Common Shoulder Pathology
The rotator cuff is a structure composed of tendons that, with associated muscles, holds the ball at the top of the humerus in the glenoid socket and provides mobility and strength to the shoulder joint.
Physiotherapy examination is used to feel for injury and discover the limits of movement, location of pain, and extent of joint instability.
Dislocated shoulder Dislocated shoulder’ is the most frequently dislocated major joint of the body. In a typical case of a dislocated shoulder, a strong force pulls the shoulder outward or extreme rotation. When a shoulder dislocates frequently, the condition is referred to as shoulder instability.
Manipulating and reducing procedure will be necessary to treat dislocation by putting the head of the humerus back into the joint socket. Rest with a shoulder immobilizer for several days and application of ice three or four times a day is mandatory. After pain and swelling have been controlled, the patient enters a rehabilitation program with physiotherapist that includes exercises to restore the range of motion of the shoulder and strengthen the muscles to prevent future dislocations.
Tendinosis, Impingement Syndrome
Tendinosis-redness, soreness, and swelling of a tendon. In Tendinosis of the shoulder, the rotator cuff and or biceps tendon become inflamed, usually as a result of being pinched by surrounding structures. Squeezing of the rotator cuff is called impingement syndrome. Initial treatment for an impingement shoulder includes rest, ice, anti-inflammatory medications. Some patients are able to relief with simple series of stretching exercises and ice or heat. If the syndrome does not go away within couple of week, it will require specialized rehabilitation -physiotherapy treatment.
An inflamed bursa is called bursitis. Sports involving overuse of the shoulder and occupations requiring frequent overhead reaching are other potential causes of irritation to the rotator cuff or bursa and may lead to inflammation and impingement Signs of these conditions include discomfort and pain in the upper shoulder and/or difficulty sleeping on the shoulder, pain when the arm is lifted away from the body or overhead. The first step in treating these conditions is to reduce pain and inflammation with rest, ice, and anti-inflammatory medicines. In some cases the physiotherapist will use gentle mobilization technique. Gentle stretching and strengthening exercises are added gradually.
Frozen Shoulder (Adhesive Capsulitis)
Movement of the shoulder is severely restricted in people with a “frozen shoulder”, is frequently caused by injury that leads to lack of use due to pain. Rheumatic disease progression and recent shoulder surgery can also cause frozen shoulder. Adhesions grow between the joint surfaces, restricting motion. There is also a lack of synovial fluid, which normally lubricates the gap between the arm bone and socket to help the shoulder joint move. People with diabetes, stroke, lung disease, rheumatoid arthritis, and heart disease, or who have been in an accident, are at a higher risk for frozen shoulder. The condition rarely appears in people under the age of 40.
Treatment of the “frozen shoulder” entails physiotherapy that involves manual therapy applied by a physiotherapist to break down the adhesive capsulities in order to restore normal range of motion and exercises that strengthen surrounding shoulder muscles in order to stabilize the joint.
Arthritis Of The Shoulder ( Glenohumeral Joint )
In arthritis of the shoulder, the cartilage of the ball and socket is lost so that bone rubs on bone. It may be caused by wear and tear, injury, surgery, rheumatoid arthritis or infection (septic arthritis).
Early on, arthritis of the shoulder can be managed with mild analgesics and gentle exercises and hydrotherapy exercises that are provided by trained and licensed physiotherapists. One treatment that is usually helpful is therapeutic massage by a licensed massage therapist.
When exercise and medication are no longer effective, shoulder replacement surgery for arthritis may be considered.
Passive shoulder exercises are started soon after surgery. Patients begin exercising about 3 to 6 weeks after surgery. Stretching and strengthening exercises become a major part of the rehabilitation programme. The success of the operation often depends on the condition of rotator cuff muscles prior to surgery and the degree to which the patient follows the exercise program applied by physiotherapist.