Shoulder Pain

Shoulder Pain Relief:

A shoulder injury can happen in any sport, and shoulder pain can be brought on from something as simple as sleeping in the wrong position. The shoulder is a very complex joint and a pathway whereby a host of nerves, blood vessels, and lymph vessels reside or travel through.

Rotator Cuff Injuries

The head of the humerus is very large compared to the socket portion of the joint and is often compared to a large golf ball on a small tee. Though this allows your shoulder joint to move much more freely, it also leads to increased room for injury and dysfunction. Below is a list of common shoulder injuries that can cause pain and mobility problems.

The rotator cuff is a unique structure in the shoulder that is formed by four tendons. These four tendons attach to four muscles that help keep the shoulder stabilized in the shoulder socket and help rotate the upper arm inward and outward. If the rotator cuff is severely torn and is not repaired, a type of arthritis of the shoulder may develop over time, which is termed rotator cuff arthropathy. This just means a ‘joint disorder’ develops. If you develop rotator cuff arthropathy, moving the arm away from the body and raising it over your head can be particularly difficult.

Normally, when the rotator cuff muscles contract, they pull the head of the humerus tightly into the socket of the shoulder. This stabilizes the shoulder and allows the large deltoid muscle to raise the arm over the head as it rotates the humeral head like a pulley. This motion needs the rotator cuff and deltoid muscles to work together in balance, in order for proper biomechanics to occur.

 When the rotator cuff is torn, the shoulder becomes unbalanced. The deltoid muscle pulls the head of the humerus up into the acromion in a sliding motion rather than in the smooth balanced movement that the shoulder was designed to undergo. Over time this abnormal sliding motion causes wear and tear on the joint surfaces, which is termed arthritis. Due to the arthritis, motion of the shoulder becomes painful and the shoulder becomes weaker and weaker until you can no longer raise the arm above the head.

During your evaluation, Dr. Trinh will assess what muscles in your shoulder are off-balance. Utilizing Astym and other manual therapy techniques, the first goal is to decrease any soft tissue restrictions and pain and improve your shoulder motion.

Next, we will focus on strengthening the proper muscles and re-balance your shoulder and scapular muscles to improve overall function and prevent further wear-and-tear on your joint.


Biceps Tendonitis:

Biceps tendonitis, also called bicipital tendonitis, is inflammation of the tendon that attaches the biceps muscle to the shoulder or forearm. The tendon most commonly irritated is the one that attaches the top of the biceps muscle to the shoulder, called the long head of the biceps tendon. 

Continuous or repetitive shoulder actions can cause overuse of the biceps tendon. Damaged cells within the tendon don’t have time to recuperate or the cells are unable to repair themselves, leading to tendonitis. This is common in sport or work activities that require frequent and repeated use of the arm, especially when the arm motions are performed overhead. Athletes who throw, swim, or swing a racquet or club are at greatest risk.

Years of shoulder wear and tear can also cause the biceps tendon to become painful. Examination of the tissues in cases of wear and tear commonly shows signs of degeneration. Degeneration in a tendon causes a loss of the normal arrangement of the collagen fibers that join together to form the tendon.Some of the individual strands of the tendon become jumbled due to the degeneration, and other fibers break which both cause the tendon to lose strength. When this happens in the biceps tendon a rupture of the tendon may occur.

Biceps tendonitis can also happen from a direct injury, such as a fall onto the top of the shoulder. A torn transverse humeral ligament can also lead to biceps tendonitis.  As mentioned earlier, the transverse humeral ligament holds the biceps tendon within the bicipital groove near the top of the humerus.  If this ligament is torn, the biceps tendon is free to jump or slip out of the groove, irritating and eventually inflaming the biceps tendon.

Biceps tendonitis sometimes occurs in response to other shoulder problems which affect the way you use your shoulder, including rotator cuff tears, shoulder impingement, and shoulder instability.

Signs and symptoms of a concussion can vary between individuals and symptoms are not always obvious. If the mechanism of injury for a concussion is present, the individual needs to be thoroughly examined.

In most cases, there is no loss of consciousness. But if you do lose consciousness, you have most certainly sustained a concussion. Any loss of consciousness should be taken seriously, and any bouts lasting more than approximately a minute are considered severe.

Signs and symptoms of a concussion can last days, weeks, months, or even longer in some cases. Fortunately, in the majority of cases, symptoms usually resolve within 7-10 days.

One of the most common symptoms of a concussion is a headache. Confusion is another common sign. This sign can easily be overlooked by the examiner unless the patient is moderately to severely confused, so ruling out a concussion should not be based on the fact that the patient ‘did not appear confused.’

Other signs and symptoms of a concussion that may be present on their own or in combination are concentration difficulties, decreased attention, difficulty with mental tasks, memory problems, difficulties with judgment, a decrease in balance and coordination, a feeling of disorientation, a feeling of being ‘dazed,’ fatigue, blurred vision, light and/or sound sensitivity, difficulty sleeping or sleeping more than usual, being overly emotional, being irritable or sad, neck pain, a feeling of ‘not being right’, and ringing in the ears. Amnesia may be another symptom. In severe concussions, a change in personality may even occur.

If you or someone you know shows even one sign or symptom listed above, you most likely experienced a concussion and it is very important to get a full evaluation.

Signs and symptoms that are even more severe after an injury to the head, such as recurrent vomiting, a change in pupil size, blood or fluid coming from the ears or nose, seizures, or obvious physical coordination or mental difficulties indicate a severe brain injury and require immediate emergency attention.

In most cases, signs and symptoms appear immediately after the concussion has occurred. In some cases, the signs and symptoms can be delayed by a few hours or possibly even days. For this reason, if the mechanism of injury suggests a concussion despite a lack of obvious symptoms being immediately present, the patient needs to be thoroughly examined before returning to activity.

Physical Therapy at Physioflow Physical Therapy can be extremely effective in treating biceps tendonitis. Our initial aim is to decrease the pain and inflammation around the tendon. 

Once the pain and inflammation are under control, we will utilize an evidence-based and highly effective soft tissue technique called Astym that will stimulate new collagen formation along the biceps tendon. From there, we will progressively load the tendon to allow the collagen to line up properly and grow stronger. We will also focus on regaining the range of motion, strength, proprioceptive control and coordination in your shoulder. 

Shoulder Dislocation:

A shoulder dislocation is a painful and disabling injury of the glenohumeral joint. Most dislocations are anterior (forward), but the shoulder can also dislocate posteriorly (backwards). Inferior and posterolateral dislocations are possible, but occur much less often.

Most shoulder dislocations are in the anterior direction. Sometimes referred to as the subcoracoid dislocation, an anterior dislocation occurs when the head of the humerus is driven forward from inside the glenoid cavity to a place under the coracoid process. The joint capsule is usually avulsed (torn away) from the margin of the glenoid cavity.

When the shoulder dislocates posteriorly, the head of the humerus moves backward behind the glenoid. An inferior dislocation describes the position of the humeral head down below the glenoid cavity. Posterior and inferior shoulder dislocations only account for about five to 10 per cent of all shoulder dislocations.

The shoulder is a very mobile joint and therefore more vulnerable to dislocation than some other joints. The glenoid cavity is small in relation to the head of the humerus. Muscles, ligaments, and the bony anatomy of the shoulder all work together to maintain shoulder stability and prevent dislocation. Dislocation can occur when any of these structures are injured or altered in any way or when there is a force great enough to overcome the ability of these structures to hold the shoulder in place.

Forceful abduction (taking the arm out to the side,) external rotation (rotating outwards,) and extension are the most common combined loads that result in a shoulder dislocation. A fall on an outstretched hand or directly on the posterolateral aspect (back and side) of the shoulder can cause an anterior dislocation. 

Many athletes whose sports involve repetitive and powerful over-head actions, such as swimmers, volleyball players, and baseball pitchers develop laxity in their shoulders simply from the repetitive stretching of the shoulder ligaments during their sports. Once lax, these ligaments do not provide the necessary passive stability that the shoulder joint needs to remain in its socket, and the joint becomes predisposed to dislocation, especially during the overhead and lateral (wind-up) movements used in their sport.

In these situations, the strength and coordination of the rotator cuff muscles and the muscles controlling the shoulder blade become even more important in order to adequately control the shoulder joint during motion and avoid injury.

Once the shoulder has been dislocated the first time, there is a high probability of a second shoulder dislocation (recurrence) especially in a younger population. The force of the first dislocation dislodging the head of the humerus forward leaves a pocket formed by sagging soft tissues that the humeral head can slip back into. Some people with very lax ligaments can dislocate the shoulder and reduce it (manually put it back in place) over and over on their own. This is referred to as habitual dislocation and should be discouraged.

Initially, the treatment we provide at Physioflow Physical Therapy will be focused on relieving any pain and inflammation caused by the dislocation and reduction of your shoulder joint. 

The next part of our treatment will focus on regaining the range of motion, strength, and coordination in your shoulder. The desired outcome of rehabilitation after shoulder dislocation is a return to full function. For athletes, this means full participation in sports activities. 

Depending on how long you were immobilized, your age, as well as the severity of the injury, your arm may feel very weak and be limited in its range of motion once the immobilizer is removed. Shoulders that have not lost some range of movement after the period of immobilization are often suspicious for eventual recurrence of the dislocation.

Frozen Shoulder:

Many adults (mostly women) between the ages of 40 and 60 years of age develop shoulder pain and stiffness called adhesive capsulitis. 

You may be more familiar with the term frozen shoulder to describe this condition. Frozen shoulder and adhesive capsulitis are actually two separate conditions.

True adhesive capsulitis, referred to as a primary adhesive capsulitis, affects the joint capsule itself.

In the case of true frozen shoulder or secondary adhesive capsulitis, the problem is really coming from something outside the joint. Some of the conditions associated with secondary adhesive capsulitis include rotator cuff tears, impingement, bursitis, biceps tendinitis, and arthritis.

In either condition, the normally loose parts of the joint capsule stick together. This seriously limits the shoulder’s ability to move, and causes the shoulder to relatively freeze.

The cause or causes of either primary adhesive capsulitis or secondary adhesive capsulitis (frozen shoulder) remain largely a mystery. Some of the risk factors for adhesive capsulitis include diabetes, thyroid dysfunction, and autoimmune diseases. 

Physical Therapy treatments at Physioflow Physical Therapy are a critical part of recovery and rehab from this injury. The first goal is to reduce pain and interrupt the inflammatory cycle. Next, our treatments are directed at getting the muscles to relax in order to help you regain the motion and function of your shoulder.  The overall goal of Physical Therapy is to help you regain full range of motion in the shoulder.

Shoulder Replacement:

Shoulder joint replacement surgery (also called shoulder arthroplasty) is not as common as replacement surgeries for the knee or hip joints. Still, when necessary, this operation can effectively ease pain from shoulder arthritis. Most people experience improved shoulder function after this surgery.

The most common reason for undergoing shoulder replacement surgery is osteoarthritis. Osteoarthritis is caused by the degeneration of the joint over time, through wear and tear. Osteoarthritis can occur without any injury to the shoulder, though that is uncommon.

Oftentimes, osteoarthritis occurs many years after an injury to the shoulder. For example, a shoulder dislocation can result in an unstable shoulder. The extra movement or repeated dislocation of the unstable joint causes damage to the articular cartilage and other joint tissues. Over time, this damage leads to osteoarthritis.

You may need to spend time with the physical therapist who will be managing your rehabilitation after surgery. This allows you to get a head start on your recovery. One purpose of this pre-operative visit is to record a baseline of information. Your therapist will check your current pain levels, ability to do your activities, and the movement and strength of each shoulder.

A second purpose of the pre-operative visit is to prepare you for surgery. You’ll begin learning some of the exercises you’ll use during your recovery. And your therapist can help you anticipate any special needs or problems you might have at home, once you’re released from the hospital.

Our first few Physical Therapy treatments will focus on controlling pain and swelling. Dr. Trinh will use manual therapy, Astym and passive motion to ease muscle spasm and pain and gradually improve your range of motion to prevent the development of adhesive capuslitis. Continue to use your shoulder sling as prescribed.

As your rehabilitation program evolves, Dr. Trinh will choose more challenging exercises to safely advance the shoulder’s strength and function.

Finally, a select group of exercises can be used to simulate day-to-day activities, like grooming your hair or getting dressed. We will also choose specific exercises to simulate work or hobby demands.

When your shoulder range of motion and strength have improved enough, you’ll be able to gradually get back to normal activities. Ideally, you’ll be able to do almost everything you did before. However, you may need to avoid heavy or repeated shoulder actions.

Although the time required for recovery varies, you may be involved in our progressive rehabilitation program for two to four months after surgery to ensure the best results from your artificial joint. In the first six weeks after surgery, you should expect to see your Physical Therapist two to three times a week. This is mainly to ensure you don’t develop scar tissue and adhesive capsulitis. At that time, if everything is still going as planned, you may be able to advance to a home program.

At Physioflow Physical Therapy, our goal is to help speed your recovery so that you can more quickly return to your everyday activities. When your recovery is well under way, regular visits to our office will end. Although we will continue to be a resource, you will be in charge of doing your exercises as part of an ongoing home program.

Are you experiencing one of the conditions described above? Get relief with Physical Therapy.