Shoulder

Background

The shoulder is made up of multiple joints including your glenohumeral joint, acromioclavicular (AC) joint, and sternoclavicular (SC) joint. It is a “ball and socket” joint allowing for the most mobility of any joint in the body. Therefore, it requires flexibility and strength from the muscles and ligaments to provide stability to the shoulder. The rotator cuff muscles provide a significant portion of that stability and are often the cause of shoulder pain.

When someone experiences shoulder pain it can be difficult pinpointing a specific event that caused the pain. In contrast, a trauma such as landing on the shoulder or grabbing hold of something during or to prevent fall can also cause lingering pain. Although people frequently expect pain to subside overtime, it can persist for weeks and months before seeking formal care.


Quick Links
Rotator Cuff Tear & Tendonitis | Shoulder Instability & Dislocation | Shoulder Impingement Syndrome | Frozen Shoulder/Adhesive Capsulitis | Acromioclavicular Joint Sprain or Dislocation | Total Shoulder and Reverse Total Shoulder Replacement


Diagnoses

Rotator Cuff Tear & Tendonitis

Woman working with stretch bands under supervision of a trainerThe rotator cuff contains small muscles that connect from your shoulder blade and attach to your humerus (arm bone). The job of these muscles is to provide stability to the shoulder joint. Due to mechanical stress the rotator cuff muscles endure during daily activities, a rotator cuff tear and/or tendonitis (inflammation of the tendon) is a common injury. The injury can come from a traumatic event, such as a fall or it can be from degenerative ‘wear and tear’ mechanism.

A Rotator Cuff Tear can be diagnosed through a clinical exam or more definitively from MRI/CT exam. If a rotator cuff tear is diagnosed, physical therapy is often prescribed and a full recovery can be achieved (1). Physical therapy’s first goal is to reduce the pain and inflammation with either manual therapy and/or modalities such as electrical stimulation, ultrasound, or ice. The next goal is to increase the strength of the rotator cuff muscles and improve the muscular stability of the shoulder joint. Improving the biomechanics of the shoulder is imperative for long term improvement as well as pain management. >> top of page <<

Shoulder Instability & Dislocation

Because the shoulder joint is the most mobile joint in the body and requires muscle, ligaments, and tendons to provide stability, it is a commonly dislocated joint from falling, sports, or other traumas (2). People with greater shoulder mobility or flexibility are at an increased risk for dislocating their shoulder.

In the event of dislocation it is important to seek care from an orthopedic physician. Often times, however, this injury does not result in surgery and a referral to physical therapy is first line treatment. In physical therapy, the goal is to initially restore the range of motion, decrease pain, and to ensure a decreased risk of recurring injury. Strengthening the small muscles in the shoulder, specifically the rotator cuff muscles, is important for securing the stability of the shoulder joint for long term management. >> top of page <<

Shoulder Impingement Syndrome

One of the most common causes of shoulder pain is impingement syndrome. There are different causes of shoulder impingement. It can be a primary problem where the mechanics of the shoulder blade muscles aren’t performing well. It can also be a secondary effect caused by shoulder bursitis or rotator cuff tendonitis. Common symptoms of impingement are pain when reaching overhead, difficulty sleeping on the effected side, and pain when lifting or carrying.

Inflammation is often the cause of pain and limited range of motion. The first goal of physical therapy, to reduce this pain and inflammation, is achieved with either manual therapy or modalities such as electrical stimulation, ultrasound, or ice. After pain and inflammation have subsided, attention is next directed at correction the mechanical problems of the shoulder. This is achieved by strengthening the muscles, correcting muscle imbalances, and improving the relationship between the shoulder blade and shoulder joint. >> top of page <<

Frozen Shoulder/Adhesive Capsulitis

Teen baseball player throwing the ball on the baseball field Frozen shoulder, also known as adhesive capsulitis, is a clinical diagnosis that presents with decreased and painful shoulder motion. Frozen shoulder is caused by adhesions and tightening of the joint capsule around the shoulder joint. The joint capsule encases the two bones whose purpose is to provide stability and support to the shoulder. It is still unclear the exact cause of frozen shoulder but diabetes, prolonged immobilization, and hypo/hyperthyroidism has been shown to increase your risk of getting frozen shoulder (3).

Physical therapy treatment for frozen shoulder is manual therapy to increase range of motion, modalities to reduce chronic inflammation, and progressive strengthening exercise. Resolution of frozen shoulder often is a long process. Physical therapists are the experts at activity modification to reduce pain and improve function while symptoms continue to improve. >> top of page <<

Acromioclavicular Joint Sprain or Dislocation

The acromioclavicular (AC) joint is the top most portion of the shoulder that connects the collar bone and the shoulder. Much of the stability of the joint comes from the ligaments. In the case of AC joint disruption, the most effective treatment is dependent on which ligaments were involved with the sprain or dislocation. The most common mechanisms for AC joint sprain or dislocation is landing on the shoulder, tackling, or bike/car accidents.

Physical therapy’s focus will be to provide stability to the joint after injury and if surgery is performed, to increase range of motion. Improving the mechanics of the shoulder blade is important to achieve full range of motion and full function of the shoulder. >> top of page <<

Total Shoulder and Reverse Total Shoulder Replacement

A total shoulder replacement is a result of arthritic changes causing significant pain and limitations in mobility and daily function. The surgery consists of replacing the surfaces of the glenoid (“socket”) and the humerus (“ball”) with a metal material. By replacing the joint surfaces it significantly reduces pain with activities such as dressing, reaching, and lifting.

In a Total Reverse Shoulder surgery, the “ball and socket” are reversed in the shoulder. The reason for deciding on this surgery is if the rotator cuff muscles are not deemed viable for re-attachment. This surgery relies heavily on the deltoid muscle to complete reaching and overhead activities.

After surgery, you will be referred to physical therapy to regain range of motion as well as progressively strengthen the shoulder. Frequently, a surgeon’s protocol requires restrictions in range of motion and the physical therapist will safely progress you through the post-operative protocol. >> top of page <<

 


Sources

  1. Kuhn JE, et al. Effectiveness of physical therapy in treating atraumatic full-thickness rotator cuff tears: a multicenter prospective cohort study. Journal of Shoulder and Elbow Surgery. 22(10): 1371-1379.
  2. Wang RY, Arciero RA, Augustus DM The Recognition and Treatment of First-Time Shoulder Dislocation in Active Individuals. Journal of Orthopaedic & Sports Physical Therapy. 2009; 39:2, 118-123.
  3. Kelley, Martin et al. Clinical Practice Guidelines Linked to the International Classification of Functioning, Disability, and Health From the Orthopaedic Section of the American Physical Therapy Association. Journal of Orthopaedic & Sports Physical Therapy. 2013; 43(5): A1–A31.

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