The shoulder joint is a very complex joint. The design of the shoulder is such that it offers us a great amount of range of motion but at the sacrifice of stability. The shoulder joint gets its stability from ligaments, muscles, the joint capsule, and the shallow shoulder ball and socket joint. Due to this design the shoulder can be a very common joint that becomes injured when one of the stability systems becomes compromised.
Rotator Cuff Strain/Tear/Tendinopathy
The Rotator cuff is the name given to the group of muscles that help protect and cover the shoulder joint. These muscles are the supraspinatus, infraspinatus, teres minor and subscapularis. Together in combination these muscles help to stabilises the arm and move it towards and away from the body.
These muscles are commonly affected by overuse injury, usually in combination with poor posture and poor biomechanics leading to injury or tendinopathy. These muscles can also be injured due to trauma such as falling onto the shoulder.
These strain/ tears or tendinopathies can be diagnosed with the use of ultrasound to confirm the suspected diagnosis. More commonly, MRI is used to confirm the diagnosis as it gives a better view of the entire shoulder joint and may give insight into other pathologies in the shoulder, like bursitis or arthritis.
In the case of a complete tear or full thickness tear, surgical consultation may be recommended.
Suggested treatment for tendinopathy, or minor strains/tears may include:
- Clinical Pilates
- Rest, ice
- Trigger point therapy
- Postural advice
- Shock wave therapy
Bursa are fluid filled sacs that help reduce friction in and around many of the joints of the body. The shoulder joint has several bursa that work to reduce friction where muscles pass over bones or joints. These bursa can become inflamed leading to a condition called bursitis.
The most common bursa that becomes inflamed is the subacromial bursa. This bursa sits between the rotator cuff tendons and the acromion (bone) of the shoulder. When this bursa is inflamed it seems to present as a shoulder impingement.
This condition often presents due to poor biomechanics of the shoulder. This can occur due to poor posture, weak stabilising muscles of the shoulder, and rotator cuff tendinopathy or other shoulder pathologies.
Treatment options for bursitis may include:
- Clinical pilates for strengthening
- Avoid aggravating activities
- Ultrasound guided cortisone injection
Frozen shoulder is also know as adhesive capsulitis. It is not known what the cause of frozen shoulder is and can often be confused with rotator cuff injury.
Frozen shoulder can be described as occurring in three phases, freezing, frozen and thawing.
In the freezing phase the movements of the shoulder become restricted. The frozen phase has extremely reduced range of motion at the shoulder. During the thawing phase the range of motion at the shoulder starts to return.
What we do know about frozen shoulder is that the shoulder capsule which, is the deepest layer of tissue around your shoulder joint becomes shrivelled and sticky causing the reduction in range of motion and pain.
Frozen shoulder can take up to a year or more to completely settle down.
Often patients with frozen shoulder undergo a procedure called hydrodilatation. This is where a fluid is injected into the joint to remove any adhesions in the shoulder capsule.
Conservative treatment options for frozen shoulder may include:
- Clinical pilates
Arthritis of the shoulder can be differentiated into two categories: inflammatory and degenerative.
Degenerative arthritis is the more common arthritis. This can affect both the acromioclavicular (AC) joint and glenohumeral (ball and socket) joint of the shoulder. This type of arthritis is basic wear and tear to the joint. It can reduce range of motion at the shoulder joint and cause some discomfort and pain.
Degenerative arthritis of the shoulder may be treated with:
- Clinical Pilates
- Postural assessment
- Specific rehabilitation/strengthening to the shoulder and surrounding joints
A less common arthritis at the shoulder is rheumatoid arthritis with is an inflammatory arthritis includes. This is associated with inflammation within the joint resulting in destruction of the joint. This may require referral to a rheumatologist for diagnosis.