Shoulder

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Shoulder

Rotator Cuff Tear

The rotator cuff is a group of four tendons and muscles that converge around the shoulder joint. Together, they form a ''cuff'' that both holds your arm in place and allows it to move with stability in different directions.  Too much stress can cause partial tears and swelling in the tendons of the rotator cuff. Abrupt stress may even cause one of the tendons to pull away from the bone or tear in the middle of the tendon.

Athletes prone to getting rotator cuff tears include: Baseball players, especially pitchers, swimmers, tennis players, and football players.

Other causes of rotator cuff tears include: faulty mechanics, weak stabilizing muscles, falling on your shoulder, using an arm to break a fall, lifting a heavy weight or lifting from an awkward position, and stopping  yourself  from falling, such as while climbing,or falling off a ladder.

Many rotator cuff tears can improve or heal with time and correct guidance by a Physical Therapist. Treatment may include mobilization of restricted joints at the shoulder, neck and upper back; exercises to strengthen the rotator cuff, the scapular (shoulder blade) stabilizers and core muscles. In throwing and overhead swing athletes, strengthening and ROM (range of motion) of the entire lower extremity may be necessary as the ability to generate work from the hip is necessary to avoid overloading the shoulder.

More serious rotator cuff tears require surgery, and we will communicate that to you if your evaluation indicates it right away, or if you don't respond to treatment. Strengthening your shoulder prior to surgery may help shorten your post-operative time.

Impingement

Shoulder impingement syndrome is one of the most common causes of shoulder pain. It occurs when there is a pinching of tendons or bursa in the shoulder. Overhead activity of the shoulder, especially repeated activity, is a risk factor for shoulder impingement syndrome. Examples include: painting, lifting, swimming, tennis, and other overhead sports. With impingement syndrome, pain is usually around the top, front, or side of the shoulder, persistent and affects everyday activities. Motions such as reaching behind the back or reaching up overhead to put on a shirt or blouse, may cause pain. 

Over time, impingement syndrome can lead to irritation of the rotator cuff tendons (tendinitis) and bursa (bursitis). If not treated appropriately, the rotator cuff tendons can start to thin and tear.

The vast majority of people who have impingement syndrome are successfully treated with physical therapy.  Treatment addresses the faulty mechanics of the shoulder girdle such as poor posture, an imbalance in strength and flexibility, weak muscles around the shoulder blade, and tight chest and shoulder muscles which contribute to impingement syndrome. This may include manual therapy techniques, postural training, and very specific exercises.

Labral Tear

A labral tear is a specific kind of injury to your shoulder involving a tear of the cartilage of the shoulder.

To help make your shoulder more stable, there is a ring of firm tissue, called the labrum, around your shoulder socket. The labrum helps keep your humeral head (head of the arm bone) in the shoulder socket.

The labrum frays or tears because of an injury. Causes of a labral tear include:  A fall on your outstretched arm, a fall on your shoulder, bracing yourself with your outstretched arm in a car accident, lifting heavy objects repeatedly or too suddenly, and repetitive  overhead activities, such as throwing a baseball (AND I WOULD PUT THIS LAST ONE FIRST)

Many people with labral tears also have other shoulder injuries, such as a tear in the rotator cuff.

Physical therapy is a reasonable and often effective first step to take before progressing to more serious interventions.  Treatment may include manual techniques to restore normal range of motion in the joints and muscles of the shoulder girdle, neck and upper back; strengthening of the muscles of the shoulder girdle and core; and addressing faulty movement patterns during throwing and/or overhead use. 

Tendonitis

Shoulder tendinitis is inflammation of a tendon attaching a muscle to bone, usually one of the rotator cuff muscles or the biceps.  It is most often caused by repetitive use of the arm.

Causes include: faulty mechanics;  overuse, or doing too much too soon when the body isn't ready for that level of activity (tennis, swimming, throwing, painting, lifting); incorrect posture at work or home;  or poor stretching or conditioning before exercise or playing sports. Tendinitis is common in "weekend warriors," people that play and exercise hard only on weekends.

Stresses from other conditions, such as rheumatoid arthritis, gout, psoriatic arthritis, thyroid disorders, or unusual medication reactions may also contribute to tendinitis.

Treatment may include manual therapy to improve mobility of stiff joints and muscles, exercises to improve the balance of strength and flexibility around the shoulder and supporting joints, postural education, taping for positioning and muscle facilitation, and advice on improving the mechanics of your painful activity.   Modalities may be utilized in the early stages.

Frozen Shoulder (Adhesive Capsulitis)

Frozen shoulder (adhesive capsulitis) is stiffness, pain, and limited range of movement in your shoulder. The tissues around the joint stiffen, scar tissue forms, and shoulder movements become difficult and painful. The condition usually comes on slowly, over the course of 1-3 months, becomes gradually more painful and stiff over 3-9 months, then goes away slowly over the course of a year or more.

The cause of frozen shoulder is a matter of debate still.  It can develop when you stop using the joint normally because of pain, injury, or a chronic health condition, such as diabetes or a stroke. Any shoulder problem can lead to frozen shoulder if you do not work to keep full range of motion.  Commonly a person is unaware of having injured his or her arm, but notices symptoms without experiencing trauma first.

Frozen shoulder occurs most often in people 40 to 70 years old, and more often in women  (especially in postmenopausal women) than in men.

A Physical Therapist can guide you through the healing process and prevent common pitfalls of frequent irritation. Treatment includes dealing with the pain in the initial phase, with modalities, manual therapy, gentle stretching, and home exercises. In the middle  stages, mobilization and more aggressive stretching and other manual techniques may be employed. In late stages, exercises to restore strength, ROM, and return to sports and activities is the emphasis.

Separation/Dislocation

They're easy to confuse. But a dislocated shoulder and a separated shoulder are two distinct injuries. Here's the rundown.

Dislocated shoulder: In this injury, a fall or blow causes  humerus to pop out of the shoulder socket. The shoulder joint is inherently unstable, prone to slipping out of place.  In severe cases of dislocated shoulder, the tissue and nerves around the shoulder joint get damaged. If you keep dislocating your shoulder, you could wind up with chronic instability and weakness. It is usually obvious when you dislocate your shoulder, but sometimes may go back “in” before seeking medical help.

Separated shoulder. Despite the name, this injury doesn't directly affect the shoulder joint. Instead, a fall or blow tears one of the ligaments that connects the collarbone to the shoulder blade, called your acromioclavicular, or “AC” joint, at the top of your shoulder.
Since it's no longer anchored, the collarbone may move out of position and push against the skin near the top of your shoulder. Although separated shoulders can cause deformity, people usually recover fully with time.  Symptoms are usually pain directly over the top of the shoulder, localized pain to touch here, and may refer pain along the collar bone and into the muscle towards your neck. Treatment may consist of taping, and focus on strengthening the surrounding musculature to support the AC joint, especially with lifting with an extended arm.

Dislocated shoulders need to be treated right away. Your doctor may need to move the arm bone back into the shoulder socket, and determine the extent of the damage to the surrounding tissue. Following relocation a Physical Therapist will work with you to strengthen the shoulder back to a stable position, if a surgical option isn’t immediately recommended.

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