The shoulder region is a challenging area to treat. The extreme mobility of the shoulder joint, with its dependency on muscular function and control, means that rehabilitation for this area is incredibly important for day to day activities.
Injuries to the shoulder region result from the same two mechanisms as those occurring elsewhere in the body: macrotrauma or repetitive microtrauma. The former generally results from shoulder impact injuries (with the ground or another person), or due to forces being applied to the outstretched arm. The overuse injuries are usually due to repetitive and sometimes forceful activities that frequently involve the extremes of the shoulders range, particularly overhead movements.
Your Advantage Physical Therapist will accurately diagnose and assess this area to determine the best treatment method. There are numerous joint and muscle tests to aid in diagnosis.
The AC joint is commonly injured in sports, especially collision sports. Typically the athlete sustains an impact to the point of the shoulder either from another competitor or when falling to the ground. The angle of the AC joint drives the acromion beneath the clavicle with resultant ligament damage. The site and severity of the ligament damage reflects the forces applied at the time of injury.
Physical therapy treatment for this type of injury is dependent on the severity of the injury. At times surgery may be necessary if the area is too unstable to treat.
Rotator Cuff Strain / Rupture
Acute strains of the rotator cuff can occur during a fall or wrenching of the arm, or in the event of a strong contraction of the rotator cuff musculature during which the expected transfer of momentum does not occur. For example, a miss-hit tennis backhand or a poorly coordinated, hard throw.
Rotator cuff tears can be treated in most instances by your Physical therapist, but many times, further evaluation and imaging by a skilled orthopedist will be indicated to determine the degree of tear.
Rotator cuff tendonitis is also another common cause of shoulder pain. Initial symptoms include pain with overhead activity and weakness. If left unchecked this can progress to a complete or partial tear.
Physical therapy aimed at restoration of normal movement may include:
- Mobilization and shoulder capsule stretching
- Pain management techniques
- Rotator cuff strengthening exercises
- Stretching and strengthening exercises
- Dislocated Shoulder
A dislocated shoulder is a common shoulder injury in contact sports such as football and martial arts. The most common form of dislocation is anterior dislocation. Unless a doctor or experienced physical therapist is on site at the time of injury, hospital treatment is often required to restore normal function. The shoulder is usually placed in a sling and shoulder physical therapy may commence after a few weeks.
Physical therapy aimed at restoration of normal movement will include:
- Functional rehabilitative exercises
- Stretching and strengthening exercises
- Soft tissue massage for tight muscles
- Proprioception exercises
- Broken Clavicle – Collar bone
This injury occurs if you fall onto an outstretched arm, where the force is transmitted up the arm causing the collar bone to break. If severe, this injury may warrant surgery or require immobilization for a period of time. Medical advice should be sought initially, and then physical therapy may commence depending on the severity of the injury.
Frozen Shoulder – Adhesive Capsulate
Frozen shoulder or ‘Adhesive Capsulitis’ is a common cause of shoulder pain in people between the ages of 40 and 60, with women affected more than men. Physical therapy treatment is the often first option for Frozen Shoulder treatment.
Common Frozen Shoulder signs and symptoms:
- Finally, there is a gradual increase in shoulder range of motion (Thawing Phase)
- First, shoulder pain begins and leads to a gradual loss in shoulder movement (Freezing Phase)
- Next, there is restriction of shoulder movement, which can last for up to a year (Frozen Phase)
- This shoulder injury may last for months to years. It is crucial that it is accurately diagnosed and assessed to prevent long term and chronic disability.
Shoulder bursitis is a common cause of shoulder pain that is often related to rotator cuff injury and tendonitis. This condition is sometimes called shoulder impingement syndrome. Shoulder bursitis can occur as a result of the Subacromial bursa being squashed or ‘impinged’ between the rotator cuff muscles (Supraspinatus, Subscapularis, Infraspinatus and Teres Minor) and the bone, during repeated overhead shoulder movements.
This condition is characterized by pain with raising the arm overhead and when lying or sleeping on the shoulder. This injury can be treated with rest and with physical therapy at the site of injury, such as strengthening rehabilitative exercises.