Shoulder

The shoulder joint complex is unique in being extremely mobile, though this leads to a compromise in stability and it is therefore a commonly injured joint.

The basic anatomy of the shoulder comprises the glenohumeral joint (the ball and socket) with other joints formed by the clavicle (collar bone) and scapula (shoulder blade) making up the shoulder complex. Muscles surrounding the joint include the rotator cuff, a group of muscles which stabilise the shoulder. Traumatic shoulder injuries are common in sport, and are a frequent presentation that require shoulder physiotherapy.

Rotator Cuff Strain/Tendinopathy

What is a rotator cuff strain?

The rotator cuff is a group of four small muscles which attach from the shoulder blade to your upper arm via a group of tendons. They act to hold the ball in the socket of the shoulder joint and help produce movement. A rotator cuff tear is a tear in one of these muscles and a rotator cuff tendinopathy is an injury to one of the tendons.

What causes a rotator cuff strain?

The rotator cuff muscle can be injured when it is forcibly contracted or overstretched. The rotator cuff tendons are most commonly injured from overuse, however falls can result in frank tears.

How does a rotator cuff strain feel?

A tear of the rotator cuff muscle is usually felt as a sudden pain or a “twinge” in the shoulder area. If you sustain a minor tear you may be able to continue participating in your sport or activity, however when the shoulder cools down and the inflammation process increases, your symptoms may increase. A more severe tear may result in you being unable to continue to participate in your sport or activity. Movement of the shoulder is restricted and there is reduced power. An overuse injury to the tendon presents gradually with pain normally felt in the upper arm.

Management of a rotator cuff strain and how to fix it?

The assistance of a sports medicine professional is important in the treatment of a rotator cuff strain and tendinopathy. Initially, they can assist in determining the exact structures damaged and the extent of this damage. This may require the use of imaging techniques such as an ultrasound or MRI to aid in the diagnosis. From the physical examination and any imaging, a determination of how long the injury is expected to take to heal can be provided and an appropriate management plan developed. Management may include activity modification, soft tissue techniques and a series of specific strengthening exercises. These exercises will facilitate your return to activity and help prevent reinjury or the likelihood of developing long term effects.

Adhesive Capsulitis (Frozen Shoulder)

What is adhesive capsulitis?

The common name for adhesive capsulitis is “frozen shoulder”. It refers to an inflammation and adhesions of the capsule that surrounds the shoulder joint. The condition is broken up into 3 phases. The Painful phase is characterised by constant pain and aching with progressive loss of movement. The Stiffening Phase sees further loss of mobility and obviously stiffness. The Thawing/Recovery phase shows improving movement and function, however, complete resolution of symptoms can take many more months from this stage .

What causes adhesive capsulitis?

The exact reason why it develops is unknown. It is common in middle to older aged people and is believed to result from an irritation to the shoulder joint and its surrounding capsule. Irritation of the shoulder joint capsule results in an inflammatory response. Associated with the inflammation is formation of adhesions or small scars between the folds within the capsule retricting movement. Adhesive capsulitis may occur without any precipitating factors, or occur secondary to any condition that results in prolonged immobilization of the arm, including rotator cuff disorders, calcific tendonitis, mastectomy, or even fractures of the fore-arm.

How does adhesive capsulitis feel?

The two main characteristics are pain and loss of movement in the shoulder joint. The pain maybe aching, dull or stabbing and is most frequently felt deep in the shoulder and over the outside of the upper arm. Symptoms may vary day to day depending on use.

Management of adhesive capsulitis and how to fix it?

A sports medicine professional will be able to develop an appropriate treatment plan with you. This will most commonly be aimed at reducing your pain and improving your movement. It may involve the use of anti inflammatory medications, stretching, strengthening and range of motion exercises. The use of an ultrasound guided cortisone injection maybe required, particularly in the early phase of the condition.

Shoulder Instability/Dislocation

What is shoulder instability?

Shoulder instability refers to when the capsule and ligaments supporting the shoulder joint are loose. This enables the bones of the ball and socket joint to move excessively on one another. If this movement becomes so much the shoulder may actually dislocate and the bones comes out and stays out of the socket.

What causes shoulder instability?

The capsule and ligaments around the shoulder joint can be loose for one of two reasons. Firstly, you may be born with ligaments and capsule that allows too much movement (laxity). You may also stretch the ligaments and capsule during activity or a traumatic event where the shoulder joint is forced out of its socket e.g direct blow or fall onto arm.

How does shoulder instability feel?

There is often a clunking sensation felt when the joint pulls apart or‘sublux’ This is a feeling of giving way in the limb. This incident may be associated with pain, numbness and weakness. Dislocation occurs when the two bones separate completely out of joint and do not return together. The intensity of pain is normally severe, movement is not possible with support of the arm being necessary.

Management of shoulder instability and how to fix it?

Shoulder dislocation is a medical emergency because many other structures can be damaged e.g nerve tissue. You should place the arm in a sling and seek a sports medicine professional or doctor. The shoulder joint is more easily ‘relocated’ soon after the injury. As time progresses, it is more likely that general anaesthetic will be required. An x-ray is important to clear any bony injury. Treatment may require surgery and a lengthy rehabilitation process. A physiotherapist can advise you on the necessary steps to take following injury.
Shoulder instability is a condition that can be treated conservatively with progressive strengthening and stability based exercises. Occasionally this is unsuccessful and orthopaedic attention is required. Sometimes surgery is needed to repair the unstable joint complex.

Acromioclavicular (AC) Joint Injury

What is an AC joint injury?

An acromioclavicular (AC) joint injury refers to an injury to the joint between the end of your collarbone (clavicle) and the upper part of your shoulder blade (acromion).

What Causes an AC joint injury?

The AC joint is usually injured following an impact to the point of the shoulder. The impact may be with the ground or an opponent. This impact can push the upper part of the shoulder blade beneath the end of the collarbone. This can injure the soft tissues (including ligaments) surrounding the AC joint.

How does an AC joint injury feel?

The pain is localised and is experienced on the top of the shoulder. It may be painful with movement and be intense enough to prevent you from wanting to use your arm. Often the AC joint is tender to touch. Different levels of injury describe the level of separation of the joint due to tearing of the ligaments.

Management of an AC joint injury and How To Fix It?

Physiotherapy initially can assist in diagnosing the injury and extent of the damage. This may require the use of an X-ray to exclude damage to the bones. Physiotherapy will be aimed at reducing your pain, increasing your movement and strength. The goals of treatment are to return you back to your desired activity as soon as possible.

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