Shoulder

*If you are experiencing persistent pain, diminished function, loss of strength, range of motion, and/or sensation, BCPT recommends that you contact your physician, as a serious underlying physical condition may be present.

Adhesive Capsulitis (Frozen Shoulder)

This is a term commonly used to describe a painful and stiff shoulder joint, caused by chronic capsular inflammation, The etimology of the condition is unknown. Symptoms include an acute onset of pain that is not relieved by rest. As the condition proceeds, pain at rest subsides and restricted, painful movement becomes the primary complaint. Subsequent loss of motion results in diminished function in activities of daily living. Surgical intervention in adhesive capsulitis is rare, as physical therapy is the treatment approach of choice. A slow progressive exercise program can reduce the symptoms, and gradually improve function. The exercise program is complimented by pain reduction modalities and a home exercise program.

Rotator Cuff Tendinitis or Impingement Syndrome

Tendons of the rotator cuff are subject to inflammation as a result of direct blows, excessive forceful movements, or repetitive microtrauma. Mechanical impingement of the rotator cuff tendons can be caused by activities requiring repetitive or sustained use of the arms overhead. There are three progressive stages of impingement syndrome. Signs and symptoms include a dull ache of the shoulder after activity, tenderness to touch, painful/weak active and resisted motion, and visible atrophy of the shoulder musculature. Conservative management involves physical therapy to evaluate joint motion, inflammation, and weakness of the rotator cuff, and supporting musculature. Modalities to control pain and inflammation are necessary in the acute stages, with progression to an exercise program to restore normal function of the shoulder joint. Surgical intervention is often reserved for cases of impingement in which conservative measures have failed.

Rotator Cuff Tears

Rotator cuff impingement may cause tendon degeneration and progression to a complete tear. Acute injuries such as a fall on to an outstretched arm, or resistance to forceful shoulder motion can also tear the rotator cuff. Significant shoulder weakness and limitation in active motion are present. Surgical intervention is often indicated, after which a period of immobilization is required. Physical therapy is common postoperatively. Gradual passive to active motion is followed with strengthening and functional training.

Dislocations, Subluxations, and Instability

The relative absence of bone stability and the large amount of range of motion, render the glenohumeral (shoulder) joint particularly susceptible to instability. In complete dislocations, the humeral head (upper arm bone) becomes displaced and often requires a reduction to relocate the joint. A subluxation occurs when the humeral head slips out of joint, but spontaneously relocates without any external force. Primary dislocation or repeated subluxations can result in underlying ligamentous, bone, and capsular injuries which can lead to subsequent instability. A mechanism of repeated injury may become apparent (i.e.. during throwing, volleyball, or swimming activity). Rehabilitation after initial dislocation/subluxation involves muscular re-education to avoid the positions of injury, while strengthening the supporting musculature. Surgery may be required when conservative management such as rigorous physical therapy have failed.

References: Norkin, CC and Levangie, PK: Joint Structure and Function, A Comprehensive Analysis Magee, DJ: Orthopedic Physical Assessment Richardson, JK and Iglarsh ZA: Clinical Orthopaedic Physical Therapy