Kā Pātai Auau

If you have had a specific injury, a GP, physiotherapist, local medical centre or emergency department can submit a claim to ACC on your behalf. If approved, ACC can provide:

• Cover or part-cover of cost of treatment and rehabilitation
• Using rongoā Māori services
• Help at home after an injury
• Transport and getting around after an injury
• Support with childcare and education after an injury
• Travelling for treatment and rehabilitation
• Get paid if you can’t work.

See also: https://www.acc.co.nz/im-injured/

You may consider surgery if you have:

• Had a shoulder dislocation that keeps on re-occurring.
• Had a fracture (broken the arm).
• A full rotator cuff tear that is not responding to rehabilitation exercises (at least 3 months).
• Continuing pain that affects your daily life or disrupts sleep despite rehabilitation exercises and pain management. 

The health care provider should discuss with you whether surgery is needed, what benefits that will have for you, what risks the surgery may have, and how long the recovery is expected to be. Ask the health care provider whether it is more likely that you will get better with surgery than without. You may also want to ask them what might happen if you choose not to have surgery.

Please see Pain Management > Treatment Options 'Reasons for seeking healthcare urgently for shoulder pain'.

You should have an X-ray if you have:

• Had a shoulder dislocation or fracture
• A frozen shoulder, to find out whether they may have been an earlier injury
• Or if shoulder osteoarthritis is suspected or any other reason that the health care provider may discuss with you.

It is unlikely that you need an X-ray if you have: 

• Rotator cuff related shoulder pain
• Shoulder instability where a dislocation did not have to be put back into place by a health care provider.

The health care provider should discuss with you whether an X-ray or other investigation (such as ultrasound imaging, MRI) are needed, what benefits that will have for you, and what risks are associated with X-ray or other investigations. 

See Your Shoulder > Common Conditions ‘How important is it to diagnose shoulder pain?’.

See Pain Management > Treatment Options ‘Specific treatment for a new shoulder injury’ and ‘General advice for shoulder pain’. 

• Find out about why you feel pain: understand that many things can influence why you feel pain. For example, besides possibly having had an injury, stress, general body health and lack of physical activity (or too much repetitive movement) can be part of a larger explanation of why you have pain or continue to have pain. See Pain Management > Pain Types and Causes.
• Find out what makes your pain worse: that may include specific movements, tasks, or postures, as well as how relaxed or tense, stressed, worried or rushed you might be feeling.
• Find out what you can do to settle the pain: that may also be specific movements or postures. It might be using ice (for example if you have had a very recent injury), doing gentle stretches or exercises, deep breathing exercises, or ‘pacing’ your activities. Going for a walk may help to settle the pain.
• Write down what helps or makes your pain worse. Share that information with your health care provider. That information will help them to make decisions and design an individual care and rehabilitation plan with you.

Pacing means that you break down tasks into smaller tasks or shorter time periods. It helps to keep active and may reduce flare ups. It helps us to do things we enjoy or that just need to be done, for example, housework or cleaning the car, or at work.  Alternate the task with another task. For example, when breaking vacuuming into 10-minute stages, walk to the post box or any other task that does not need work with the arms. 

Pacing in the workplace

• Alternate the tasks. If you are doing repetitive tasks, alternate high-intensity with low-intensity tasks. Take regular short mini-breaks of one or two minutes. Take the breaks before the pain starts or flares up.
• Gradually increase the time that you can spend on the required task.
• Include active breaks. Go up a flight of stairs during the mini-break, or a walk during lunch break (preferably outside). Take a few minutes for yourself.
• Listen to your body and how it responds. Start by taking note of when the shoulder pain gets worse. Write down your observations and make a plan that works for you and your responsibilities. People with shoulder pain can have 'good days' and 'bad days'. Make a plan for pacing, particularly for the 'bad days'.

Your physiotherapist can help you to work out a plan that is relevant to you. If you have shoulder pain at work, talk with your line manager or Health & Safety officer, and ask for an occupational health physiotherapist or nurse to help you design a plan. 

Focussing on your breathing while exercising can help you to keep calm. When having shoulder pain, it is common to tense shoulder muscles such as the upper trapezius, and to use more shallow breathing patterns. Focussing on breathing helps to relax those muscles, breath deeper, feel calmer, and may make the exercises more effective. 

Contrary to previous thinking, there is no perfect posture. By itself, posture does not predict shoulder pain. It is more important that you vary your posture and movement patterns throughout the day, and to take regular short breaks from intense tasks or from computer-based work. 

A physiotherapist can assist you to find out whether there are specific postures or movement patterns that make your shoulder pain worse, and what postures or movement patterns might work for you. 

Our body and brain produce and regulate specific hormones (e.g. cortisol) and chemicals when we feel stressed. These hormones and chemicals are important for the fight/fright/flight response to keep us safe in emergency situations. When those hormones and chemicals are produced at higher levels for a longer time, the central nervous system (including the brain) can become more sensitive to ‘danger’ or alarm signals from within the body. Thereby, the shoulder pain can become more sensitive. Sometimes, it is the pain or injury that leads to worry and stress, adding to a cycle. 

Physiotherapists can work with you to find out what strategies work for you to manage stress, negative thoughts or worries. If pain lasts for a long time, your health provider may refer you to a counsellor, occupational therapist or Pain Clinic who can help you find strategies that work for you in your life to manage your pain and get control of your life again.

The dimensions of taha hinengaro (mental wellbeing) and taha wairua (spiritual wellbeing) of Te whare tapa whā remind us of the importance of different aspects of life influencing our wellbeing. Dealing with stress in life can influence our taha tinana (physical wellbeing). It is thus important to consider how we can manage our responses to stress. Rongoā Māori (traditional Māori health) includes Māori cultural beliefs and practices, physical therapy and spiritual healing. If this is important for you, you may find a GP, physiotherapist or other health provider familiar or trained in Rongoā Māori.

Massage by itself is unlikely to help recovery of shoulder pain. However, many people find that massage can help them feel more relaxed, to improve mobility of the shoulder, neck and spine and, generally, to feel more positive about themselves. All of those benefits can be helpful as part of your recovery.

An analgesic (pain relieving) or corticosteroid injection into the shoulder can be helpful in some cases for people with relentless pain. In particular, such injection may be helpful for those with relentless rotator cuff related shoulder pain or in the early, painful period of frozen shoulder. Such benefit is likely to be reduced pain and improved function in the short term (a few weeks), but not in the long term.

How the corticosteroid injection improves pain is not certain. It may be by decreasing inflammation or decreasing the sensitivity of the tissues in the short term. 

Harms or side-effects of corticosteroid injections may include slowing down tendon healing and might lead to tendon rupture. Although rare, short-lived side-effects can include facial flushing, bruising and possible flare-up of pain after the injection.   

Your GP or pharmacist should give you information about how an injection may be helpful for you, and what risks or potential harms are involved.

Always consult with a pharmacist, GP or orthopaedic surgeon for your medications. Simple pain medication, for example paracetamol, may be enough to help your pain. If that does not help, the GP will consider prescribing stronger medication, considering whether you are also taking medication for other health conditions. 

Ask the GP or pharmacist what benefit the medication may have for you, as well as what harms or risk they may have. 

There are many different types of creams that people with shoulder pain can find helpful. Those include topical pain relieving or anti-inflammatory creams, gels, sprays or rubs, herbal creams, and traditional remedies. 

Consult with a pharmacist or GP for specific advice for topical ointments for your shoulder pain. 

Rongoā Māori (traditional Māori health) may include rākau that might be useful for shoulder pain. For Rongoā Rākau, consult with a Māori GP or health provider who has relevant knowledge and experience. For futher information, please see: Health Navigator - Rongoā Māori

Recovering from shoulder injury and/or pain depends on many different factors. These may include the extent of the injury, as well as your general health (‘the body whānau'), physical fitness and how active (or inactive) you are. Age-related factors and your genes (family history) may also influence recovery.

Most recovery happens in the first 3 months after an injury. Recovery then slows down and it may take up to a year or more to be close to ‘normal’.

Rotator cuff related shoulder pain may need rehabilitation for at least 3 months.

Frozen shoulders can last up to 1 ½ to 2 years. The initial painful phase may last up to 3 or more months.

Your health care provider will be able to give you an informed estimate for recovery time after listening to your history (your story) and a physical examination.

There are many factors that influence how soon you can return to work or sport. That includes the type of injury or pain, the extent of the injury, your general health and requirements for the specific work or sports. Your return to work or sport may also rely on how routinely you are doing your shoulder exercises. 

Most people with shoulder pain recover sufficiently within a few days or weeks to return to work, particularly if their work does not need loading of the shoulder. Many people continue working despite having a shoulder injury.

Frozen shoulder generally takes longer to recover compared to other shoulder conditions. Although it can take up to 2 years to recover, many people can continue with work despite having a frozen shoulder.

If you are considered for surgery, the orthopaedic surgeon and the physiotherapist will provide information about how much time you will need to take off from work and sport.

• After a rotator cuff repair, the surgeon may recommend up to 6 weeks of limited movement.
• After surgery for a shoulder dislocation, you may be away from work for around 6 weeks, depending on your type of work. It may take up to 6 months to return fully to sport, possibly longer for contact sports, such as rugby or ice hockey.

Your health care provider will be able to give you more specific information for return to work or sport after listening to your story, a physical examination, and based on how you respond to initial treatment and rehabilitation.

Getting older, by itself, does not predict whose pain will get worse or not.

There are many factors that influence how we recover from an injury, as well as what may make the injury or pain worse. Age may be just one of those factors.

Focus on the factors that you can control:

• remain physically active,
• keep the shoulder (and the rest of the body) strong in the long term,
• take care of our general health (‘whole body whānau’),
• remain connected with people that are important to you.

A rotator cuff tear does not always heal, and depends on many factors, such as the size of the tear, your general health, your physical activity, genes (family history) and age.

Tears can be painless or can become painless.

Focus on strengthening the intact parts of the rotator cuff muscles (and their tendon) and all muscles of the shoulder girdle and trunk, as well as taking care of your whole body health.

It is not uncommon that the other shoulder also hurts, regardless of what injury or pain condition you may have. Here are some reasons:

• You may have also had an injury in the other shoulder.
• Pain is generated within the brain (see ‘Why does my shoulder hurt’), and over time, movement of the other shoulder can be interpreted by the brain as being a ‘danger’. Thus, the other shoulder can hurt because the nervous system has become more sensitive.
• Your sports, work or other activities may entail work with both shoulders.
• You may be compensating with the other arm, for example at work and daily tasks. Compensating with the other arm may then render that shoulder painful.
   

Consider including the 'other' shoulder in the rehabilitation exercises: do those exercises for both shoulder. Ask your physiotherapist or other health provider what you can do to ensure that the 'other' shoulder remains well. If you have pain in that shoulder, ask them what you can do about it.