The shoulder is the most complex joint in the human body. It has to move through more than 180 degrees of motion in many directions, while rotating, sliding, or spinning at the same time.
The shoulder is made up of the humerus bone, scapula (shoulder blade) and clavicle (collar bone). There are technically four joints that make up the connections between these bones that comprises the entire shoulder complex. The muscles of the shoulder have to work in concert to ensure the shoulder joint tracks properly with everyday activities.
Prolonged postures, restricted range of motion, muscle weakness, or injury can all factor into shoulder pain. It is important to note that just because your pain is felt in one location, it is not necessarily the location of the pain’s origin. Additionally, pain felt at a particular location on your shoulder may be the result of a problem with different parts of the shoulder complex. For example, pain on the outside of the shoulder can be from an impingement of the joint or problems with the rotator cuff muscles. However, this can be caused by altered mechanics of other moving parts like the shoulder blade or clavicle. Treat the source of the problem and the irritation will resolve.
What is a Shoulder Sprain / Strain?
A sprain in the shoulder involves the ligaments while a strain involves the muscles around the shoulder. A sprain/strain typically occurs because the tissue has been overstretched too quickly, sometimes while under contraction, resulting in micro-tearing of the tissue. This results in painful inflammation, typically increased with movement and use of the damaged tissue. The damage from a sprain/strain can be minor or major, depending on the severity of the injury, person’s health, and age.
Rotator Cuff Injuries
The rotator cuff is a group of muscles surrounding the shoulder. They are made up of the supraspinatus, infraspinatus, subscapularis, and teres minor muscles. While these muscles are small and not that powerful, they play a critical role in shoulder stability and how the shoulder moves.
The rotator cuff takes a lot of abuse over a lifetime and tearing is very common as we age. Many factors can lead to injury to the rotator cuff such as sports injuries, falls onto the shoulder or arm, repeat lifting movements or other improper loading, prolonged posture, or heavy lifting in abnormal positions.
Rotator cuff tears can be minor, causing pain and inflammation, or major which can require surgery. Conversely, rotator cuff tears of any size can exist in someone’s shoulder and they don’t experience any pain at all.
What is Frozen Shoulder?
Frozen shoulder is a painful shoulder joint condition. In medical terminology it is called “adhesive capsulitis”. How a frozen shoulder exactly begins is still a bit of a mystery, however, it typically occurs after a trauma or repetitive injury to the shoulder. Women in the pre and post–menopausal age range are more likely to experience frozen shoulder, however men can also experience it.
With frozen shoulder, the body begins a cycle of inflammation that causes the capsule around the shoulder joint to contract and become limited in its flexibility. This results in very painful shoulder range of motion. There is no quick fix for frozen shoulder, and typically lasts anywhere from months to a couple of years.
About Labrum Tear
The labrum is a thick ring of cartilage around the socket part of your shoulder joint (glenohumeral joint). The labrum acts like a cup for the head of the humerus to sit in (like a ball inside a cup). The labrum gives stability to the joint and also helps to cushion as the shoulder joint moves.
The labrum can tear with injury from a blow to an outstretched arm, from repetitive overhead injuries, or other improper loading. Sometimes, a labrum tear can be involved when the rotator cuff is torn. A common tear is called a SLAP lesion (Superior Labral tear from Anterior to Posterior). This often needs surgical repair.
Dislocation of the shoulder typically occurs from falling onto an outstretched arm (think fall off a bike) or from impact to an overhead outstretched arm (think someone blocking your layup). Dislocations are managed medically to relocate the head of the humerus bone. Depending on the severity of the dislocation, your physician will typically prescribe physical therapy to help stabilize the shoulder joint and protect it during a recovery phase.
With frequent dislocations, the shoulder can become unstable as many structures in the shoulder get damaged and become too lax. By strengthening the muscles around the shoulder, stability can be increased in the shoulder, preventing future dislocations.
At times, dislocations can be quite severe and lead to tearing of cartilage, tendons, ligaments or muscles. In this case, surgery is often needed. After surgery physiotherapy is an important part of recovery and returning to normal activities.
What is Bursitis / Tendonitis?
The ending of the word “itis” is defined as inflammation. Therefore, bursitis is inflammation of a bursa and tendonitis is inflammation of a tendon. A bursa is a fluid filled sac that sits between muscles or tissues to cushion and reduce friction. In the shoulder there is a rather large bursa between the deltoid muscle and joint. This is called the sub-deltoid bursa. This bursa can often become inflamed due to improper loading, prolonged posture, and weakness of the surrounding musculature. This causes strain to the tissues and excessive friction on the bursa. People tend to feel pain with movement and especially movement out to the side or reaching behind them.
Tendons connect muscles to bones. In the shoulder common areas for tendonitis are in the rotator cuff tendons (supraspinatus, infraspinatus, teres minor and subscapularis) and bicep tendons. Pain can be felt deep in the shoulder or in the front of the shoulder. Pain is usually felt as a sharp, catching sensation with certain movements.
About Sports Injuries
Whether you are a professional athlete, high school athlete, or just like to be active and play sports, injuries can occur. Many shoulder sports injuries occur because of a fall onto an outstretched arm or from excessive overhead actions, in sports like swimming, baseball, or tennis, and other improper loading of the shoulder. Sometimes, muscle imbalances can put someone at risk of injury.
About Shoulder Fractures
Fractures in the shoulder occur for a variety of reasons, but typically from a fall onto the shoulder itself. Fractures can occur in seniors also due to osteoporosis (thinning and weakening of bone).
The goal with fracture management is to provide a safe position for the bone to heal (typically around 8 weeks), while maintaining range of motion. As the bone heals, strengthening can begin and rehabilitation back to normal activities is progressed.
About Shoulder Post-Surgery Rehab
There are a variety of shoulder surgeries that may have to be done in order to stabilize the shoulder, or repair damaged tendons or ligaments. With the advances in arthroscopic surgery, recovery times for shoulder injuries have improved, however physical therapy is still needed to reduce pain quickly, restore range of motion, improve strength, and return the individual to the normal activities they like to do.