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Shoulder

Rotator cuff tear

rotator-cuff-image1Diagnosis: The rotator cuff is a group of muscles in the shoulder preventing the head of the upper arm bone from slipping out of the socket. Risk for injuries to these muscles tends to increase with age and in people who perform repetitive overhead motions in their jobs or sports.

Symptoms: Tears can range in severity between slight and complete tears. They can often be accompanied by symptoms such as:

  • Dull ache deep in the shoulder
  • Difficulty lying on the affected side
  • Difficulty reaching behind the head or back, a complete tear will make it impossible to lift arm over the head.
  • Possible arm weakness

Causes: Rotator cuff injuries may be the result of traumatic damage to the shoulder or to progressive degeneration and gradual wear and tear of the tendon. Risk factors include:

  • Age: Rotator cuff tears are most common in people greater than 40 years old.
  • Sports: Athletes who actively perform overhead arm motions such as baseball pitchers, archers and tennis players.
  • Construction jobs. Occupations such as carpentry or house painting require repetitive arm motions, often overhead, that can damage the rotator cuff over time.
  • Family history: Possible genetic component as tears seem to be more common in certain families.

Our Physical Therapy Treatment: Goals of physical therapy will ultimately be to reduce pain, restore normal pain free range of motion, and allow for a safe return to all functional and leisure activities. Length of treatment and plan of care will depend on the severity of the injury, but will most commonly include:

  • Mechanical diagnoses/treatment for improved movement and pain reduction
  • Postural education and awareness
  • Shoulder and scapular stability and strengthening exercises
  • Manual therapy

Treatment will focus on educating the patient in an individualized self-treatment plan and establishing a home exercise program to further promote healing and prevention of future injury.

Shoulder Impingement

impingementDiagnosis: Shoulder impingement is a condition where the tendons of the rotator cuff are intermittently caught and compacted during various shoulder motions. This can cause injury to the rotator cuff tendons and/or bursa, creating inflammation and pain with movement.

Symptoms: Symptoms often include local irritation and swelling which results in tenderness of the shoulder. Pain may occur when you are raising the arm or when lowering it from an elevated position. Symptoms typically begin mild and may progress over time. Other symptoms might include:

  • Pain that is present with activity
  • Pain with lifting and reaching movements
  • Performing overhead activities
  • Pain at night
  • Often pain free when not moving shoulder.

Causes: Shoulder impingement can occur in the shoulder when the space between the acromion (top of shoulder) and rotator cuff narrows. This condition typically causes pain in the shoulder when the arm is raised. The acromion can rub or impinge the tendon and/or bursa, creating irritation and such pain. Causes are grouped into primary and secondary forms of impingement.

  • Primary: Structural narrowing due to decreased space at birth, osteoarthritis, or bone spurs.
  • Secondary: Narrowing due to faulty movement patterns of shoulder or soft tissue restrictions.

Our Physical Therapy Treatment: Goals of physical therapy will ultimately be to reduce pain, restore normal pain free range of motion, and allow for a safe return to all functional and leisure activities. Length of treatment and plan of care will depend on the severity of the injury, but will most commonly include:

  • Mechanical diagnoses/treatment for improved movement and pain reduction
  • Postural education and awareness
  • Shoulder and scapular stability and strengthening exercises

Shoulder Instability

Shoulder-Dislocation_1Diagnoses: Shoulder instability occurs when the head of the humerus separates from the socket. Once the tissues stabilizing the humerus in the socket become stretched, the structure becomes less stable resulting in increased likelihood of future dislocations or subluxations.

Symptoms: Common symptoms of chronic shoulder instability include:

  • Pain following a shoulder injury
  • Repeated dislocations or subluxations of the shoulder
  • Repeated episodes of shoulder giving way
  • Sensations of the shoulder feeling unstable or “loose”

Causes: Potential causes of shoulder instability include:

  • Shoulder dislocation: Dislocation occurs when the head of the humerus pulls away from the shoulder socket. It typically occurs with trauma or injury to the shoulder. Once a shoulder dislocates the likihood of future dislocations increases due to laxity of the joint.
  • Repetitive strain: Joint laxity can also be the result of repetitive overhead motions. Sports such as swimming, tennis, volleyball, and baseball can stretch out the shoulder ligaments resulting in a less stable joint.
  • Multidirectional instability: Ligament laxity and instability might also be present at birth. These patients have naturally loose ligaments and are typically present throughout the body.
  • After a stroke or any paralysis of the arm subluxations are frequently seen due to the muscles inability to contract.

Our Physical Therapy Treatment:

Goals of physical therapy will ultimately be to reduce pain, restore normal pain free range of motion, stabilize the shoulder, and allow for a safe return to all functional and leisure activities. Length of treatment and plan of care will depend on the severity of the injury, but will most commonly include:

  • Mechanical diagnoses/treatment for improved movement and pain reduction
  • Isometric exercises
  • Postural education and awareness
  • Shoulder and scapular stability and strengthening exercises

Adhesive Capsulitis (Frozen Shoulder)

A00071F02Diagnoses: Adhesive capsulitis, also referred to as frozen shoulder, is a pathology characterized by pain and decreased motion of the shoulder joint. Symptoms typically worsen gradually, then improve within one to three years. Risk increases when recovering from a

Symptoms: Frozen shoulder typically progresses slowly, and is categorized into three stages:

  • Freezing stage: Motion of the shoulder becomes limited and painful
  • Frozen stage: Pain begins to decrease, but motion becomes more limited and using the shoulder becomes difficult.
  • Thawing stage: Motion in the shoulder begins to improve

Causes: The cause of frozen shoulder continues to be unknown. However, there is a higher incidence in people with diabetes or have recently had to immobilize their shoulder. When frozen shoulder occurs, the capsule encompassing the bones, ligaments, and tendons thicken and tighten around the shoulder joint, resulting in limited motion.

Our Physical Therapy Treatment: Goals of physical therapy will ultimately be to reduce pain, restore normal pain free range of motion and enable return to all functional and leisure activities. Treatments will vary depending on the severity and stage of the condition, but will most typically include:

  • Mechanical diagnoses/treatment for improved movement and pain reduction
  • Postural education and awareness
  • Manual therapy
  • Functional activity training for compensatory motion

Treatment will focus on educating the patient in an individualized self-treatment plan and establishing a home exercise program to further promote healing and prevention of future injury.

http://www.mayoclinic.org/diseases-conditions/frozen-shoulder/basics/treatment/con-20022510