Shoulder Injury Physio

Shoulder injuries occur due to the joint being one of the most used joints in the body and easiest to destabilise.

Coupled with being highly mobile joints, the type of injuries that can occur can range from acute dislocations, to long term shoulder pain and instability problems. All of which can be managed effectively through Physiotherapy.

Responsible for providing movement to our arms, the shoulder is the main structural connection between the upper limb and our body.

Consisting of the scapula (shoulder blade), humerus (upper arm) and clavicle (collar bone), the shoulder is the most mobile joint in the body. And so is easily injured through sport, work or daily wear and tear.

The humerus is the bone of our upper arm, spanning from the shoulder to our elbow. As it attaches to our shoulder at the glenohumeral joint, the humerus, especially the proximal head, is the site of a lot of muscular attachments. It is movement of the humerus which allows us to lift and move our arm, and so it is integral to many of our daily tasks. Fracture of the humeral neck is what people usually call a broken shoulder and can severely limit our ability to complete day-to-day tasks.

Fracture of the humerus will usually occur via a fall onto an outstretched arm though less common causes include fall onto a bent elbow or the point of the shoulder, or even direct trauma to the upper arm such as in a motor vehicle accident. The fracture will present with acute pain, loss of function of the upper limb and swelling, bruising and inflammation.

The symptoms of a rotator cuff tear will be different depending on the mechanism of injury. If resulting from a single traumatic event, there will be acute pain at the joint, with immediate weakness and possible a snapping noise or feeling. Though gradual rotator cuff tears can be asymptomatic, not presenting with pain, most patients will identify a dull ache or muscular weakness and pain, especially when the arm is raised above shoulder height.

Physiotherapy will be incredibly important to help in decreasing pain and increasing function. It will be important to attend physiotherapy so that your practitioner can identify the extent of the injury so that you can move forward in the treatment of the injuries, minimising pain and then prescribing a gradual reloading program to re-strengthen the joint and allow full range of motion.

As dicussed previously, the shoulder is a shallow joint, this allows its mobility however also means the decreased stability. The ligaments and rotator cuff help to increase stability; however, the glenoid labrum is one of the most important structures of the joint, increasing the surface area and depth of the joint, therefore greatly improving stability.

The labrum is a small fibrocartilaginous tissue which provides a rim to the glenoid cavity, increasing stability and providing attachment for several ligaments.

Injury to the labrum most often occurs due to traumatic force applied to the joint or from repetitive strain from overhead or throwing activities. Common mechanisms of injury include, fall onto an outstretched arm, direct trauma to the shoulder, fast or heavy movements of the arms over shoulder height and shoulder dislocations. These injuries are common in athletes who do a lot of activity above shoulder or head height, such as weightlifting or throwing events.

Labrum tears will present as a loss of function of the shoulder, instability, weakness and limited range of motion; pain with movement and lifting objects; feelings of the catching, popping or grinding in the joint throughout motion.

There are different treatment strategies for a torn labrum depending on its severity. Conservative treatment will include shoulder/rotator strengthening exercises, if extensive enough however the injury may require surgical intervention. In either strategy, the injury will require physiotherapy to ensure complete recovery and to minimise the likelihood of re-injuring the labrum.

Ligament injuries are quite common for the shoulder. Often caused through falls, repetitive strain or contact sports, these injuries can greatly impede function, limit mobility and stability, and lead to a range of further complications.

The ligaments most often injured are those stabilising the acromioclavicular (AC) joint. The AC joint is where the lateral edge of the clavicle and the acromion of the scapula meet. It is easily identified as the ‘point’ of the shoulder, slightly protruding near the outside of the shoulder where it can be felt and seen.

The joint is supported by a joint capsule and further by the acromioclavicular and coracoclavicular (trapezoid and coracoid) ligaments. Injury will often occur when a force is applied directly to the point of the shoulder, such as a tackle if rugby or a fall, but can also occur from a fall onto an outstretched arm.

Symptoms of the injury will include pain, initially this may be general, encompassing the whole shoulder but with time will become specific to above the site of injury (at the end of the collar bone). Pain will increase or become present when trying to move the arm, especially when trying to raise it above shoulder height. Swelling will also occur and depending on the extent of the injury some deformation, where the joint has separated and a lump is raised.

As with most ligament injuries, it is important to consult with your physiotherapist if you have been diagnosed with or suspect an AC joint tear. AC tears, especially lower grade tears, will often be conservatively treated with prescription of gradual loading joint stabilising and strengthening exercises that will be effected by your physio to ensure a complete and timely recovery and return to duties.

A shoulder dislocation occurs when the humeral head is completely forced out of the glenoid cavity, or socket, and usually doesn’t return until forcefully repositioned. A subluxation is a similar injury, except the humerus moves partially out of the joint and then returns to its natural position. Both injuries are very painful and are often coupled with ligament or tendon damage and even bone fractures.

Dislocation can occur either anteriorly or posteriorly, the humerus exits the socket out the front or back respectively. Anterior dislocation is far more common, making up almost all incidence of shoulder dislocations and will usually occur due to falls onto an outstretched arm or a blow to the area, such as in contact sports or falls. These dislocations are called traumatic shoulder dislocations and often can be coupled with fractures of the proximal humerus.

Other common causes of shoulder dislocations are associated with ligament laxity or looseness. Whether due to hypermobility from genetics, or repetitive strain from sports or physical activity, loose ligaments will decrease the ability of the rotator cuff to stabilise the shoulder, increasing the likelihood of dislocation. Both genetic hypermobility and sports related laxity can be managed by shoulder stability programs and rotator cuff strengthening exercises.

The main symptoms of a shoulder dislocation will be acute, intense pain and deformation, the shoulder won’t look right. It is important to pay attention to any warning signs around the shoulder, as there will generally be indications of susceptibility to dislocation before the actual event. A simple loss of function, weakness through normal ranges of motion or tightness when undertaking normal activities, even when not painful, can indicate an increased likelihood of dislocation or subluxation.

• Manual therapy (soft tissue massage and trigger pointing).
• Joint mobilisation.
• Stabilisation exercises
• Education about what is a normal experience with shoulder pain.
• Taping or brace support (especially important in recovery from ligament ruptures).

• Exercise programs for rehabilitation or pre-habilitation.
• Ice or heat treatment.
• Work or activity modification advice and referral.
• Dry needling.
• Gradual return to work program.

Exercise programs will be of key importance during rehabilitation for all shoulder injuries due to its large movement responsibilities. As it is a major movement centre and important for stability, to restore full function for work, sport and general living, the shoulder will require correct and gradual reloading otherwise further complications can occur.

When addressing your recovery, our physios will plan and prescribe a program which will help to remedy current injuries and minimise the likelihood of them occurring again in the future. For adolescents and young athletes who are experiencing repetitive strain it is important to strengthen the rotator cuff. Our adolescent strength and conditioning class addresses issues such as these, working to correct imbalances and minimise injury risk in our clients.