What We Treat
The shoulder is a very complicated joint and can give rise to many different problems such as ‘Frozen Shoulder, Rotator Cuff problems, Impingement Syndrome and joint dislocations.
It is a ball and socket joint, similar to the hip. The ball is at the top of the bone in the upper arm (the Humerus) and the socket is part of the shoulder blade (scapula).
Very little of the ball sits in the socket (in fact only about 25% at any one time), this gives the shoulder great mobility but as a result it is also a very unstable joint, which means that it is prone to injury.
Most of the joint’s stability comes from the muscles and ligaments around it and so these can often be a problem.
The way the shoulder moves is heavily influenced by other surrounding parts of the body such as the neck, thoracic spine, shoulder blade, collar bone and ribs. Frequently it is necessary to work on these areas in order to treat a shoulder problem effectively.
If the problem is with the shoulder specifically it will usually cause pain to be felt in the upper arm.
Pains extending further down the arm, or in the area of the shoulder blade often stem from the neck or thoracic spine.
This is the common name for Adhesive Capsulitis.
The joint capsule is a ligamentous structure which completely surrounds the joint. Normally it is quite loose and so allows the shoulder to move freely. However, often for reasons that we do not fully understand, it can become inflamed and tightens up. This can also happen following trauma to the joint, such as a fall or dislocation.
It can be very painful and restricts the movement of the shoulder. Left untreated it can persist for some 18 – 24 months and then often resolves as mysteriously as it first appeared.
Physiotherapy can help to reduce the pain and regain movement at the joint.
Most problems at the shoulder will cause loss of movement, the difference with a Frozen Shoulder is that movement is restricted both actively (i.e. when you try to move yourself) as well as passively (i.e. when someone else tries to move it for you). This forms a major part of the diagnosis of a Frozen Shoulder.
Rotator Cuff Injuries
The Rotator Cuff is a group of 4 muscles (Suprapspinatus, Infraspinatus, Subscapularis & Teres Minor) all of which are on the shoulder blade and attach around the edge of the ball part of the shoulder joint.
Working as a unit, their main job is to keep the ball in the socket, making sure that it is properly aligned when we use the arm. As a result they are working almost constantly.
Rotator cuff problems are common in racket ball players, throwers and swimmers and can be caused by very repetitive movements, strong acceleration & deceleration forces or a traumatic event such as a fall or joint dislocation.
Symptoms are usually those of pain, weakness and reduced movement.
Sometimes one or more of the muscles may become torn. A minor tear will usually respond well to physiotherapy.
However, depending on the size, and especially depth of the tear surgery is sometimes necessary to repair it.
Physiotherapy is very important post operatively in order to regain movement, strength and function of the shoulder.
As we age these tears can happen spontaneously (usually after the age of 55 and more commonly in men). This is because the quality of the muscle tissue deteriorates and so it can no longer cope with the forces being put through it. An everyday movement or activity can then cause the muscle to become torn.
Impingement occurs at the shoulder when structures become trapped between the ball part of the shoulder joint and the bony arch (acromion) which lies above it.
Normally there is space (approx 5mm) between the top of the ball and the under side of the bony arch. As the arm moves upwards the ball travels down in the socket and the space is maintained.
However, sometimes the ball does not travel downwards and so bangs up against the arch, trapping the structures there. This causes them to become irritated, inflamed and swollen, which reduces the space and causes more trapping.
This problem builds up over a period of time. It usually starts with just a ‘catch’ of pain at a certain point of movement, this then becomes more acute in nature, the pain lingers for longer leading to reluctance to use the arm which can then become increasingly stiff as a result.
The impingement can be produced initially by stiffness in the neck or thoracic spine, alterations in the positioning and movement of the scapula or structural changes at the shoulder itself.
Particularly in the early stages, an impingement can be successfully treated by physiotherapy.
If left for longer, with more severe symptoms, again an operation (called a Subacromial Decompression) may be necessary. Physiotherapy is usually necessary post operatively to maximise the function of the shoulder.
The shoulder is a highly mobile joint, the problem though is that it is relatively unstable as a result.
The ball and socket can be thought of as a football sitting in a saucer. It does not take much force for the ball to be pushed out of the socket.
This will usually happen traumatically from a fall, a heavy tackle at rugby or football, even a car accident.
The ball will usually come out of front of the joint, but can also come out of the back, or even the bottom of it on occasion.
Sometimes the joint will ‘pop out’ and then go straight back in again (a subluxation) but if it comes out and stays out then it will need to be relocated by a doctor in hospital (and not like Mel Gibson does in Lethal Weapon!!!!)
Any dislocation will cause some damage to the muscles and ligaments. This can vary from minor to severe. Physiotherapy can help with the initial pain and stiffness, but also to help strengthen the muscles around the joint again to help prevent a dislocation from recurring.
In the worst case scenarios it can cause damage to the joint itself (either a Bankarts or SLAP lesion). These will usually require an operation, followed a lengthy period of rehabilitation afterwards during which physiotherapy plays a key role.