The Shoulder Joint
or glenohumeral joint, is a ball and socket joint between the humerus (upper arm) and the scapula (shoulder blade). It is a loose joint and the rotator cuff muscles help to hold the shoulder in the socket. This is important because it allows an enormous range of motion to do all the tasks that are required everyday, but that large range of motion also makes it vulnerable to injury. The rotator cuffs which hold it in the socket have to combine flexibility as well as strength to keep the shoulder stable, and be able to do all the jobs it has to do everyday. If they get tight or weak through injury, then we get pain.
There is also a bursa, which is a sac of fluid which separates the rotator cuff tendons from the bones. They allow the tendons to glide smoothly when you move your arm. As we said earlier, the shoulder is a very mobile joint which also needs to do heavy lifting and repetitive work. If the muscles, ligaments or tendons are not working well together or coordinating properly, we can get pain and inflammation in the muscles, tendons, bursa and even the joint itself.
Shoulder impingement occurs when the rotator cuff or bursa become compressed, or ‘pinched’ in the space between the ball of the shoulder and the socket. This causes inflammation of the tendon and bursa which can cause pain and restriction of the shoulder range of movement.
It is a very painful condition, often felt at the front of the shoulder or down the arm towards the elbow. It can be painful to sleep on it at night, to lift something heavy, or to reach overhead or behind your back.
It can be caused by repetitive movements such as reaching, overhead work, poor posture and biomechanics, repetitive computer and mouse use, or trauma like a fall.
Shoulder physio will identify the cause of the impingement and help to alleviate the tightness with massage and joint mobilisations, as well as providing pain relief with ultrasound, heat and TENS. We also provide a stretch program to alleviate the muscle tightness, and strength work to correct the imbalances. Impingement injuries respond very well to shoulder physiotherapy, and we get great results with treatment.
Rotator Cuff Tears
The rotator cuff are the four tendons of the shoulder which keep the shoulder firmly in the shallow shoulder socket. When injured, they can cause a dull ache in the shoulder and it can be painful to sleep on the injured side. It can cause weakness and pain when lifting the arm, difficulty reaching to comb your hair, or to put your hands behind your back. They are most commonly injured with repetitive overhead work or sports, eg. Painters and carpenters, tennis, netball or basketball players. The risk also increases with age, with progressive degeneration and wear and tear of the tendon tissue. The tendons can weaken as we get older and become more susceptible to injury, with activities like lifting, reaching, putting luggage overhead.
Physiotherapy aims to restore the shoulder movement with massage, gentle joint mobilisations, and a progressive program of stretches and strength work aimed at restoring the biomechanics of the shoulder. Rotator cuff tears respond well to shoulder physio, but a small percentage may require surgical intervention. Physiotherapy is important before surgery to stretch out the tight muscles, restore shoulder movement and improve strength to help speed up your recovery after surgery. Physiotherapy postoperatively aims at pain reduction, restoration of movement and flexibility and strength. We closely follow your surgeon’s protocol to help get you the quickest recovery possible.
Shoulder Subluxation or Dislocation
A shoulder subluxation is a partial dislocation where the shoulder comes part of the way out of the shoulder socket before it goes back into the joint. A dislocated shoulder occurs when the ball of the shoulder joint comes completely out of the socket. It is an extremely painful condition and the shoulder can not move until it is relocated back into its socket.
A subluxed or dislocated shoulder can occur with trauma like a fall, car accident or with sports like football tackle. It can also be caused by a ligament overuse strain. Some people have more flexible ligaments in their bodies, or are hypermobile, which allows the shoulders to dislocate more easily.
Some sports, like tennis, swimming, throwing sports like cricket, softball and baseball require repetitive overhead activities which can overstretch the ligaments and shoulder joint capsule.
These looser ligaments make the rotator cuff muscles work harder to maintain the shoulder inside the socket. If they fatigue with too much repetitive work like throwing, bowling or serving in tennis, or they get injured, then the shoulder is at risk of subliming or dislocating.
People with loose ligaments, hyper mobility or who play sports with repetitive overhead tasks would benefit from a specific assessment and rotator cuff strengthening program, tailored their activity or sport.
Adhesive capsulitis or Frozen Shoulder is characterised by stiffness and pain in the shoulder joint. It tends to start gradually and worsen over time, and can continue for up to three years. It is more common in diabetic patients, and can also occur after surgery to the shoulder or trauma, like a fall. Sometimes however, it can just start spontaneously.
Shoulder physiotherapy treatment aims to speed up your recovery. We do this by massaging the muscles around the shoulder, gently mobilising the shoulder joint, prescribing range of motion stretches, and strengthening work once the pain subsides. It is unusual for frozen shoulders to reoccur in the same shoulder, but some people can develop them in their other shoulder. However if this happens they tend to much quicker to resolve than the original frozen shoulder. It is important to get treatment and advice as soon as possible to help speed up your recovery.
Acromioclavicular (AC) Joint Injury
An AC joint injury is a frequent injury in physically active people. The AC joint is the joint between the collarbone (clavicle) and the shoulder blade (scapular). It is most commonly caused by a fall onto the ‘point’ of the shoulder, a direct blow in contact sport like rugby, or a throwing sport like shot putt. The pain is felt at the end of the collar bone over the top of the shoulder joint. It can be swollen, and with a more severe injury a step deformity may be visible. There is pain on moving the shoulder, especially above shoulder height.
Shoulder physiotherapy is aimed at easing the pain and swelling with gentle massage, ultrasound, ice and taping, or providing a sling. We do gentle shoulder stretches to help maintain the range of motion of the shoulder, and strengthening exercises once the pain starts to settle. It is important to restore the shoulder biomechanics to prevent future damage to the shoulder tendons.
Spondylolysis (Back stress fracture)
Spondylolysis is a common cause of back pain in children, adolescents and active young adults. It is a non-displaced stress fracture of the spinal vertebra, also known as a pars stress fracture. In more severe cases, the vertebral body can slip forward. This is called spondylolisthesis and is more common in individuals with pars fractures on both sides of the vertebra. Activities that require repetitive rotation and/or hyperextension can cause stress fractures, for example, cricket, gymnastics and dancing. The pain is usually sharp and aggravated by arching and standing. Most cases respond well to conservative treatment which consists of pain management and a comprehensive exercise program targeting flexibility, strength and core stability. Indication for surgery is extremely rare in this condition.