The shoulder is a ball and socket joint formed by the arm bone (humerus), shoulder blade (scapula) and collar bone (clavicle). However the shoulder is not a stable joint because the ‘ball’ is too large for the ‘socket’. Hence it is prone to certain injuries or conditions arising from instability. Often these can be treated with physiotherapy techniques such as joint mobilisations, massage, dry needling, taping and specific exercises for the surrounding shoulder muscles.

Rotator cuff injuries

The rotator cuff is a group of four small, but powerful, muscles that ensure the humerus stays drawn into the socket. They also help rotate the humerus within the socket. Correct rotation is essential so the humerus can move freely within the socket when the arm is involved in actions such as reaching overhead, throwing and swimming.

A common injury to the muscles is rotator cuff tendinopathy. This may occur from awkward lifting, excessive or repetitive overhead activities, incorrect technique in throwing or racquet sports, or a direct blow to the shoulder. It leads to damage and wear and tear of the rotator cuff tendons. If the injury is not treated appropriately, inadequate healing of the tendons occurs as a result.

Treatment for this is resting the arm from aggravating activities and allowing healing to take place. Physiotherapists can give advice on exercises to strengthen the rotator cuff and surrounding shoulder muscles. Occasionally corticosteroid injections may be required.

If a muscle tear has occurred in the rotator cuff, a person will often report feeling a ‘twinge’ in the area with sudden pain.  Small tears can be managed with rest and a gradual strengthening program. Larger tears may be surgically repaired before the person commences on a shoulder rehabilitation program.

 

Acromioclavicular joint (ACJ) injuries

The ACJ is formed by the clavicle connected via ligaments to the part of the scapula called the acromion. This is near the front tip of the shoulder joint.

ACJ injuries are caused by falling onto that area of the shoulder or direct blows. The severity of the injury is classified as

  • Type I – sprain or partial ligament tear, with a person reporting pain on reaching their arm across the body
  • Type II – subluxation (partial dislocation) of the joint due to ligament tear, with a small step deformity visible on examination
  • Type III –  complete rupture of ligaments with clear step deformity

Treatment for a type I injury may include putting the arm in a sling or sports strapping for a couple of days to relieve pain. Physiotherapists may use modalities such as taping, dry needling and massage to relive symptoms.  The arm may be in a sling or strapped up longer for type II injuries. Type III injuries may require surgery. In all cases the person will have to undergo strengthening and retraining of the shoulder when symptoms have subsided and joint stability is established.

 

Impingement

Impingement is caused by the impinging of structures such as rotator cuff tendons and cushioning sacs of fluid (bursa) which are located within the shoulder joint.

This can be caused by abnormalities with the socket such as bony formations or arthritis on the acromion. This is known as primary impingement.

Causes that arise from outside the shoulder joint are commonly from poor positioning of the scapula due to inadequate muscular control of the scapula. For example someone with rounded shoulders and a slumped upper back posture will have the scapulae pulled into a forward tipping position which makes the joint prone to impingement. In another example someone with a rotator cuff injury may not be rotating and positioning the humerus correctly within the socket. This means the humerus could easily impede on underlying joint structures when the person is lifting his or her arm. These are classed as secondary impingement. It is commonly seen in people who do repetitive overhead work with their arms or people who adopt slouched upper body postures. Sometimes it can occur from a direct blow to the shoulder joint.

Treatment generally involves retraining of the rotator cuff and surrounding scapula-thoracic muscles to correctly position the scapula. Physiotherapists may use myofascial release, massage, dry needling and joint mobilisations to release tight tissues or muscle groups to enable good scapula positioning.  In addition, physiotherapy treatment may involve strapping for optimal positioning and relief of symptoms. If a person is still not improving they can be sent for scans to check for any joint abnormalities. In some cases corticosteroid injections may be used to relieve symptoms.

If you or someone you know is suffering with a shoulder problem, it is better to have it assessed sooner rather than later.  To help this happen, we have a limited number of Free Assessment Vouchers available to get you in and get the problem seen to now.  Simply call us on 6654 0244 for Woolgoolga or 6655 6865 for Urunga to secure a FREE assessment and get to the bottom of the problem now, before it becomes more serious.

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