Shoulder

Impingement really is a waste basket term. It refers to irritation or inflammation to tissue that lies above the head of the humerus (the ball, of the ball-and-socket joint) and the underside of the acromion, a shelf-like projection of the scapula. This space is referred to as the subacromial space. In this space exists rotator cuff tendons, the bicep long head tendon, bursa, joint capsule and ligaments. Any of these structures are susceptible to compression in the subacromial space, which can lead to injury. And once inflamed, it can be quite painful and limiting.

‘Impingement’ can happen as a result of abnormal movement and tracking of the humeral head (the ball) on the glenoid (the socket) which leads to decreased space in the subacromial space  as you lift your arm overhead. 

Arthritis is quite  common and can affect anyone at any age. The two main forms of arthritis that affect the shoulder are rheumatoid arthritis and osteoarthritis. Rheumatoid arthritis, an autoimmune disease, occurs when the immune system attacks the inner membrane of the capsule surrounding the shoulder joint, resulting in pain and inflammation. Osteoarthritis – the ‘wear-and-tear’ arthritis – occurs when the cartilage on the joint surface in the shoulder joint undergoes degeneration. This occurs normally as we age, but in some people it advances to a level that it becomes painful and limiting. An injury or excessive overuse and inflammation at the shoulder can eventually lead to arthritis also. Both of these conditions can result in a painful loss of mobility, weakness to the shoulder muscles, and difficulty performing normal daily tasks.

Frozen shoulder, a lay term for a  condition is also known as “Adhesive Capsulitis” has multiple causes. There are two main classifications of adhesive capsulitis: Primary (or Insidious) and Secondary.  Frozen shoulder results in a painful loss of motion in the shoulder with a tightening of the shoulder joint that severely limits motion.

Primary frozen shoulder isn’t fully understood and occurs unrelated to an injury, overuse, surgery or immobilization. It is most common in the peri- and post-menopausal female and research does report correlations to hormonal imbalances also exist. Women from the ages of 40 to 60 tend to experience this condition more than men, and some ethnicities are more predisposed to than others as well. There is also a higher rate of Primary Adhesive Capsulitis in the diabetic person, especially if insulin dependent. This class of frozen shoulder limits all directions of motion at the shoulder joint and can be quite debilitating and take a long time to get better. 

Secondary frozen shoulder can occur after injury, or if you have been immobile for a period of time such as wearing a sling after injury or surgery. This type tends not to limit all directions of shoulder mobility like Primary frozen shoulder does.

Understanding and identifying the two classifications of ‘Frozen Shoulder’, and the stages of development are important for successful treatment with physical therapy. That which our shoulder specialists at Rose City Physical Therapy are versed in identifying and treating successfully.

Tendon injury at the shoulder most commonly involves the rotator cuff and bicep long head. Tendinitis is less commonly referenced any longer as research supports that there in fact is little to no inflammation in an acutely injured tendon. Hence, it is more common to now refer to an injured tendon as tendinopathy. 

When the shoulder joint is overused excessively, tendon injury can occur. It’s typically due to the demands of a laborious job, overhead activity, or sport. Furthermore, poor posture can also be a contributing factor as it alters the biomechanics at the shoulder complex and normal muscular forces on the tendons. Less common, but still one to assess for in a physical therapy evaluation, is the possible contribution to shoulder pain and tendinopathy due to a problem stemming from the cervical spine.

The rotator cuff consists of four different muscles that  are designed to guide precise movement of the ball on the socket and keep it centered in the joint. If you experience an injury to the shoulder, have poor posture, or overuse your shoulder incorrectly, your rotator cuff can get injured and result in a partial or completely tear. Depending on the severity of the rotator cuff injury, you may need surgery. However, research supports that most people with a partial and some even with a full thickness tear of the rotator cuff do well with physical therapy and never have to have surgery. Our physical therapy shoulder specialists at Rose City Physical Therapy can drastically help reduce pain, restore range of motion and strength to the rotator cuff to get you back to function and avoid potential surgery.