Shoulder injuries are very common and can be extremely painful. These injuries can cause many difficulties managing work, sport and home activities. Even simple activities such as driving, hanging out the washing and doing your hair can become difficult. Sleeping on your sore shoulder can become impossible because of the pain.

The most common shoulder injuries are

• Rotator Cuff Impingement
• Rotator Cuff Tears
• Frozen Shoulder
• Fractures
• Dislocations

Rotator Cuff Impingement

The shoulder joint is very mobile allowing us to move our hand in any direction. The joint is held together by ligaments and a strong group of muscles called the rotator cuff. These rotator cuff muscles hold the shoulder joint in place while the bigger shoulder muscles move the arm around. One of the rotator cuff tendons passes between the top of the arm bone (humerus) and the tip of the shoulder blade (acromion). If this tendon is injured, it swells and becomes pinched between the two bones. This is called Rotator Cuff Impingement.

Rotator Cuff Impingement can start with a single injury such as a fall, however, it more commonly starts with repetitive overuse activities such as cleaning, lifting, overhead activities in sport such as the tennis serve or swimming or working with your arms overhead for prolonged periods in activities such as hanging washing or painting ceilings.

Once the rotator cuff tendon is pinched it becomes more swollen causing more pain, more swelling, more pinching and so on. For this reason impingement syndrome injuries progressively become worse if left untreated.

Treatment
Impingement syndrome can be treated very successfully with physiotherapy and usually makes a full recovery. Our physiotherapy treatment begins with a full assessment of your shoulder and then we will develop a treatment programme that is specific to your shoulder injury. This will involve

• Easing pain and reducing swelling and inflammation.
• Restoring range of movement, if restricted.
• Restoring muscle strength and co-ordination around the shoulder and shoulder blade.
• Modification of painful activities to promote a quick recovery.

The pain of impingement syndrome usually begins to settle within
2 - 3 weeks, but full recovery may take 4 – 6 months.

Rotator Cuff Tears

With continued pinching and rubbing of the rotator cuff tendon as it passes through between the bones, it will start to fray and can eventually tear. Tears can also occur in a traumatic incident such as a fall.

Treatment
If your rotator cuff impingement injury is slow to respond or you have a lot of rotator cuff weakness then your physio may recommend that you have an ultrasound or MRI scan which will detect any tearing in the rotator cuff. If you have a tear in the rotator cuff tendon that is only small or is only through part of the thickness of the tendon then the treatment and the results are usually the same as for rotator cuff impingement.

However, if you have a tear that is through the full thickness of the tendon or a spur growing on your bone, then treatment may only give you a partial recovery. Surgery may be needed to repair the tendon and/or remove the spur.

Frozen Shoulder

A frozen shoulder occurs when adhesions form around your shoulder joint causing pain, loss of function and loss of movement in your shoulder. A frozen shoulder can occur if impingement syndrome and rotator cuff injuries are left untreated. In about 3% of people with shoulder injuries, a frozen shoulder will develop despite treatment. The reason for this is unknown, but it is more common in women, in people over 40 years and in those with diabetes. Frozen shoulder can also occur after surgery for breast cancer.

Treatment
The best treatment for frozen shoulder is prevention. In most cases frozen shoulder is preventable simply by keeping the shoulder moving and by seeking early treatment to resolve any shoulder problems before the shoulder joint can "freeze". However, in some people a frozen shoulder can develop despite following an appropriate exercise program.

Once a frozen shoulder develops it tends to run its own course and usually recovers spontaneously. However, recovery is slow and can take from 1 – 2 years. Physiotherapy treatment for frozen shoulder involves a gentle exercise programme aimed at maintaining available range of movement and strength, activity modification to prevent worsening of the condition and treatment to ease pain.

Fractures

Fractures of the humerus and clavicle (collar bone) are common and are usually the result of a fall.

Treatment
Fractures of the humerus are usually put in a sling for 6 weeks. Fractures of the clavicle are treated with a sling, or a figure '8' band across the back to keep the shoulders back and hold the fracture in the correct position. More severe fractures are often treated surgically. Physiotherapy can start as early as 1 week after the fracture and is aimed at preventing the formation of a frozen shoulder.

Dislocations

Dislocations of the shoulder joint are common in contact sports and sports requiring a lot of arm strength such as rock climbing and can also result from a fall.

Treatment
The shoulder should be relocated as soon as possible by a qualified doctor. Physiotherapy can start within a few days of the injury. Initially,the aim of physiotherapy treatment for the dislocated shoulder is to reduce pain and swelling. It is important to begin strengthening and stabilisation exercises as early as the pain allows, to restore the stability of the shoulder and help to prevent a recurrence.

At Sutherland Shire Physiotherapy Centre we have many years experience in the treatment of shoulder injuries. Call today to schedule an appointment with one of our physiotherapists.

Last updated: 1st August, 2020

Please note that the above information is of a general nature and is not intended to substitute for professional advice. You should always seek the advice of your qualified health practitioner to attain a proper diagnosis before starting any treatment regime.

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