Common Shoulder Injuries

Frozen Shoulder (Adhesive Capsulitis)

Inflammation, scaring, thickening and shrinkage of the joint capsule may cause progressive stiffness and pain in the shoulder, commonly known as “Frozen Shoulder”.

It affects more women than men, and usually occurs between the ages of 40 and 65.

The cause of frozen shoulder is unknown, but is probably associated with inflammation following prolong immobilisation, following trauma or surgery.

 

Frozen shoulder progresses in 3 stages:

In stage one, (the freezing phase) the patient begins to gradually develop mild pain and stiffness in the shoulder joint.

The pain is more severe at night and the person cannot sleep on the affected side.

This stage can last from a few weeks to a few months.

 

In stage two, (the frozen phase) the stiffness remains but the pain begins to decline and moving the arm is more comfortable.

However, the range of motion is now much more limited, as much as 50% less than in the other arm.

This stage may last 4 – 12 months.

 

In stage three, (the thawing phase), the shoulder begins to ‘loosen’ up and movement to the shoulder is gradually restored.

 

Treatment is aimed at minimising pain and maintaining range of movement and muscle strength in the shoulder joint.

In the initial phase (first 72 h), patients benefit from following R.I.C.E. Regime (Rest, Ice, Compression, Elevation).

This primarily involves resting from aggravating activities, regular icing,and keeping the arm elevated (i.e. sleeping on the opposite side).

Powerful anti-inflammatory herbs and nutrients can help rapidly reduce swelling and inflammation and promote healing.

Bioceuticals Ultramuscleze are the best choices of high magnesium powders to help relax the stiff muscles around the shoulder and reduce pain.

Avoid any aggravating activities so the body can begin the healing process.

Physiotherapy treatment for a frozen shoulder is vital to hasten the healing process and ensure an optimal outcome. Treatment may comprise:

  • soft tissue massage
  • exercises to improve flexibility, strength and posture
  • electrotherapy (e.g. ultrasound, T.E.N.S.)
  • joint mobilization
  • dry needling
  • hydrotherapy

Pendulum exercises are often one of the first exercises prescribed for your frozen shoulder because it uses only the force of gravity to initiate movement in your joint.

Bend over, to allow your arm to hang down towards the ground. Keep it close to your body and relax your shoulder muscles.

Allow your arm to slowly swing forward to back, then side to side, then in small circles in each direction. Only minimal pain should be felt.

Stretch the arm only (without added weight) for the first week. Increase the stretch by adding 0.5 kg per week and gradually increase the diameter of the movements (not to exceed 50 cm).

 

Wand Exercises

You will need a long wooden rod (or broom stick).

Start by lying on your back holding the rod against the abdomen with both elbows straight and hands shoulder-width apart.

Keeping elbows straight, lift arms up to shoulder height while keeping shoulder blades squeezed down and back together.

Return wand to rest on abdomen.

Perform 5 to 10 repetitions, lifting the wand to 90 degrees (shoulder height), then if there is no pain, move the wand through a full range of motion (over the head). Increase to two sets of 10 repetitions with a 2-3 second pause at the end of the motion.

 

Sleep Stretch

Lie directly on affected shoulder with head well supported by pillows. Slide your arm up to 90 degrees and bend your elbow to 90 degrees.

Use your unaffected side hand to gently push the forearm and hand toward the ground alongside your body until you feel a stretch in the back of your shoulder. Maintain the stretch for at least 30 seconds. If you start to feel a pinch, ease up on the stretch.

In most severe cases arthroscopic surgery can successfully release and repair the shoulder, but it must be followed by an exercise program to maintain motion and restore function.

 

Rotator Cuff Tear

Rotator cuff tears often occur suddenly due to activities such as heavy or awkward lifting, a fall onto an outstretched hand, heavy pushing or pulling, or a forceful throw.

Sometimes a rotator cuff tear may develop over time due to repetitive or prolonged activities placing strain on the rotator cuff.

Most tears occur in the supraspinatus muscle and tendon, but other parts of the rotator cuff may also be involved.

In Partial Tear the tear damages the soft tissue, but does not completely sever it.

Complete (full-thickness) tear splits the soft tissue into two pieces. In many cases, tendons tear off where they attach to the head of the humerus.

The most common symptoms of a rotator cuff tear include:

  • Muscle spasm and decreased range of motion
  • Pain at rest and at night, particularly if lying on the affected shoulder
  • Gradual shoulder weakness
  • Pain when lifting and lowering your arm
  • Decrease in the ability to abduct the arm or move it out to the side
  • Crepitus or crackling sensation when moving your shoulder in certain positions

Tears that happen suddenly, such as from a fall, usually cause intense pain.

There may be a snapping sensation and immediate weakness in your upper arm, followed by severe pain shooting from the upper shoulder area (both in front and in back) down the arm toward the elbow.

Early treatment will prevent further damage of the rotator cuff muscles.

As with most soft tissue injuries the initial treatment is RICE – Rest, Ice, Compression and Elevation.

Wearing a sling can help you to avoid activities that will provoke pain in the shoulder.

High potency anti-inflammatory herbs will help reduce inflammation and will help to relieve pain.

Arnica cream or Arnica Pillules are very effective in reducing swelling and inflammation and in preventing bruising of the tissues.

Pain relieving techniques including ultrasound, T.E.N.S., massage, acupuncture or dry needling will assist in relieving pain.

Symptoms related to rotator cuff tears may take several weeks to improve.

Tightness in the ligaments/capsule of the shoulder can contribute to further movement abnormalities and pain in the shoulder.

Your exercise program should include stretches to improve flexibility and range of motion. Stretching exercises should be performed once per day every day.

Range of motion exercises are recommended early in the recovery period to help maintain joint mobility and flexibility of the muscles and tendons in the shoulder.

You can begin strengthening exercises for the shoulder once your shoulder has full range of motion, including overhead activities, with minimal pain.

 

The Best Exercises for Rotator Cuff Strengthening is:

Prone External Rotation with Soft Weight

Lay on your stomach with your arm hanging by your side. Bend your elbow to 90 degrees holding the soft ball. Lift your elbow upward until it’s level with your body. Rotate your forearm upward.

Hold and slowly return.

Exercises should not cause more than a mild level of pain.

 

AC Joint Injury

The acromio-clavicular (AC) joint is the joint formed between the clavicle (collarbone) and the acromion (the tip of the shoulder blade).

Several ligaments surround this joint, and depending on the severity of the injury, a person may tear one or all of the ligaments.

Torn ligaments lead to acromioclavicular joint sprains and separations

The distal clavicle and acromion process can also be fractured. Injury to the acromioclavicular joint may injure the cartilage within the joint and can later cause arthritis of the acromioclavicular joint.

The most common cause of an AC joint separation is falling on the shoulder, especially in contact sports (rugby, football, basketball).

AC joint separations are graded from mild to severe, depending on which ligaments are sprained or torn.

Grade I injury is the mildest type of injury is a simple sprain of the AC ligaments.

Grade II AC separation involves a tear of the AC ligaments and a sprain of the coracoclavicular ligaments.

A complete tear of the AC ligaments and the coracoclavicular ligaments is a grade III AC separation. This injury results in the obvious bump on the shoulder.

 

Symptoms range from mild tenderness to the intense pain of a complete separation. Grade I and II separations can cause a considerable amount of swelling and bruising.

In grade III separations, you may feel a popping sensation due to shifting of the loose joint and a noticeable bump on the shoulder.

The goal of the early recovery period is to limit excessive movement of the shoulder and in particular any extra load on the arm to reduce the strain through the repaired area.

Any weight held in the hand or lifted with the arm has a tendency to separate the AC joint.

Following a period of icing and immobilisation for grade I & II injuries, mobility exercises can be undertaken, but only once shoulder movement is pain free (normally 7 days for grades 1 and 2).

BeginPendulum Exercises on day 2 or 3.

After the acute stage the treatment can progress to range of motion exercise and strength training as symptoms permit.

Muscle strengthening exercises are necessary to improve shoulder muscle strength and help to prevent further injury.

These exercises can often be started approximately one to two weeks after beginning the pendulum stretch exercises (described above), depending upon the level of pain.

No heavy lifting, stresses, or contact sports until full painless range of motion is achieved (usually by 2-3 weeks).

Type II injuries should avoid heavy lifting, pushing, pulling or contact sports for at least 6 weeks.

Anti-inflammatory formula will help to reduce pain and inflammation.

Grade 3 injuries are now more frequently being treated with conservative treatment, but if it doesn’t bring significant improvement, surgery might be needed.

Mobility exercises are initiated within the first week of injury to restore mobility and gradually increase range of motion.

Exercise is progressed with strength exercises, focusing on the scapular and rotator cuff muscles.

The shoulder blade (scapular) and upper arm bone (humerus) should move together, this is called “scapulo-humeral rhythm”. Usually ,when there is an injury to the AC joint, this rhythm is lost.

Shoulder Impingement / Rotator Guff Tendinits

Normally, there is enough room beneath the acromion, so that lifting the arm upwards above shoulder level or backwards causes no problem.

Structural or anatomic abnormalities might result in a narrower subacromial space.

The acromion can rub against (or “impinge” on) the tendon and the bursa, causing irritation and pain.

This can lead to thickening of the tendon which may cause further problems such as further impingement by the structures of the shoulder joint and the muscles themselves.

Impingement Syndrome could be a clinical sign of Rotator cuff injury, Labral injury, Shoulder instability, or Biceps tendinopathy.

Rotator cuff pain commonly causes local swelling and tenderness in the front of the shoulder. You may have pain and stiffness when you lift your arm. There may also be pain when the arm is lowered from an elevated position.

As the problem progresses, the symptoms increase:

  • Pain at night
  • Loss of strength and motion
  • Difficulty doing activities that place the arm behind the back, such as buttoning or zippering

In the early stages of impingement R.I.C.E. regimen and avoidance of painful activities, e.g. overhead activities is essential for initiating the healing process.

Anti-inflammatories will help decrease inflammation and swelling in the bursa or tendons.

Once your injury has healed, incorporate rotator cuff strengthening exercises as these exercises are crucial for successful treatment.

The aim of the exercises is to build the rotator cuff muscles, which then push the ball and socket joint downwards creating, in effect, more space.

Internal Rotation

Begin with one end of the band securely attached at waist-height. (You may place a towel roll under your arm as well.)

Grasp the other end of the band with tension.

Pull the band away from the wall, rotating your forearm inward. Hold and slowly return.

TIP: Be sure to keep your forearm parallel to the ground, your elbow by your side, and your wrist straight.

External Rotation

Begin with one end of the band securely attached at waist-height. (You may place a towel roll under your arm as well.)

Grasp the other end of the band with tension.

Pull the band away from the wall, rotating your forearm outward. Hold and slowly return.

TIP: Be sure to keep your forearm parallel to the ground, your elbow by your side, and your wrist straight.

If left untreated, shoulder impingement can result in a rotator cuff tear.

 

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