Physiotherapy plays a vital part in the treatment of upper limb conditions. The majority of common problems, such as Frozen Shoulder and Rotator Cuff Tendinopathy, can be treated successfully without surgery in most patients. Physiotherapy has moved away from the old-fashioned ‘hands-on’ techniques, such has massage and electrotherapy, as these have been found to give very short-term benefit without long term gain. Modern Physiotherapy involves the prescription of tailored exercise regimes for the patient’s individual problem and research would suggest that for many upper limb conditions this strategy is as good as or better than surgery. Of course, this does not work for all patients and not all conditions but physiotherapy support is also imperative after all upper limb surgeries and fractures to aid patients recover their arm movement, function and strength.

Rotator Cuff Tendinopathy:
This is the most common cause of shoulder pain. The shoulder tendons can become painful after an injury or simply as a result of the tendons weakening as part of the normal aging process. It is common for people over the age of 60 to even develop tendon tears without injury that may or may not be painful. Physiotherapy can help to strengthen weak painful tendons or strengthen surrounding muscles to compensate for torn tendons. We were recently involved in a multi-centred research study that found that teaching patients how to strengthen their shoulders and self-manage the problem resulted in better long term outcomes than traditional forms of Physiotherapy.

Frozen Shoulder:
This is a very painful condition that usually affects people of middle age. The cause is unknown but it is more common in women and in the diabetic population. Typically patients complain of pain in the upper arm, rather than over the shoulder itself, and it usually feels worst at night. As time goes by the shoulder becomes less mobile having an impact in day-to-day function. Physiotherapy, usually in combination with a steroid injection, can help reduce pain and restore shoulder movement.

Shoulder Instability:
The shoulder joint is very mobile but can be prone to instability when the ball of the joint slips partly or fully out of the socket. This is usually caused by injuries in young sporty adults but can sometimes happen without injury in people who are hypermobile (double-jointed). The muscles around the shoulder play an important role in maintaining stability so need be retrained after episodes of shoulder instability. Our Physiotherapy treatment regime is detailed in The Derby Shoulder Instability Rehabilitation Programme and videos showing the exercises are available on YouTube.  Instructions have also recently been published in Italian and Spanish.  Physiotherapists wishing to help us with our research can evaluate the Rehabilitation Programme with their own patients and return the electronic data capture form.

Post-operative Physiotherapy:
The majority of shoulder surgeries in Derby are done with a regional anaesthetic, rather than a general anaesthetic, meaning patients usually go home the same day. A Physiotherapist sees the patient before they go home to instruct them on how long to wear a sling and which gentle exercises to do in the early stages. The post-operative instructions vary depending on the type of surgery performed so specific details are listed in the attached protocol documents for each procedure. Patients are referred to the hospital of their choice for Out-patient Physiotherapy which usually commences within two weeks for most procedures. If complex surgery has been performed patients are usually encouraged to have their post-operative Physiotherapy in Derby where they can be monitored more closely.

Please click on the links below for the relevant post-operative protocol:

Shoulder Arthroplasty

Rotator Cuff Repair

Bankart Repair

Latarjet Stabilisation

ACJ Stabilisation

Shoulder decompression +/- ACJ Excision/SLAP repair/LHB tenodesis

Elbow Arthroplasty

OK or Column Elbow Debridement

In-Space Balloon for Irrepairable Rotator Cuff Tear