Shoulder Injuries

The shoulder complex is an orchestration of muscles and articulations working together to produce movement, yet stable enough to cope with the activities of our daily life and the complexities of sport.
Your shoulder complex can occasionally suffer from a variety of problems such as pain, instability due to a lack of strength or endurance, capsular and muscular stiffness, aberrant patterning and poor neuromuscular control.
Common Symptoms:
Painful with activities
Pain in the shoulder and arm
Pain while sleeping or at rest
The inability to raise your arm
Sudden catching on movement
Decreased movement


Common causes of pain and dysfunction

Some of these conditions may be work, age, trauma, disease or sport related.
Tendinopathy
Rotator cuff tears
Impingement syndromes
Osteoarthritis
Bursitis
Instabilities
Frozen shoulder
Scapular dysfunctions
Sports injuries


Assessment

Treatment is based on accurate history and functional assessment of the respective areas.
Screening may involve active, passive range of movement, strength and sports specific movements that may involve the whole kinetic chain.
Assessment of the cervical and thoracic spine is important to eliminate referred pain.

Anatomy

Scapular/thoracic joint: This area needs the freedom of movement, combined with dynamic stability and optimal timing to place the Gleno-humeral joint in the optimal position for torque production.

Problems:
Scapular dyskinesia
The Rotator Cuff provides stability to the gleno-humeral joint, also enables pre-setting for the desired movement, proprioception, and getting the system ready for action.

Problems:
Traumatic
Non-traumatic
Frozen shoulder
Degenerative joint disease


Treatment

Based on:
Acute / overuse
Irritable / non-irritable
Structural / non-structural
Reduce symptomatic of pain, ensuring education of the patient to avoid aggravating activity.
Tight muscles and capsular stiffness may be treated with manual therapy and dry needling to decrease pain, allowing for an optimal range of movement prior to commencing exercise.
The innervation to the bursa and rotator cuff arise from the C5/6 segments.
There is some evidence that mobilisation of these segments may decrease pain, and facilitate rotator cuff activation.
It has been suggested that the rotator cuff have at least 70% of movement in most ranges relative to the un-injured side prior to commencing exercise.
Exercise prescription and loading must be specific and progress appropriately for each individual, leading to a balance of strength, endurance, motor control, including the functional capacity required for activities during sport and daily life.
References

BJF Dean, SEG Wilim, AJ Carr.2013, Why Does my Should Hurt? A review of neuroanatomical and biochemical basis of shoulder pain. BJSM: 47: 1095-1104.

P Brukner. 2017. Brukner & Khan’s Clinical Sports Medicine. 5th Edition. 377-438

J Gibson. 2018. The Sporting Shoulder, Clinical edge podcast 43.

WB Kibler, PM Ludewig, PW McClure, et al. 2013 Clinical implications of scapular dyskinesis in shoulder injury: 2013 consensus statement from the ‘scapular summit’. BJSM; 47: 877-885.

A Jaggi, S Lambert. 2010. Rehabilitation for shoulder instability. BJSM: 44:333-340.

JA Porterfield, C De Rosa. 2003. Mechanical Shoulder Disorders. Perspectives in Functional Anatomy.

Simons D, Travell JG, Simons LS.1999. Myofascial pain and dysfunction. The trigger point manual. Upper half of body. 2.: Lippincott, Williams and Wilkins.

F Struyf, A Tate, K Kuppens et al. 2017. Musculoskeletal dysfunctions associated with swimmers shoulders. BJSM: 51: 775-780.

Shoulder treatments available with Raymond Smith, 114 Alexander Street, Crows Nest, NSW 2065


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