June 17, 2009


Some of you may have heard that ‘your author’ was foolish enough to fall off his mountain bike while trying to keep fit and keep the expanding waistline manageable.

This happened on the 16th December, just before Christmas and just after getting back from holiday – excellent timing!

I won’t go into the gory details, but I dislocated my right shoulder and fractured part of the upper arm bone. I can’t fault the Ambulance Service who promptly picked me up from the back of the Downs, but I’m not convinced that ‘gas-n-air’ does more than give you something to do! However, thanks boys for bringing me in, mud and all.

Worthing A&E did their sterling best to put things back in place, but sadly failed. My ‘inferior’ dislocation, (and I can tell you it didn’t feel at all inferior at the time), is apparently rare, but the sight of them checking up on the internet before ‘having a go’ was a bit unsettling, as you can imagine. By now I had had my arm above my head for 6 hours and I was prepared to let them try anything. They told me I wouldn’t remember anything! I’d like to have a word with that very enthusiastic chap sometime.

Next day,after a good, morphine-induced sleep, I was taken to theatre to have the shoulder back in place, discharged later that day with a promise to screw the detached bits back in a few days.

Three weeks later, it was expertly done, leaving me with three shiny screws, a lovely scar and a lot of physio to look forward to.

Physio was an experience, I can say. As an osteopath and with a now-long-ago background in the NHS, I did have some apprehensions, but they were completely unjustified. I won’t mention her name so as to avoid embarrassment, (after all, her colleagues might blackball her for treating ‘the enemy’), but I had expert, professional and effective treatment and I like to thinkthat weboth learned somewhat from each other.

Weekly treatments for 5 weeks, with lots of self-torture at home meant that I was back at work part-time 6 weeks after surgery. I was also aided by a device that I ordered from the US, called the ‘ Rotater ‘, which proved to be a huge benefit. It is a simple device that gives control to the user and lets you relax the shoulder while in use. It’s is so easy to fight the therapist and ‘cheat’, thinking you are getting more improvement than is real.

I was discharged after about 10 weeks post-op and now comes what I think is the really hard part. I and most of my friends and relatives have become bored with the whole thing. It is now, back on my mountain bike, SCUBA diving and working full time again, that it is so easy to stop doing the exercises and stretches – I’m coping OK, aren’t I? Well, yes, but it isn’t better yet and it is easy to avoid doing the things that still hurt or are difficult. Please take my word for  it, keep it up – shoulder injuries, including frozen shoulder, sub-acromial impingement problems, rotator cuff tears and dislocations take a long time to really heal – think in terms of at least a year!

Looking on the positive side, I have learned a great deal both about my specific injury type, as well as shoulder injuries in general. I hope that I will be both more sympathetic and empathetic toward my patients in future – but beware, I have also learned that a I have been too soft on them in the past………


Rotater Cuff Injury & Tear


A group of 4 muscles in each shoulder, named for its vague similarity to a short sleeve shirt cuff. Damage to the cuff may be referred to as rotator or rotater cuff tear, rotater cuff strain or rotator cuff injury.

  • These muscles are the supraspinatus, the infraspinatus, the subscapularis and the teres minor muscles. These muscles start on or under the shoulder blade and their tendons wrap around the shoulder joint and the tendons attach to the humerus, or upper arm bone. Their job is to stabilise the joint while it goes through its many movements.**
  • The most likely point of injury is to the tendons of the muscles and can range from microscopic tears to large holes in the cuff.
  • The supraspinatus tendon is the commonest site of tearing.
  • The size of the tear and the amount of pain suffered does not correlate well. Large tears can be seen on scanning that are symptom-free!
  • Rotater cuff tears can happen at any age and may from sporting activities, such as throwing sports, traumatic injuries like dislocations and fractures, but are most common in older age. Degeneration of the tendons, abrasion under the acromio-clavicular joint, (the bony knob on top of your shoulder) and postural problems, (being increasingly round shouldered), are all causes.


  • · Pain often starts around the upper, outer arm
  • · Pain gets worse when you lift the arm and try to use it above your head
  • · A painful arc of movement – i.e. lifting the arm, initially without pain, until you get a sharp pain, which you might be able to go through with effort, when it then eases again
  • · Pain when turning the arm out to the side when the elbow is bent, (external rotation)
  • · Waking at night with a dull, persistent ache or just when you are resting
  • · Pain over the front and side of the shoulder when you lean on the arm of a chair
  • · Pain when you push the arm sideways against a resistance (the ‘impingement sign’)
  • · Weakness, especially overhead or out to the side
  • · Poor range of motion – can’t do up bra, reach back pocket, brush hair and so on
  • · Crackling (crepitation) and creaking when you do move


  • · Shoulder dislocation from sports injuries
  • · Lifting or catching something heavy
  • · Falls on to an outstretched arm
  • · Overuse, especially new activities or sports – perhaps soon after retiring from a sedentary job
  • · Age-related degeneration of the shoulder tendons and impingement, (pinching)
  • · Poor posture, (round-shouldered), which reduces the amount of room under the acromion, especially the supraspinatus muscle (more…)