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Shoulder

The shoulder joint is a ball-and-socket joint. It primarily has three joints – the shoulder blade (scapula), the collarbone (clavicle) and the upper arm (humerus). The head of the humerous rests in a shallow socket in the shoulder blade called the glenoid. Typically, the humeral head is much larger than the socket and a soft fibrous tissue rim (labrum) surrounds the socket to assist in stabilising the joint. The rim deepens the socket by up to 50%, thus giving the humeral head a better fit in the socket.

Stiff Shoulder – Home exercise program

Stiff shoulder is usually uncomfortable, even if the degree of stiffness is not great. That’s the unfortunate aspect. The positive aspect is that most stiff shoulders can be managed successfully by a simple exercise regime conducted by the patient at home.

It is basically a procedure of gently and gradually getting the shoulder moving again. This regime is the safest of all treatments for frozen shoulders. Although months of these specific exercises may be required, persistence is almost always rewarding. Even if arthritis is present, this program may help preserve and even improve the shoulder’s range and comfort. Prior to beginning these exercises, you should consult your physician.

There are two components to the home program for stiff shoulders. The first is a series of stretching exercise and the second relates to regular participation in a fitness program.

Your opposite arm is a great therapist for your stiff shoulder. Your ‘therapist arm’ is always available to apply a gentle stretch in any direction of tightness. Each of these gentle stretches needs to be held up to a count of 100.

If other directions of stiffness are identified, they can be stretched with a similar approach. An important principle of the stretching exercise is to allow your muscle to relax so that the stretch can be applied to the soft tissues without muscle interference. Tissues of a tight shoulder do not like to be stretched suddenly, roughly or with a lot of force. Thus, the strategy is to apply a gentle stretch so that at most minimal soreness results. Any soreness should go away within 15 minutes after you stop the exercises.

The great thing about this exercise is that you are in control. You can adjust the vigour of the stretching to do what is most easily tolerated by your shoulder. The exercise program is ‘portable’ and can be performed in your home, car, office, bus, airplane or wherever you happen to be. This is important, because consistency in this exercise regime pays off. If pain results from this program, do not stop or alter the frequency of your exercise sessions, just reduce the vigour of the stretches so that they become comfortable.

  • Forward Elevation – Lying
  • Forward Elevation – Sitting
  • External Elevation – Standing and Lying
  • Cross Body Stretch – Cross Body

Rotator Cuff Tear

Rotator cuff is the group of tendons in the shoulder joint providing support and enabling wider range of motion. Major injury to these tendons may result in tear of these tendons and the condition is called as rotator cuff tear. It is one of the most common causes of shoulder pain in middle aged adults and older individuals.

Causes

Rotator cuff tear results from pressure on the rotator cuff from part of the shoulder blade (scapula) as the arm is lifted. It may occur with repeated use of arm for overhead activities, while playing sports or during motor accidents.

Symptoms

Rotator cuff tear causes severe pain, weakness of the arm, and crackling sensation on moving shoulder in certain positions. There may be stiffness, swelling, loss of movements, and tenderness in the front of the shoulder.

Diagnosis

Your surgeon diagnoses Rotator Cuff Tear based on the physical examination, X-rays, and imaging studies, such as MRI. Rotator cuff tear is best viewed on magnetic resonance imaging.

Conservative treatment options

  • Rest
  • Shoulder sling
  • Pain medication injection of a steroid (cortisone) and an local anaesthetic in the subacromial space of the affected shoulder to help decrease the inflammation and pain
  • Certain exercises

Surgery

Rotator cuff repair may be performed by open surgery or arthroscopic procedure. In arthroscopy procedure space for rotator cuff tendons will be increased and the cuff tear is repaired using suture anchors. These anchor sutures help in attaching the tendons to the shoulder bone. Following the surgery you may be advised to practice motion and strengthening exercises.

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Shoulder Impingement

Shoulder impingement is the condition of inflammation of the tendons of the shoulder joint. It is one of the most common causes of pain in the adult shoulder. The shoulder is a ‘ball-and-socket’ joint. A ‘ball’ at the top of the upper arm bone, humerus, fits neatly into a ‘socket’, called the glenoid, which is part of the shoulder blade, scapula. Shoulder impingement is also called as swimmer’s shoulder, tennis shoulder, or rotator cuff tendinitis.

Causes

Impingement results from pressure on the rotator cuff from part of the shoulder blade (scapula) as the arm is lifted. It is more likely to occur in young and middle aged people who engage in physical activities that require repeated overhead arm movements. The pain may be due to a “bursitis” or inflammation of the bursa overlying the rotator cuff or a “tendonitis” of the cuff itself. In some circumstances, a partial tear of the rotator cuff may cause impingement pain.

Symptoms

Individuals with shoulder impingement may experience severe pain at rest and during activities, weakness of the arm and difficulty in raising the hand overhead.

Diagnosis

Diagnosis involves physical examination by the doctor where in the doctor checks for the possible range of movements with the affected shoulder. X-rays and MRI scans may be ordered to see the injury and inflammation.

Conservative Treatment Options

Shoulder impingement can be treated with rest, ice packs, anti-inflammatory drugs, and avoiding the activities involving the shoulder. Physical therapy may be advised to strengthen the muscles and steroid injections may be given if pain persists.

Surgery

Arthroscopic surgery is recommended if the rotator cuff tendons are torn and to remove the bony spurs.

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Frozen Shoulder

Frozen shoulder, also called adhesive capsulitis is a condition characterized by pain and loss of motion in shoulder joint. It is more common in older adults aged between 40 and 60 years and is more common in women than men.

Causes

Frozen shoulder is caused by inflammation of the ligaments holding the shoulder bones to each other. The shoulder capsule becomes thick, tight, and the stiff bands of tissue called adhesions may develop. Individuals with shoulder injury, shoulder surgeries, shoulder immobilized for longer period of time, other disease conditions such as diabetes, hypothyroidism, hyperthyroidism, Parkinson’s disease and cardiac diseases are at risk of developing frozen shoulder.

Symptoms

Frozen shoulder may cause pain and stiffness and limit the movements of shoulder.

Diagnosis

Frozen shoulder condition can be diagnosed by the presenting symptoms and radiological diagnostic procedures such as X-rays or MRI scans.

Conservative Treatment

Conservative treatment options include:

  • Non-steroidal anti-inflammatory drugs and steroid injections for pain
  • Physical therapy to improve your range of motion
  • Sometimes heat may be applied to reduce pain

Surgery

Your surgeon may recommend Shoulder arthroscopy when the conservative treatment does not work. During surgery, the scar tissue will be removed and tight ligaments, if any, will be dissected. Following surgery physical therapy will be advised to bring full range of motion and strengthen the muscles.

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Shoulder Instability

Shoulder instability is a chronic condition that causes frequent dislocations of the shoulder joint. A dislocation occurs when the end of the humerus (the ball portion) partially or completely dislocates from the glenoid (the socket portion) of the shoulder. A partial dislocation is referred as subluxation, whereas the complete separation is referred as dislocation.

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Shoulder Joint Replacement

Shoulder joint replacements are usually done to relieve pain and when all non-operative treatments to relieve pain have failed.

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Rotator Cuff Tear

Rotator cuff is the group of tendons in the shoulder joint providing support and enabling wider range of motion. Major injury to these tendons may result in tear of these tendons and the condition is called as rotator cuff tear.

For more information about Rotator Cuff Tear, click on below tabs.

Shoulder Stabilisation

Shoulder instability is a chronic condition that causes frequent dislocations of the shoulder joint. A dislocation occurs when the end of the humerus (the ball portion) partially or completely dislocates from the glenoid (the socket portion) of the shoulder.
For more information about Shoulder Stabilisation, click on below tabs.

Reverse Total Shoulder Replacement

Reverse total shoulder replacement, is an advanced surgical technique specifically designed for rotator cuff tear arthropathy, a condition where the patient suffers from both shoulder arthritis and a rotator cuff tear.

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Shoulder Hemiarthroplasty

Shoulder hemiarthroplasty, also called partial shoulder replacement is a surgical procedure during which the upper bone in the arm (humerus) is replaced with a prosthetic metal implant, whereas the other half of the shoulder joint (glenoid or socket) is left intact.
For more information about Shoulder Hemiarthroplasty, click on below tabs.

Click on the topics below to find out more from the orthopaedic connection website of American Academy of Orthopaedic Surgeons.

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