Q: Physiotherapy for the same A: Your MRI shows a right AC-joint sprain without separation, with surrounding swelling and a bone bruise at the outer clavicle/acromion. There is also bursitis, supraspinatus/infraspinatus tendinosis, and biceps tenosynovitis, but importantly no rotator-cuff or labral tear. Because the scan is dated 28 September 2026, this is still the very acute stage. The priority is protecting the AC joint and settling pain, not aggressive exercise. Physiotherapy plan Phase 1: First 7-10 days Goals: reduce swelling/pain, protect ligament and bone bruise, prevent stiffness. - Use a sling only for comfort for a few days, especially outdoors or during travel. Take it off several times daily to gently move the elbow, wrist, and hand. Do not keep it on continuously unless your orthopaedic clinician instructs it. - Ice over the top/front of the shoulder for 10-15 minutes, 3-5 times/day, with a cloth barrier. - Sleep on the back or the opposite side, with the injured arm supported on 1-2 pillows. - Avoid: - lifting, carrying bags on that side - pushing/pulling - overhead reach - cross-body movements, such as reaching to the opposite shoulder - push-ups, bench press, dips, planks, pull-ups - forceful massage directly over the AC joint - stretching into pain Gentle exercises, 3-5 times/day, only in a comfortable range: 1. Hand, wrist and elbow movements: 20 repetitions each. 2. Pendulum: Lean forward with the healthy hand supported on a table. Let the injured arm hang relaxed and make small forward-back, side-to-side, and circular movements for 30-60 seconds each. No active lifting of the arm. 3. Scapular setting: Sit tall, gently draw shoulder blades slightly back and down, without shrugging or forcing the injured shoulder backward. Hold 5 seconds, 10 reps. 4. Assisted shoulder elevation: Lying on the back, use the uninjured hand to help raise the affected arm only to the point of mild stretch, not sharp pain. 10 reps. Stop an exercise if pain rises above mild discomfort, persists into the next day, or produces a painful click or sense of instability. Phase 2: Approximately weeks 2-3 Begin only when resting pain and swelling are clearly improving and your clinician/physiotherapist agrees. Goals: regain range of motion and restore shoulder-blade control. - Continue pendulums and assisted movements. - Wall slides: Slide the hands up a wall slowly, staying below painful range. 2 sets of 8-10. - Table slides: Sit facing a table, place hands on a towel, and slide forward gently. 2 sets of 10. - Isometric rotator-cuff exercises: Keep elbow at the side, bent to 90 degrees, press gently into a wall or the opposite hand without moving the shoulder: - external rotation - internal rotation - gentle forward press Hold 5 seconds, 8-10 reps. Start at about 20-30% effort, never maximal effort. - Serratus/scapular control: Wall-supported shoulder-blade protraction, sometimes called a wall push-up plus, only after ordinary wall slides are comfortable. Do not yet do heavy resistance bands, side planks, overhead strengthening, chest presses, or cross-body adduction stretching. The AC ligament and bone bruising can remain tender for several weeks. Phase 3: Approximately weeks 3-6 Progress only if you have near-full comfortable movement and no significant AC-joint tenderness after daily activity. Goals: build rotator-cuff and scapular strength, then restore function. Perform 3 times/week, starting with light resistance: - Resistance-band external rotation with elbow tucked at side: 2-3 sets of 10-15 - Resistance-band internal rotation: 2-3 sets of 10-15 - Row with band, keeping elbows close to body: 2-3 sets of 10-15 - Low-row / scapular retraction - Wall push-ups, then incline push-ups if pain-free - Light biceps curls only when front-of-shoulder pain has settled Rehab for rotator-cuff related pain commonly focuses on restoring full comfortable movement, strengthening the cuff, and retraining the shoulder blade. Posterior scapular stabilisers such as serratus anterior, trapezius, and rhomboids help reduce load on the supraspinatus and long-head biceps tendon. Campbell's Operative Orthopaedics, 15th ed., treatment of primary extrinsic impingement. Return to gym, work, or sport Return gradually when all are true: - full or near-full pain-free movement - no tenderness/swelling over the AC joint - strength close to the other side - no pain during or the day after work/gym drills - clearance from your orthopaedic clinician or physiotherapist Start with light loads close to the body. Overhead lifts, bench press, contact sport, falls-risk activities, and heavy lifting should be the last activities to return to. Activity modification, range-of-motion work, and progressive strengthening are standard components of PT for biceps-related shoulder pain, as described by the APTA ChoosePT guidehttps://www.choosept.com/guide/physical-therapy-guide-biceps-tendinitis. See the orthopaedic doctor sooner if - deformity or increasing bump at the top of shoulder - worsening swelling, redness, or fever - numbness, tingling, coldness, or weakness in the arm/hand - inability to lift the arm at all after the first few days - pain is not improving over 1-2 weeks - persistent night pain or marked loss of motion A supervised physiotherapy assessment is advisable because the program needs to be adjusted to AC-joint tenderness, the bone bruise, and whether the bursitis or biceps tendon is the main remaining pain source. Q: Electrotherapy A: For this acute AC-joint sprain with bone bruise, bursitis, and cuff/biceps tendinopathy, electrotherapy can be used as an adjunct for pain relief, but it should not replace protection, graded movement, and exercise rehabilitation. Useful options in the first 1-2 weeks - Cryotherapy / cold pack: best-supported practical modality for acute pain and swelling. Apply 10-15 minutes, 3-5 times daily, with a cloth between ice and skin. - TENS: can be used around the painful shoulder for temporary pain control, allowing gentler movement and better sleep. Pads should be placed around, not directly over, the tender AC-joint prominence. - Interferential therapy IFT: may be used by a physiotherapist for short-term pain relief if TENS is not tolerated or ineffective. - Pulsed therapeutic ultrasound: some physiotherapists use it for acute soft-tissue pain, but its additional benefit is uncertain. It should not be the main treatment and should not delay exercise progression. - Low-level laser therapy: may be considered for pain relief where available, but evidence is mixed and treatment should be clinician-directed. Avoid for now - Shock-wave therapy ESWT: not appropriate in the acute phase, especially with a recent AC-ligament sprain and marrow contusion/bone bruise. It is not indicated by this MRI, which shows no calcific tendinitis. - Deep heating, continuous ultrasound, short-wave diathermy, or vigorous heat: avoid while there is visible swelling and acute inflammation over the AC joint. - Electrical muscle stimulation NMES: not needed initially. It may be considered later only if there is demonstrable muscle inhibition/weakness and it does not provoke pain. Typical session approach A physiotherapist may use cold therapy plus TENS/IFT for pain, followed immediately by pain-free pendulum movements, scapular-setting, and gentle assisted range-of-motion work. The essential rehabilitation components remain restoring shoulder movement and progressive rotator-cuff/scapular strengthening. Campbell's Operative Orthopaedics, 15th ed., pp. 7262-7270. Do not use electrotherapy over broken/irritated skin, areas with reduced sensation, a pacemaker/implantable defibrillator region without medical clearance, or if it makes pain/swelling worse. A recent systematic review in frozen shoulder found variable results for electrophysical agents, so these treatments should be viewed as symptom-relief tools rather than curative treatment 2024 systematic reviewhttps://pubmed.ncbi.nlm.nih.gov/37667875/.
