Impingement is one of the most common causes of pain in the shoulder. It results from pressure on the soft tissues of the shoulder from part of the shoulder blade (scapula) as the arm is lifted. The pain may be due to bursitis, tendonitis, and/or a partial tear of the rotator cuff. Impingement is common in both young athletes and middle-aged people.
Young athletes who use their arms overhead for swimming, baseball, and tennis are particularly vulnerable. Those who do repetitive lifting or overhead activities using the arm are also susceptible. Pain may also develop as the result of minor trauma or spontaneously with no apparent cause.
While protecting the injured area, exercise and manual (hands on soft tissue and joint mobilization) techniques restore the mechanics of the shoulder joint. We will strengthen your rotator cuff muscles as well as the muscles that stabilize your shoulder blade; ensure that your mid and upper back has improved mobility, and optimize muscular balance in your upper body. To relieve pain, we may also use PT modalities and therapeutic taping.
Shoulder instability is a problem that occurs when the structures that surround the joint do not work to maintain the ball within its socket. If the joint is too loose, it may slide partially out of place, a condition called shoulder subluxation. If the joint comes completely out of place, this is called a shoulder dislocation. Patients with shoulder instability often complain of pain and an uncomfortable sensation that their shoulder may be about to slide out of place.Shoulder instability tends to occur in three groups of people:
1. Patients who have sustained a prior shoulder dislocation often develop chronic instability. In these patients, the ligaments that support the shoulder are torn when the dislocation occurs.
2. Young athletes who compete in sports that involve overhead activities may develop a loose shoulder. These athletes, such as volleyball players, swimmers, and baseball pitchers, stretch out the shoulder capsule and ligaments, and may develop chronic shoulder instability.
3. Patients with some connective tissue disorders may have loose shoulder joints. In patients who have a condition that causes joint laxity, or “double-jointedness”, their joints may be too loose throughout their body. This can lead to shoulder instability and even dislocations.
Frozen Shoulder (Adhesive Capsulitis)
Frozen shoulder, also known as adhesive capsulitis, is a condition that causes stiffness and pain in your shoulder joint. The ball and socket of your shoulder joint is encased in a capsule of connective tissue. Frozen shoulder occurs when this capsule thickens and tightens around the shoulder joint, restricting its movement. Many people acquire frozen shoulder for no known reason. Your risk of developing frozen shoulder increases if you've recently had to have your arm in a sling for several weeks (such as after a fracture or surgery to your shoulder).
The shoulder joint is a ball and socket joint, similar to the hip; however, the socket of the shoulder joint is extremely shallow, and thus naturally unstable. The shoulder joint if often compared to a golf ball sitting on a golf tee. To compensate for the shallow socket, the shoulder joint has a cuff of cartilage called a labrum. The labrum circles the shallow shoulder socket (the glenoid) to make the socket deeper. This cuff of cartilage makes the shoulder joint much more stable, and allows for a very wide range of movements. When a person sustains a shoulder injury, it is possible that they can tear their labrum. The labrum also becomes more brittle with age, and can fray and tear as part of the aging process.
Symptoms of a labral tear depend on where the tear is located, but may include an aching sensation in the shoulder joint, catching of the shoulder with movement and/or pain with specific activities.
Trauma may cause a fracture of the humerus (upper arm) at the joint (ball), the glenoid (socket) or at the upper part of the arm (proximal humerus). Fractures of the upper part of the arm (humerus) are more common in the older (over 65 years of age) population. The majority of fractures in children occur in the clavicle (collar bone). The majority of these injuries can be treated without surgery with a good, long-term result.
Physical therapy plays a very important part in the recovery from a fracture. These injuries often result in shoulder stiffness and weakness leading to loss of function. The stiffness results from associated injuries to the muscles and tendons as well as the ligaments. Weakness occurs due to the trauma to the shoulder and the period of disuse while waiting for the fracture to heal.
Shoulder Arthritis / Total Shoulder Replacement
Shoulder arthritis is a condition in which the cartilage that normally provides a smooth covering over the ball and socket is lost. This cartilage loss can result from wear and tear, inflammatory disease (i.e. rheumatoid arthritis), or injury. When arthritis occurs in a younger person, it is often due to injury or problems from a previous surgery or rheumatoid arthritis. When arthritis occurs in an older person, it is usually from wear and tear or from a rotator cuff problem.
Shoulder arthritis often leads to shoulder pain, weakness, stiffness of the joint, bone spurs and loss of the normal shape of the bones. It may also grind and catch when the shoulder moves. When arthritis is advanced, it may prevent work, play, activities of daily living and comfortable sleep. When shoulder arthritis is advanced and does not respond to physical therapy, consideration is given to joint replacement surgery in which the joint surfaces are replaced. Following surgery, physical therapy will be important to your recovery. The first goal of rehabilitation is to restore range of motion. Once this is achieved, the focus shifts to strength and endurance to maximize the recovery of shoulder function. We will strengthen your rotator cuff muscles as well as the muscles that stabilize your shoulder blade; ensure that your mid and upper back has improved mobility, and optimize muscular balance in your upper body. To relieve pain, we may also use PT modalities and therapeutic taping.
The vast majority of patients who have a rotator cuff injury will not need surgical treatment. The goal of physical therapy is to normalize the function of the shoulder joint and the muscles that surround the shoulder. While protecting the injured area, exercise and manual (hands on soft tissue and joint mobilization) techniques restore the mechanics of the shoulder joint. We will strengthen your rotator cuff muscles as well as the muscles that stabilize your shoulder blade; ensure that your mid and upper back has improved mobility, and optimize muscular balance in your upper body. To relieve pain, we may also use PT modalities and therapeutic taping.
At CPTI, we have been successfully rehabilitating rotator cuff injuries (pre and post-operative) for many years. Our comprehensive evaluation will find the root of the problem and you will be educated about your condition as we will guide you through the rehabilitation process. Physical therapy is a team effort between patient and therapist. The positive atmosphere at CPTI makes physical therapy enjoyable as you restore normal function to your shoulder.
"I had chronic neck and shoulder pain from a skating injury and was causing spasms. After coming to CPTI, I was able to get back onto the recovery road and keep up with my three children as well as enjoy running and swimming again. I felt relief at the first visit and have exercises and stretches to keep the pain from flaring up. Thank you CPTI!"
Rotator Cuff Tendonitis and Rotator Cuff Tears-The rotator cuff is the group of four tendons and muscles that surround the shoulder joint. When the rotator cuff is injured, it's the tendons of the rotator cuff that are injured. It is these tendons that connect the rotator cuff muscles to the bone. When the tendons are inflamed or torn, they cannot function properly.
The most common symptom of a rotator cuff problem is pain. Patients usually complain of pain over the top of the shoulder and arm. In some patients, the pain can descend down the outside of the arm all the way to the elbow. The other common symptom of a rotator cuff tear is weakness of the shoulder. Weakness causes difficulty lifting the arm up overhead or difficulty with activities such as reaching, getting dressed, or carrying objects.
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