What treatment and management options are recommended for a patient with a shoulder injury from a fall a month ago, presenting with ongoing pain and stiffness?

Patient Education for Shoulder Injury from Fall One Month Ago

You need to start a structured physical therapy program immediately focusing on external rotation and abduction exercises, combined with pain control using over-the-counter medications like ibuprofen or acetaminophen, to prevent your shoulder from becoming permanently stiff. 1, 2

Understanding Your Injury Timeline

At one month post-injury, you are at a critical window where proper treatment can prevent long-term disability. If formal physical therapy is not initiated by 6-8 weeks post-injury, permanent shoulder dysfunction may result. 2 Your shoulder pain and stiffness likely involve:

• Capsular inflammation and early fibrosis (tissue scarring) 3
• Rotator cuff muscle weakness from disuse 4
• Loss of external rotation, which is the single most critical factor related to ongoing shoulder pain 1, 2

What You Must Do Now

Immediate Actions (Start Today)

Begin gentle stretching exercises multiple times daily, focusing specifically on:

• External rotation movements (rotating your arm outward away from your body) - this is your highest priority 1, 2
• Abduction movements (lifting your arm away from your side) 1, 2
• Perform these stretches 3-4 times daily to prevent frozen shoulder 4

Take pain medication regularly to enable you to participate in exercises:

• Ibuprofen or acetaminophen as first-line options 4, 2
• Take these before exercises to control pain and allow proper movement 2

Critical Things to AVOID

Never use overhead pulleys or pulley systems - this single intervention carries the highest risk of worsening your shoulder pain and should be completely avoided. 4, 1, 2

Do not immobilize your shoulder with a sling for extended periods - while a sling may provide short-term comfort, prolonged immobilization causes muscle atrophy and promotes frozen shoulder development. 1, 2

Do not rest completely - complete immobilization causes muscular atrophy and deconditioning, yet you also need to avoid activities that cause sharp pain. 1

Your Treatment Plan

Phase 1: Pain Control and Gentle Motion (Weeks 1-2)

• Use ice for 15-20 minutes after exercises to reduce inflammation 4
• Take NSAIDs or acetaminophen regularly, not just when pain is severe 4, 2
• Perform gentle pendulum exercises (letting your arm hang and swing gently) 5
• Gradually increase external rotation range of motion - this prevents the most common cause of persistent shoulder pain 1, 2

Phase 2: Progressive Strengthening (Weeks 3-6)

• Begin rotator cuff strengthening exercises with resistance bands 4, 1
• Focus on scapular stabilizer muscles (muscles around your shoulder blade) 4, 1
• Strengthen weak muscles while restoring proper shoulder alignment 4, 2
• Continue emphasizing external rotation and abduction movements 1, 2

Phase 3: Functional Recovery (Weeks 6-12)

• Progress to functional activities that mimic daily tasks 6
• Restore proprioceptive control (your shoulder's sense of position) 6
• Achieve pain-free mobility before returning to full activities 4

When to Seek Additional Medical Care

See your doctor within 1-2 weeks if:

• Pain is not improving with over-the-counter medications and exercises 5
• You cannot lift your arm away from your body 5
• Stiffness is worsening despite daily stretching 3

Your doctor may recommend:

• Intra-articular corticosteroid injection (triamcinolone) if pain prevents you from doing physical therapy - this provides significant pain relief particularly in early-stage shoulder stiffness 4, 2
• Formal physical therapy referral for supervised rehabilitation 2, 5
• Imaging (ultrasound or MRI) if rotator cuff tear is suspected, especially if you have persistent weakness 1

Understanding Why This Approach Works

Short-term treatments like ice and NSAIDs only provide symptomatic relief without addressing the mechanical causes of your shoulder problem. 1 The real issue at one month post-injury is:

• Chronic changes involve collagen disorientation and fiber separation with degenerative changes rather than acute inflammation 1
• External rotation limitation relates most significantly to the onset and persistence of shoulder pain 1
• Stretching programs that neglect external rotation motion lead to treatment failure 1

Your shoulder will not heal properly with rest alone - you need active rehabilitation to restore normal mechanics and prevent permanent stiffness. 1, 2, 3

Expected Recovery Timeline

• Weeks 1-2: Pain reduction and initial motion improvement 3
• Weeks 3-6: Progressive strength gains and functional improvement 4
• Weeks 6-12: Return to normal activities if rehabilitation is consistent 4, 3

Most patients with acute shoulder injuries can be treated successfully with this conservative approach using targeted musculoskeletal rehabilitation. 5 However, the key to success is starting immediately and performing exercises consistently - waiting longer significantly increases your risk of permanent shoulder dysfunction. 2