Common Shoulder Injuries

Biceps Tendinopathy (Tendonitis) occurs when the long head of biceps tendon is compressed under a bone at the top of the shoulder called the acromion. This compression is normally due to changes in posture, poor control of the muscles of the shoulder or as a result of a traumatic injury where other structure of the shoulder are damaged. The treatment of biceps tendinopathy requires improvements in motor control in the muscles surrounding the shoulder often but not limited to the muscles of the shoulder blade and the rotator cuff. In addition developing a solid foundation through the trunk and hips is important.

Rotator Cuff Tendinopathy (Tendonitis) occurs when the rotator cuff tendon is compressed under a bone at the top of the shoulder called the acromion. This compression is normally due to changes in posture, poor control of the muscles of the shoulder or as a result of a traumatic injury where other structures of the shoulder are damaged. The treatment of rotator cuff tendinopathy requires improvements in motor control in the muscles surrounding the shoulder often but not limited to the muscles of the shoulder blade and the rotator cuff muscles themselves. It is also extremely important to develop the control of the trunk and hips in order to provide a solid foundation for shoulder stability.

Multidirectional Instability occurs when the capsule that holds the shoulder in place is stretched, torn or naturally loose. This situation results in less static stability (stability arising from the joint itself) in the shoulder and results in greater aberrant movement in the shoulder joint. This can result in impingement of the rotator cuff and result in further injuries. Treatment of multidirectional instability requires conditioning of the muscles that help keep the head of the humerus (the top of the arm in the shoulder joint) in addition training of the muscles of the trunk and hip to provide a foundation for shoulder stability is also extremely important.

Superior Labral Injury (SLAP lesion). The labrum is much like the meniscus in the knee and provides additional stability in the shoulder joint. Superior Labral Injuries often result due to a fall with an outstretched arm or onto the shoulder directly.  When the arm is forced into these positions the labrum can be damaged. Labral injuries often present with the patient reporting clicking, locking or giving way as the shoulder is moved. Treatment of severe labral injuries is surgical and takes between 6 to 12 weeks to recover depending on the extent of the damage and type of repair that is performed.

Inferior Labral Injury (Bankart). The inferior labrum deepens the shoulder socket and provides greater stability to the shoulder. Inferior labral injuries are less common than superior labral injuries and occur when the bottom section of the labrum is torn by the force of the arm during twisting and impact. These injuries often occur during shoulder dislocation and require surgical repair. The expected time of recovery is between six and twelve weeks depending on the severity of the injury and type of surgery involved. Physiotherapy is required in these conditions to maintain optimum shoulder range of motion and maintain normal muscle control around the shoulder.

The Acromioclavicular Joint (A/C joint) injuries are common in contact sports like rugby and in sports where falls on the shoulder are common. The A/C joint is the joint that joins your collar bone to the shoulder blade at the top of the shoulder. In severe A/C joint injuries a step deformity is produced. In this situation the ligaments that hold the joint together are torn resulting in a dropping of the top of the shoulder blade relative to the collar bone. A/C joint injuries rarely require surgery and normally heal well with physiotherapy management. The goal of a physiotherapy programme in A/C joint injuries is to restore full pain free range of motion and control of the muscles of the shoulder as quickly as possible.

Rotator Cuff tears normally occur in the later years of life as the tendons of the rotator cuff become less elastic. These injuries are often repaired surgically depending on the age of the patient and the degree of injury and loos of function. Irrespective of the degree of the injury or whether surgery is carried out management with physiotherapy in an attempt to compensate for the loss of function and pain that arises after a tear is important. Specific exercises to maintain range of motion control and strength in the surrounding muscles is also extremely important.

Dislocation of the Glenohumeral Joint. The glenohumeral joint is the joint that joins the top of the arm and the shoulder blade. With an impact or with twisting the top of the arm can become dislodged from the shoulder resulting in a dislocation. The shoulder capsule is often torn and other structures such as the labrum (the fibrous ring that deepens the shoulder joint) can also be damaged. More than two dislocations in a twelve month period often necessitates surgical intervention. Physiotherapy can help reduce the pain and improve the range of motion after shoulder dislocation. Exercises are extremely important to improve the function of the shoulder both before and after surgery.

Frozen Shoulder is condition that can develop after a traumatic insult to the shoulder. The condition is defined by three distinct phases. 1. Freezing - the shoulder is commonly sore and painful in this stage and there is progressive limitation of movement particularly in internal and external rotation. 2. Frozen - the shoulder is stiff and limited in movement but pain is normally not  a major issue in this stage. 3 - Thawing - the shoulder begins to regain some of its lost range of motion. Frozen shoulder has been shown to be more common in individuals who have a history of diabetes and the reason for its development remains unclear. Maintaining range of motion during the freezing stage and improving range of motion though the later stages is important. Medical management of the condition may complement physiotherapy.