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Shoulder

Thursday, 02 March 2017 13:41

Labral Tears Of The Shoulder

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What is the Labrum of the shoulder?
The shoulder is a remarkably mobile joint, however this flexibility comes with the cost of less stability. The glenohumeral joint, where the upper arm meets with the shoulder blade is a ball and socket type joint. The surface area of the ‘socket’ part of the joint (the glenoid fossa) is actually much smaller than the ball part of the joint (the head of the humerus). A fibro-cartilaginous ring called a labrum, surrounds the edge of the glenoid fossa which acts to increase both the depth and width of the fossa. This labrum provides increased stability and is also the attachment for a part of the biceps muscle via a long tendon. The labrum is able to provide flexibility and stability that a larger glenoid fossa might not be able to, however being a soft structure it is prone to tearing which can be problematic.

Thursday, 05 May 2016 14:20

Shoulder Dislocations

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The shoulder is an amazing joint with incredible flexibility. It doesn’t attach directly to the spine, like the hip joint; instead, it is held to the body through a complicated system of musculature and indirectly by the collarbone (clavicle) to the front of the rib cage. Many other joints in the

body are extremely stable, thanks to the structure of the bones and ligaments surrounding them. However, the shoulder has so much movement that some stability is sacrificed. It is for this reason that shoulder dislocations are a relatively common occurrence.

What is a dislocation and how does it happen?

As the name suggests, a dislocated shoulder is where the head of the upper arm is moved out of its normal anatomical position to sit outside of the shoulder socket joint. Some people have more flexible

Joints than others and will unfortunately have joints that slip out of position easily without much

cause. Other people might never have a dislocated shoulder except for a traumatic injury that forces it

out of position. The shoulder can dislocate in many different directions, the most common being anterior. This occurs when the arm is raised and forced backwards in a ‘stop sign’ position, which can occurin many situations.

What to do if this happens

The first time a shoulder dislocates is usually the most serious. If the shoulder doesn’t just go back in by

itself (spontaneous relocation), then someone will need to help to put it back in. This needs to be done by a professional as they must be able to assess what type of dislocation has occurred, and often an X-ray needs to be taken before the relocation happens. A small fracture can actually occur as the shoulder is being put into place, which is why it is so important to have a professional perform the procedure.

How can physiotherapy help?

Following dislocation, your physiotherapist can advise on how to allow the best healing for the shoulder. It is important to keep the shoulder protected for a period to allow any damaged structures to heal

as well as they can. After this, a muscle-strengthening and stabilization program can begin. This is aimed at helping the muscles around the shoulder to provide further stability and prevent future dislocations.

Friday, 26 February 2016 01:58

Shoulder Impingement

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What is Shoulder Impingement?

Shoulder impingement is a very common shoulder condition, also called painful arc syndrome, supraspinatus syndrome, swimmer's shoulder and thrower's shoulder, it is due to mechanical compression and irritation of the soft tissues around the shoulder joint. It occurs in people of all ages, and affects males and females equally. If the impinged tissues are not treated appropriately, they can become extremely painful and cause significant difficulty during day-to-day activity.

How does it happen?

Shoulder impingement occurs when the tendons or bursa in the shoulder are compressed against the humerus (upper arm bone) and the acromion process (a bony part of the top of the shoulder blade that protects the shoulder). This typically occurs in people who perform lots of repeated overhead activities. Some people also have bone and joint structures that put them at more risk than others in developing this condition, for example a curved or hooked acromiom rather than a flat one.

Shoulder impingement is usually classified in two ways: (1) Primary impingement - this usually happens in people over 40 years of age due to degeneration of the rotator cuff tendons, acromion process, and shoulder joint resulting in reduced space for soft tissues during shoulder movements;and, (2) Secondary impingement - typically seen in people aged 15 to 35 years old. In these cases, impingement is usually due to poor movement patterns and muscle imbalances that lead to impingement.

What are the signs and symptoms?

Pain located at the front or side of the shoulder during arm movements is the most common symptom of shoulder impingement. This pain typically occurs in an “arc” as a person lifts their arm. The start of the movement will be painless, becoming increasingly painful as the movement progresses and eventually is pain-free again. Pain with overhead reaching is a common complaint particularly in mid-range. The onset of pain is typically gradual with no known trauma.

Many people complain of difficulty with performing activities such as doing up buttons, zippers or getting a wallet from the back pocket. Patients will eventually avoid using the involved shoulder, which then leads to muscle weakness. Loss of movement will also develop due to pain. Pain may also interfere with sleep, particularly when rolling onto the involved shoulder.

Just like every other conditions, shoulder impingement begins with a medical history and evaluation. During, physical evaluation, the physician will try to reproduce the pain by twisting or elevating the patient's arm. Diagnostic procedures like X-ray, MRI and Ultrasound scan are done to rule out other shoulder conditions.

How can physiotherapy help?

The primary goal of physiotherapy will first be to reduce pain before eventually restoring function and strength to the shoulder. Your physiotherapist will achieve this through stretching exercises, retraining of movement patterns, muscle releases, taping and resistance exercises. As the level of pain starts to decrease, strengthening exercises will be increased to allow your shoulder to function at its optimal level.

An important part of physiotherapy treatment is also education, which allows you to avoid a re-occurrence of shoulder impingement in the future. For patients who don’t respond to physiotherapy, cortisone injection or surgery are options to explore.

Friday, 26 February 2016 01:57

Rotator Cuff Tears

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WHAT IS THE ROTATOR CUFF?

The rotator cuff refers to four small muscles in the shoulder joint that connect the shoulder blade to the upper arm. They stabilize the shoulder joint, keeping the joint where it is and also act to rotate the shoulder inwards and outwards.

The muscles attach at different points around the shoulder blade and attach as four tendons into the top of the humerus (upper arm bone).

HOW DO THEY TEAR?

These tendons are commonly injured through a fall onto an outstretched arm. However, they can tear from seemingly harmless movements of the arm repeated over a long period of time if the tendons are weakened. This is often referred to as ‘repeated microtrauma’. Tears occur most commonly at the point where the muscle turns into tendon, called the musculotendinous junction.

WHAT DOES IT MEAN IF I TEAR MY ROTATOR CUFF?

What to expect after a rotator cuff tear depends on how bad the tear is. It is possible to tear the tendon completely in two, which usually requires a surgical repair and subsequent rehabilitation. Partial tears can heal with physiotherapy rehabilitation and the length of time required will depend on the severity of the tear.

Unfortunately, while many rotator cuff tears are resolving and healing, secondary complications begin to occur. The shoulder girdle is a very complex and flexible part of the body and as such is quite vulnerable to pain caused by poor movement patterns

Many people move differently when they have pain. They might tend to elevate the shoulder blade, move their neck less to that side or simply move that arm less.

A common condition associated with rotator cuff tears is shoulder impingement, which is where, due to poor muscle control, structures within the shoulder joint are compressed and irritated as the arm is moved.

CAN PHYSIOTHERAPY HELP?

Physiotherapy is an important part of the rehabilitation process of rotator cuff tears, both surgically and naturally repaired. Your physiotherapist will help to prevent secondary neck and shoulder problems and give you a strengthening program to restore you to your previous function. For the best outcomes it’s important to seek treatment as soon as possible and get started on your rehabilitation program.

Wednesday, 06 February 2013 08:32

Swimmer's Shoulder

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Shoulder pain is a very common complaint among swimmers.The term “swimmer’s shoulder” is a general term encompassing a spectrum of shoulder dysfunction.

The pain associated with swimmer’s shoulder is usually due the pinching of the rotator cuff tendons (tendons around the shoulder) or the bursa (fluid filled sac) underneath the arch of the shoulder.

The four rotator cuff muscles are the dynamic stabilizers of the shoulder joints.They act to control the movement of the shoulder joint.When these muscles start to function abnormally, they allow the humerus (long arm bone) to rise up and pinch structures within the shoulder joint.

Any imbalance of these muscles can contribute to the development of swimmer’s shoulder.Other factors are:

  • Poor posture
  • Muscle tightness
  • Increased mobility of the shoulder joint
  • Stiffness of the neck or back
  • Long duration training sessions
  • Excessive paddle work
  • Breathing on one side only
  • Poor swimming techniques
  • Continued pinching of the tendons underneath the shoulder arch results in swelling and pain and will eventually result in damage to the tendons and cause them to degenerate.

Management by a physiotherapist includes:

  • Stretching of muscles contributing to the imbalance
  • Massage
  • Re-education of the weaker muscles
  • Strengthening exercises for the rotator cuff muscles and/ or the specific muscles causing the imbalance
  • A graduated and progressive rehabilitation program
  • And, very importantly, technique correction.

“Swimmer’s shoulder” can be a real problem to the keen swimmer and merely reducing the amount of laps or “resting” is not the answer. Physiotherapists can assist with all the above management strategies and the problem should be addressed before it gets worse.

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