Shoulder Therapy & Shoulder Recovery
Shoulder Therapy & Shoulder Recovery
Guide to Shoulder Pain and Its Treatment
Shoulder Problems We Treat
With more and more people trying to stay fit, shoulder problems are on the rise.
Most shoulder problems can be solved without surgery. If you have shoulder pain
or the movement of your shoulder is restricted, it’s time to seek help from an
orthopedic physical therapy expert familiar with the full spectrum of shoulder
problems and treatments.
Physical therapy is conservative care. Fortunately, most shoulder problems do
not require surgery, and respond to a directed physical therapy exercise program
and anti-inflammatory medication. Physical therapy will help you recover from a
shoulder injury. Physical therapists develop customized exercises programs for
you to increase flexibility in the shoulder, strengthening exercises that help
prevent muscle shrinkage, and good body mechanics to help you avoid shoulder
strain and pain.
Evaluating shoulder pain: Your physical therapist will
thoroughly examine your shoulder and take your health history. Depending on the
results of the evaluation sometimes we will refer you out to a physician for
medical review and imaging studies.
The shoulder: a different joint. The shoulder is a complex
joint made up of the humerus (upper arm bone), scapula (shoulder blade) and
clavicle (collarbone), along with tendons, muscles and ligaments. These help us
lift, carry, throw and reach up or backward. The shoulder is the most mobile –
and least stable – joint in the body, because it is not anchored firmly by bone
to the skeleton but by surrounding muscle. When you have muscle imbalance in the
shoulder this may result in pain and loss of function of the arm.
Rotator cuff and related injuries: The rotator cuff comprises four muscles and cord-like tendons, tightly enclosed within the shoulder joint.
Rotator cuff injuries are the most common causes of shoulder pain and activity
restriction at all ages.
Tears: A torn rotator cuff, sometimes called “pitcher’s
shoulder” or “tennis shoulder,” is the most common cause of shoulder pain. The
rotator cuff tendons can split or tear suddenly with injury, or slowly by
rubbing bone spurs. Untreated tears can weaken the arm, prevent you from lifting
your arm overhead and cause visible muscle shrinkage. Pain occurs during motion
and also at night.
Tendonitis: The mildest rotator cuff injury is tendonitis
(tendon inflammation). Tendonitis can develop with repetitive over¬head
activities such as playing tennis, pitching, raking, shoveling or painting.
Tendonitis can also arise from joint degeneration due to osteoarthritis. It
produces pain like a toothache radiating through the upper arm that can awaken
you from sleep. Reaching overhead or behind your back is painful.
Shoulder Bursitis: Bursitis, which often accompanies rotator
cuff tendonitis, involves painful inflammation of one or more bursa
(fluid-filled sacs that surround our joints to provide lubrication and
Impingement Syndrome: Swelling and inflammation of tendons and/
or bursa can place undue pressure on tendons as they pass between the upper arm
bone and the shoulder tip, called the scapular acromion. In its cramped space,
blood flow to the swollen tendon is reduced, and it begins to fray. The
resulting pain intensifies when reaching overhead or backward. Ongoing
impingement may produce a torn rotator cuff.
Labral Tears: The labrum, a cartilage cuff around the socket that encircles the head of the upper arm bone to hold it within its shallow bony
socket, can tear with injury to the shoulder. It also becomes more brittle with
age and thus susceptible to fraying. Aching in the shoulder, “catches” in the
shoulder when moved, and pain with some activities may signal a torn labrum.
A SLAP lesion is a tear of a specific area of the labrum. SLAP
stands for Superior Labrum from Anterior to Posterior. Usually the biceps tendon
is affected as well. The SLAP tear occurs at the point where the tendon of the
biceps muscle inserts on the labrum. The most common reasons for a SLAP tear
o Fall onto an outstretched hand (most common in
Alaska, from falling on ice).
o Repetitive overhead actions (throwing).
o Lifting a heavy object.
Typical symptoms of a SLAP tear include a catching sensation and pain with
shoulder movements, most often overhead activities such as throwing. Patients
usually complain of pain deep within the shoulder or in the back of the shoulder
joint. It is often hard to pinpoint symptoms, unless the biceps tendon is also
involved. In cases of SLAP tears with associated biceps tendonitis, patients may
complain of pain over the front of the shoulder.
Frozen Shoulder: Between ages 40 and 60, the joint capsule surrounding the shoulder can shrink, making movement painful and stiff.
Reluctance to use the shoulder brings increasing stiffness, restricted motion
and a persistent, dull aching. This condition is most frequently associated with
diabetes, but in more than half the patients has no known cause. Pain fades
after several months, but the shoulder becomes “frozen” and may take two to
three years to “thaw” without treatment. Treatment is directed at pain relief
until the acute phase passes, followed by therapy.
Arthritis: Osteoarthritis is the wearing down of cartilage that allows bones to glide smoothly within the joints, and can occur with aging,
trauma or overuse injury. The bones in the shoulder begin to rub against each
other, and growths called bone spurs can develop. Stiffness, swelling, pain and
reduced range of motion can occur, along with a “catching” sensation in the
joint. Rheumatoid arthritis, a disorder of the immune system, produces chronic,
painful inflammation of the joint’s lining, and eventual joint deterioration.
Instability and Dislocation: When one of the shoulder bones moves or is pushed out of place due to injury, the shoulder becomes unstable and
is at risk for partial or complete dislocation. Recurrent dislocations cause
pain and unsteadiness when raising the arm or moving it away from the body, and
a feeling that the shoulder is “slipping out of place” when reaching overhead.
Recovery from Surgery: Physical therapy is essential to regaining your range of motion and strength, which relieves pain. Your therapist
will work closely with your surgeon to tailor a program to meet your needs. Your
therapist will ensure that you perform your exercises correctly, give you advice
on body mechanics so that you avoid straining your shoulder, and check your
Other Shoulder Problems: Common causes of shoulder pain include infection (osteomyelitis), soft-tissue or bone tumors and nerve problems. A
shoulder specialist can help pinpoint the reason. When shoulder pain is intense,
it’s important to seek help promptly.
Shoulder fractures are usually caused by trauma: a fall while
skiing, a collision during football, a car accident, etc. A fracture of the
“ball” at the top of the arm bone or its socket, or of the collarbone, can
disable the shoulder. Bruising, pain with or without swelling, or a deformed
appearance can indicate a shoulder fracture. Most fractures are effectively
treated by immobilizing the arm in a sling until the bone fragments “knit
together,” which takes about six weeks. All fractures should be assessed; some