Physiotherapy Treatment for Shoulder Injuries
Shoulder injuries and the resulting shoulder pain is one the most common reasons why patients seek the services of the best professionals in physiotherapy clinics in South Auckland.
The shoulder joint
The shoulder has a ball and socket type of joint and is one of the major joints in the body. The joint connects the upper arm bone called humerus and the shoulder bone called scapula. The bony end of the scapula is the acromion. The rotator cuff is a group of four different muscles that surround and support the shoulder joint. Rotator cuff muscles include the supraspinatus, infraspinatus, Teres Minor, and subscapularis muscles. Besides these muscles, there are tendons and the bursa – a fluid-filled sac- that also cushion and support the shoulder joint.
Injuries resulting in shoulder pain
The common injuries in the shoulder that result in pain, stiffness, and weakness of the shoulder are:
Rotator cuff sprain/tear
The rotator cuff allows us to lift our arms above our head, play sports like tennis and swim.
Rotator cuff refers to a group of four muscles that support the shoulder and enable movement.
The four muscles are:
Supraspinatus muscle that holds the humerus or the long arm bone in its place and helps in lifting the arm
Infraspinatus muscle that helps in rotation and extension of the arm
Teres Minor that enables abduction or movement of the arm away from the body.
Subscapularis that allows us to straighten lower or extend the arm.
Tendons and bursa which is a sac filled with fluid also support the rotator cuff.
The common symptoms of severe rotator cuff injury are pain, loss of movement and weakness of the shoulder. In partial tears of rotator cuff the symptoms are mild shoulder pain and popping sound while trying to lift the shoulder.
The rotator cuff can be damaged either due to weakness or wear and tear of the muscles and tissue. Repetitive actions that involve overhead arm extension such as in sports can lead to wear and tear of tendons and muscles.
A mild inflammation of the rotator cuff tendon is called tendinitis. Tendinosis is when there is degeneration of the rotator cuff tissue. Partial or incomplete tear of the rotator cuff tendon can cause severe pain and trauma and progress to complete tear if not treated with physiotherapy. In addition inflammation of the bursa, called bursitis can also result in similar symptoms.
The condition is also called thrower’s or swimmer’s shoulder. Whenever the arm is lifted, the rotator cuff tendon has to pass through the narrow opening below the acromion (shoulder bone). With repetitive motion such as in swimming, the tendons become impinged as they move below the bone.
The shoulder is a large joint made up a ball and socket joint that makes movement in all planes possible. The joint is formed when the scapula or the shoulder blade joins the upper arm bone. The rotator cuff surrounds the shoulder and is made up of tendons and muscles that support the movements. Shoulder impingement occurs when the acromion or the bony end of the scapula presses on the irritated and inflamed muscles of the rotator cuff.
The typical symptoms of shoulder impingement are pain, loss of movement and weakness in the shoulder that is affected. Moving the shoulder overhead or stretching it can worsen the pain. Repeated actions such as those normally seen in swimming, overhead throwing and tennis are known to cause shoulder impingement.
When diagnosed early, most shoulder impingement and rotator cuff sprains can be effectively managed with physiotherapy. With early intervention there is complete resolution in 23% of new shoulder pain episodes, in a period of one month. About 44% of cases can be resolved in three months. Most acute shoulder injuries resolve within a period of six months to one year with appropriate physiotherapy interventions. When untreated, shoulder impingement can cause rotator cuff sprain or tendinitis. Long term sprain or injury to the tendons leads to tearing of the tendons in the rotator cuff.
The bursa is a fluid-filled sac that cushions and reduces friction between the bones and tissues in the shoulder. Bursitis is a condition where the bursa becomes inflamed due to the overuse of the shoulder or injuries sustained during falls.
Rotator cuff tendonitis
The rotator cuff tendonitis is a condition where the tendons and the muscles supporting the shoulder get inflamed and irritated. The inflammation usually happens because of repetitive motions that involve raising the arm over the head in sports like baseball, tennis, and in swimming.
AC joint sprain
Acromio-Clavicular injury is also known as AC joint sprain or “shoulder separation.”
The acromioclavicular joint connects the collarbone and the scapula or the shoulder blade. The AC joint allows movement of arms above the head and across the body. The joint also helps spread the pressure that comes from actions such as pulling, pushing or lifting to the rest of the body. The AC joint is supported by ligaments that hold the joint intact
Repetitive movements such as certain gym routines or falls during sporting events or running are some of the common causes of AC joint sprain. Such activities or falls cause the ligaments to stretch excessively while the scapula and collarbone separate.
The shoulder joint is also called as the glenohumeral joint, which is made up of large bones that are supported by muscles, tissues, tendons, and bursa. The synovial fluid helps lubricate the bones in the shoulder joint. In adhesive capsulitis, the tissues that surround the shoulder joint become inflamed leading to the loss of synovial fluid and the thickening of the capsule that surrounds the joint.
Shoulder dislocations occur when the bones in the shoulder joint are not aligned. In a dislocated shoulder, the upper arm bone separates from the scapula or the shoulder joint. The symptoms are the same as that of fracture shoulder.
Fracture shoulder: Fractures refer to broken bones in the shoulder that involve the collarbone or the clavicle, humerus or the end of the upper arm bone or the shoulder blade also called scapula. The symptoms include pain, swelling and difficulty in lifting the arms overhead or across the body.
Physiotherapy for shoulder injury/pain
All of the above conditions respond well to physiotherapy. Physiotherapists begin with an accurate assessment and diagnosis that are followed by an individualistic treatment course. Patient education is an important part of physical therapy sessions. The most competent practitioners of physiotherapy clinics in Auckland will determine the extent and nature of injury by ordering X-rays and MRI scans if necessary. X-rays will help understand if there is a fracture of shoulder bones.
Physiotherapy exercises including stretching and massaging help restore the normal lengths of muscles which can be shortened in acute injury while improving blood circulation.
A number of treatment modalities are used to ensure relief of symptoms and joint mobility.
Some of the treatment modalities include:
The use of sling if required to immobilize the joint
Exercises to mobilize the joint
A range of motion stretches
Strengthening of the scapulohumeral complex or the upper shoulder joint
Physiotherapy treatments are focused on providing maximum pain relief with soft tissue massages, therapeutic taping and other therapies.
Once the pain is minimized, a combination of strengthening and mobility exercises involving acupuncture, exercises to improve joint mobility and strength, and stretching exercises are prescribed. Furthermore, some exercises to perform at home on a long-term basis are also prescribed to prevent future injuries.