Six Months Post-Car Accident: Managing Shoulder Injuries and Pain

After six months of rehabilitation following a car accident, there has been no improvement. The injuries include joint sprain, rotator cuff injury, and acromioclavicular joint dislocation?

On July 24, 2023, I was injured in a car accident and was taken by ambulance to Chengda Hospital, where I underwent X-rays.
The hospital stated that there were no fractures, only soft tissue injuries that required suturing, and I was discharged.
Since then, I have been feeling unwell.
I tried acupuncture with a traditional Chinese medicine practitioner, but there was no improvement.
I then sought treatment at a rehabilitation clinic, where I gradually started to feel better.
However, for the third to fourth month, I was unable to lift my right arm; I could only raise it forward horizontally.
Initially, I experienced pain on the inner side of my elbow, which improved, but I occasionally felt sharp pain on the outer side of my elbow.
I also had vague shoulder pain, which has persisted for almost six months.
(During this half-year, I have been unable to sleep well due to the pain.) On October 24, I underwent PRP therapy (for a rotator cuff tear of over 1 cm).
On November 23, I was preparing for a second PRP treatment, but the rehabilitation physician felt the treatment was ineffective and referred me to Chimei Hospital's rehabilitation department for further examination (including X-rays and MRI) on November 24.
During this period, I continued rehabilitation with electrical therapy, laser treatment, heat therapy, and manual therapy.
On January 10, I completed the MRI at Chimei Hospital.
On January 18, the rehabilitation physician reviewed the examination reports, which indicated joint capsule injury, rotator cuff injury, and acromioclavicular joint dislocation.
The rehabilitation physician now wants me to see a sports medicine specialist at a major hospital for treatment.
I would like to ask Dr.
Wang: how should I proceed with treatment after discovering the joint capsule injury, rotator cuff injury, and acromioclavicular joint dislocation six months later? Currently, my right shoulder has been in constant pain every day for the past six months, especially at night while sleeping.
My right arm feels weak, and I can’t lift it without assistance from my left hand.
I need to ride a motorcycle for work and started riding again on November 10, but turning while riding is quite difficult.
Each ride lasts about 1 to 2 hours.
(This is my first inquiry; I would appreciate Dr.
Wang's advice.
Thank you.)

Si Yun, 40~49 year old female. Ask Date: 2024/01/19

Dr. Wang Shouji reply Orthopedics

You can go to the outpatient clinic for evaluation.

Reply Date: 2024/01/19

More Info

It sounds like you have been through a challenging recovery process following your car accident six months ago. The symptoms you describe, including persistent pain in your shoulder and arm, limited range of motion, and difficulty sleeping, are not uncommon after such injuries. Let's break down your situation and discuss potential management strategies.

First, it's important to understand that shoulder injuries, particularly those involving the rotator cuff and joint structures, can take a significant amount of time to heal. The rotator cuff is a group of muscles and tendons that stabilize the shoulder and allow for a wide range of motion. Injuries to this area can lead to pain, weakness, and limited mobility, which seems to align with your experience of not being able to lift your arm fully and experiencing pain during activities.

Given that you have already undergone PRP (Platelet-Rich Plasma) therapy, which is often used to promote healing in soft tissue injuries, and have engaged in various rehabilitation therapies, it’s crucial to continue working closely with your healthcare providers. The fact that you are experiencing ongoing pain and functional limitations suggests that further evaluation and possibly more intensive treatment may be necessary.

Here are some steps you might consider:
1. Consult a Specialist: Since your rehabilitation physician has recommended seeing a sports medicine specialist, this is a critical next step. A sports medicine doctor can provide a comprehensive evaluation of your shoulder, including a review of your MRI results, and discuss potential treatment options tailored to your specific injuries.

2. Physical Therapy: Continuing physical therapy is essential. A physical therapist can help you with specific exercises to improve strength and flexibility in your shoulder. They can also employ modalities like ultrasound or electrical stimulation to help manage pain.

3. Pain Management: If pain is significantly affecting your quality of life, discussing pain management options with your healthcare provider is important. This may include medications, injections, or alternative therapies such as acupuncture or chiropractic care.

4. Activity Modification: Since you mentioned that riding your motorcycle is challenging, consider modifying your activities to avoid exacerbating your shoulder pain. This might mean taking breaks during long rides or adjusting your riding position to minimize strain on your shoulder.

5. Surgical Options: If conservative treatments do not yield the desired results, surgical intervention may be necessary, especially if there are structural issues such as a significant rotator cuff tear or joint instability. A sports medicine surgeon can discuss the risks and benefits of surgery based on your specific condition.

6. Sleep Hygiene: Since pain is affecting your sleep, consider strategies to improve your sleep hygiene. This could include using pillows to support your arm and shoulder while sleeping, adjusting your sleep position, or exploring relaxation techniques to help you fall asleep.

7. Follow-Up Imaging: If your pain persists, follow-up imaging studies may be warranted to assess the healing process and determine if there are any new issues that need to be addressed.

In summary, while it is concerning that you are still experiencing significant pain and functional limitations six months post-accident, there are multiple avenues for further evaluation and treatment. Collaborating with a sports medicine specialist and continuing your rehabilitation efforts will be key to improving your shoulder function and reducing pain. Remember, recovery from such injuries can be a gradual process, and it's important to be patient while actively participating in your recovery journey.

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