Shoulder Pain & Injury Treatment
The shoulder is the most mobile joint in your body and hence very prone to injuries. Shoulder pain is very common, but is most often felt on the outside of the upper arm rather than in the joint itself. In most cases the pain develops gradually over a long time without any known reason to the patient. In the beginning lifting the arm feels uncomfortable, but after a while it turns into a sharp pain. At later stages the pain might even be constant during day and night and can radiate in severe cases into the forearm and hand. In those cases the joint has stiffened already significantly and daily activities are severely impaired. Repetitive movements with poor posture and muscular weakness are usually the cause of the problem and lead to inflammation of the rotator cuff (muscles surrounding the shoulder) or bursa (protective fat pad).
Traumatic injuries usually occur after bike accidents or falls onto the shoulder. In these cases the tendons might be ruptured or a bone fractured. These conditions may require surgery and rehabilitation afterwards.
Common Shoulder Injuries:
Tendonitis refers to an inflammation (-itis) of the tendon, which connects the muscle belly with the bone. It is one of the most frequent reasons for shoulder pain. Common causes are overuse of the muscles, repetitive movements of the arm and shoulder and poor biomechanics. Physiotherapy helps to reduce the pain and inflammation and restores proper movement of the shoulder.
Impingement refers to a trapping of usually one of the tendons of the rotator cuff between the shoulder roof and the humerus. When the arm is moved upwards and rotated inwards (e.g. freestyle swimming or putting the hand behind the back) the soft tissues are compressed. Over time this tendon usually develops an inflammation (please click for more information on tendonitis). It can occur in any sports with repetitive shoulder movements, any daily activity with lifting the arm above 90° or simply frequent computer work. The reason is usually poor biomechanics, a hunched back, muscular weakness and joint stiffness. The problem can be further complicated by irregular bony outgrowths (bone spurs), which are often present in people above the age of 50. In the acute painful stage physiotherapy helps reducing the pain and inflammation. Once the condition improves exercise therapy will be added optimizing the strength and restoring optimal biomechanics with the goal to prevent recurrent shoulder problems.
Frozen shoulder or adhesive capsulitis refers to an inflammation and stiffening of the joint capsule. The cause is still unknown; however, there are a number of risk factors predisposing you to developing frozen shoulder:
- shoulder trauma
- inflammatory conditions
- inactivity of the shoulder
- autoimmune disease
Frozen shoulder has three stages, each of which has different symptoms:
- Freezing – During this stage, pain occurs with any movement of the shoulder, and the range of motion starts to become limited.
- Frozen – Pain may begin to diminish during this stage. However, the shoulder becomes stiffer, and the range of motion decreases notably.
- Thawing – During the thawing stage, the range of motion in the shoulder begins to improve until full recovery is regained.
Each of these stages can last a number of months. Physiotherapy can help to optimize recovery, but each patient reacts different to the treatment. Therefore it is impossible to give the patient an exact recovery timeline.
Approximately 20% of people who have had a frozen shoulder will also develop frozen shoulder in their other shoulder in the future.
Acromioplasty refers to a surgical procedure in which parts of the bony shoulder roof (acromion) is excised to create more space in between the acromion and the humerus. The reason is to prevent an impingement (please click for more information on impingement) of the rotator cuff in between those two structures, which can lead to chronic or recurrent shoulder pain. The rehabilitation takes about 8-12 weeks depending on the complexity of the surgery. After successful completion of the rehabilitation the patient will have regained full function of the shoulder without any restrictions in daily life and sport.
Rotator cuff repair
A rotator cuff repair refers to a surgical procedure in which the torn part of the rotator cuff is re-attached to the bone. In most cases this is done by keyhole surgery (small buttonhole-sized incisions). Only with larger and complex tears the surgeon might opt for an open procedure. The rehabilitation takes about 3-6 months depending of the complexity of the surgery. After successful completion of the rehabilitation the patient will have regained full function of the shoulder without any restrictions in daily life and sport.
A Bankart procedure refers to a surgical technique for the repair of recurrent shoulder joint dislocations (please click for more information on shoulder dislocation). In the procedure, the torn ligaments are re-attached to the proper place in the shoulder joint, with the goal of restoring normal function. The rehabilitation takes about 8-12 weeks depending on the complexity of the surgery. After successful completion of the rehabilitation the patient will have regained full function of the shoulder without any restrictions in daily life and sport.
There are two forms of dislocations:
- Partial dislocation (subluxation): the head of the humerus slips out of the socket momentarily and then snaps back into place
- Full dislocation: the head of the humerus comes completely out of the socket
In most cases this happens forcefully after an accident or fall. However, some patients with severe shoulder instability (please click for more information on shoulder instability) may dislocate their shoulder by simply reaching up for something. If the shoulder does not ‘pop in’ by itself, the doctor will move the head of the humerus back into the shoulder joint socket under anesthetics.
Most people regain full shoulder function with the help of physiotherapy within a few weeks.
However, some dislocations may have damaged the shoulder too severely that surgical repair (please click for more information on Bankart repair) is necessary. This may also be the case with frequent re-dislocations as the shoulder has become too unstable. Post-surgical rehabilitation takes about 3-6 months depending of the complexity of the surgery. After successful completion of the rehabilitation the patient will have regained full function of the shoulder without any restrictions in daily life and sport.
MDI of the shoulder is defined as generalized laxity (looseness) of the joint due to increased mobility and muscle weakness. The shoulder joint may “slip” in and out of its socket in a forward (anterior), backward (posterior), or downward (inferior) direction. This “laxity” may be exaggerated in people who participate in activities that require repeated overhead movement of the arm, such as badminton players or swimmers. The most common cause of MDI is overuse of the shoulder. Although sometimes the shoulder can be dislocated (please click for further information on dislocation), often people report their shoulder will “slip” out and go right back into the socket.
After treating the pain and inflammation caused by MDI, physiotherapy focuses on strengthening the muscles that support the shoulder blade (scapula) and shoulder joint (rotator cuff) keeping the joint stable to help returning to unrestricted, pain free activity and to prevent re-injury.
A humerus fracture is an injury to the bone of the upper arm close to the shoulder joint. This happens most commonly after a fall or in elderlies with osteoporosis. The majority of patients can be treated conservatively with a sling. The fracture will heal usually within 6-8 weeks with the help of physiotherapy treatment to restore full function.
Surgery may be required when the bone fragments are far out of position or if the fracture extends into the joint. The rehabilitation takes usually at least 6 months depending on the severity of the injury. Especially elderlies may not regain full function even after optimal treatment.