Specialised Shoulder Physiotherapy
The following descriptions of these shoulder problems are designed only to give you a general idea of what they are and how they occur. Properly diagnosing and managing these problems involves a comprehensive examination by an experienced physiotherapist.
Rotator cuff issues
The rotator cuff is made up of four muscles which originate from the shoulder blade and attach around the humeral head. They are the supraspinatus, infraspinatus, subscapularis and teres minor. Their role is a complex interplay of actions designed specifically to centre the ‘ball’ in the ‘socket’ during all movements no matter how fast or repetitive they are.
Unaccustomed movement patterns, such as repetitive overhead activities (e.g. painting the ceiling) may cause an acute tear or aggravate a degenerative tear in the tendon. This occurs when the rotator cuff tendons are not properly conditioned for the strength and endurance requirements of the new repetitive task or sporting activity.
Tendinopathy is terminology used to describe adverse changes in the tendon which result in pain and dysfunction. A tendon attaches muscle to bone. Tendons are made up of smaller fibres, much like a rope is. Microtearing of these fibres and the tendons inability to heal (due to factors such as not avoiding the aggravating activites) cause an inflammatory reaction (tendonitis) felt as pain. The longer this pain is ignored the more likely a tendinosis (i.e. degenerative changes) will occur. This may mean a longer rehabilitation or surgery to fix the problem.
A bursa is a fluid filled sac which sits between anatomical structures to help prevent friction . The subacromial bursa is one of the biggest in the body and sits between the supraspinatus tendon and the acromion (the bony protrusion above the humeral head). This may become inflamed and may cause impingement issues.
This starts when passive constraints around the shoulder joint are too loose or too tight. Instability (or subluxation) follows if the surrounding muscles fail to centre the ball in the socket. This then puts unaccustomed stress on structures which are not designed to withstand such forces. Ultimately this leads to pain and dysfunction.
In order to treat this condition effectively, it is imperative to be professionally guided by a physiotherapist through a rotator cuff recruitment/strengthening program (and scapular stabilisation) with emphasis on sport/task specificity.
Occurs when the ball of the shoulder ‘pops’ out of the socket. This causes extensive damage to the passive constraints (i.e. ligaments, capsule labrum). Remember, these passive constraints play an integral role in maintaining the stability of the glenohumeral joint. Most dislocations are classified as anterior, meaning that the ball moves forward out of the socket and commonly occurs when the arm is in a ‘stop sign’ position (abducted and externally rotated).
Immediate medial assistance should be sort to relocate the shoulder, take x-rays to rule out any fractures, protect the relocated joint, have an orthopaedic review and undergo a comprehensive rehabilitation program from a physiotherapist. This rehabilitation program is designed to minimise the chance of re-dislocating the shoulder. The orthopaedic review is for the specialist to determine whether or not surgery is indicated. There are a variety of braces on the market which claim to protect you from re-dislocation.
The clavicle is also known as the collar bone, joining the shoulder blade to the sternum (or breast plate). This bone can break when landing on an outstretched arm, shoulder ‘charging’ an opponent or falling on the ‘point’ of your shoulder. If a fracture is suspected, seek medical help to assess, x-ray and plan your course of treatment. They usually take between 4 and 8 weeks to heal and some require surgery.
A/C Joint Injury
The A/C (acromioclavicular) joint is the articulation between the collarbone and the acromion (the bony protrusion on the top of the shoulder which forms part of the shoulder blade). An injury to the A/C joint can occur in the same way a clavicular fracture may occur. The ligaments and capsule surrounding the joint get torn causing varying degrees of subluxation (may be seen as a step deformity) which will be graded by an experienced physiotherapist. The type and length of rehabilitation is determined by the level of subluxation.
Also known as adhesive capsulitis. The cause is largely unknown in many cases. It may also occur after a significant shoulder injury or surgery. The main complaint with this condition is stiffness (lack of range) and pain. Treatment in many cases can help and may involve a hydrodilitation procedure (injection) followed by extensive physiotherapy.
These can occur from blunt trauma, stretching of the nerve, traction on the neck/shoulder or from nerve compression. Symptoms may include pain that is deep and poorly localised, weakness, muscle wasting and dysfunction. It is sometimes seen in throwing sports, weight lifters etc. A thorough examination by an experienced physiotherapist or doctor is paramount.
A strain or a tear of muscle fibres occurs when the force involved in the action (sport) outweighs that with which the muscle is accustomed to. Many things can contribute to a tear including poor technique, biomechanical issues, no warm-up, past-injury, unaccustomed movement patterns, impact etc. A thorough examination by a physiotherapist can address all of these issues.
The neck and upper back commonly refer pain to the shoulder.
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