle injury. I have yet to get a confirmed diagnosis of the problem and was thinking of going private, not that I have the cash anyway. I have another GP appointment this Tuesday. But I don’t hold out much hope.

In reply to mrgleb:

I would steer clear of osteopaths in the absebce of a diagnosis and the doc is right not to xray, as nothing you have said suggests a bony process.A reasonable solution may be to pay to see a physio who you feel understands the problem,and they can write to your GP.Physios are like everyone else,some good some less so,you need to shop around.

May be worth discussing with GP something called fibromyalgia?

In reply to nickinscottishmountains:

Well, I've been trying my best to be a pain in the arse without blotting my copybook. Have persuaded the Sheffield osteopath to write to my gp strongly recommending imaging. Every little helps.

MrGleb: that sounds horrible. The shoulder is my big problem, but I too have doses of golfers and tennis elbow. Manageable. One thing at a time.

So roll on Friday week. Have the company of my delightful better half in the interim. And a stack of painkillers I try to avoid taking. Fingers crossed.

In reply to David Alcock:

Hi mate, problem is, and I'm not getting into the rights and wrongs of this, a doctor won't pay much attention to a letter from an osteopath, but will pay attention to a letter from a physio.

Sorry to hear about the shoulder injury, mine took over a year, I feel your pain!

In reply to nickinscottishmountains:

Yeah, it had crossed my mind. The physio I saw was a student who left the room every thirty seconds to confer with a grown up.

In reply to mrgleb:


Ask for An MRI or CT scan which could show soft tissue damage.

In reply to David Alcock:
If you can get to Nottingham you could get a GP referral to Mr Paul Manning at the City Hospital. Google him. One of the best in the business. In fact, Nottingham has some of the best surgeons/specialists globally. Prof Wallace if still practising is the designer of the Nottingham Shoulder replacement and has international recognition.

I know Paul, he operated on me, but i know him professionally as I have some experience in orthpaedics.

http://www.nottinghamshoulders.com/The-team/Mr-paul-manning.aspx

http://www.nottinghamshoulders.com/The-team/Prof-w-angus-wallace.aspx

In reply to David Alcock:
Is there an NHS sports injury clinic in your area?

For example Oxford has the OxSport Clinic that is run at the Nuffield Orthopaedic Centre, and is a multidisciplinary service run with Sports Injury Physicians, Orthopaedic Surgeons, etc etc. (www.ouh.nhs.uk/oxsport). I would expect there are other similar services around the country.

My experience at OxSport (regarding my elbow tendinosis) was that they understood the need to remain active, and they understood many of the issues / concerns raised on this forum. Being part of an NHS service there was straightforward access to what ever imaging/onwards referral necessary

The way to get a referral to the specialist sporting injury clinics (rather than standard Orthopaedics) is to explain to the GP that it is a sport-related issue & for them to write that in their referral letter. Worked for me.

PS one more thought: If you are under the care of a Consultant Psychiatrist for your mental health issues, you *might* be able to convince him/her to write a consultant to consultant referral, especially if he/she thinks that the shoulder injury may be impacting on your mental health issue or its treatment.

In reply to TheDrunkenBakers:

I told my GP today I wanted an MRI but he said they would do the X-ray first as the MRI was too expensive ! So they did an X-ray on my left shoulder, even after I said the pain has now moved to my right side and back , see it tends to shift about. My Osteopath said " no it's a twisted spine the doctor is talking rubbish !".

So I will just have to wait 7-10 days and see.

It's all very fustrating.

In reply to David Alcock:

I have had a shoulder dislocation and whilst the shoulder is good for pretty much everything (weights wise it is stronger than before the dislocation)its hard to trust it climbing.

i have done endless rehad exercises but if there is damage its virtually impossible as far as I can tell to get full stability back without an Op.

I got back to onsighting up to about 6a+ with no issues. Then when climbing a hold pulled off and I moved my arm quickly to compensate and the shoulder popped again!!

I am trying again with intensive strength building and every stability exercise you can think of.

But I think the answer may be as Dave Macleod says in his book, surgury and nothing else will do!!

In reply to mrgleb:


It often seems there is only one osteopathy diagnosis,the twisted spine.