Frozen shoulder, also known as Adhesive Capsulitis, is a condition in which the shoulder is painful and presents with decreased range of motion in multiple planes of movement. Patients who have been diagnosed with diabetes mellitus and/or thyroid disease are at increased risk for developing frozen shoulder. Frozen shoulder is more common in individuals 40 to 65 years of age and also more common in women. Frozen shoulder starts gradually with both pain levels and loss of range of motion worsening over time.
A combination of corticosteroid injections from the physician and shoulder mobility and stretching exercises from a physical therapist is the most effective way to help treat frozen shoulder. Physical therapists incorporate individualized stretching exercises and joint mobilization techniques to help treat frozen shoulder and improve a patient’s range of motion. Physical therapists can also help with modifying a patient’s activities in order to promote pain free range of motion and improved functional ability.
Labral Tear, sometimes referred to as a SLAP tear (depending on the location of the tear), is a condition in which the glenoid labrum of the shoulder is ruptured. There are four types of labral tears with Type 1 being the least severe and Type 4 being the most severe1. Labral tears occur in about 4-6% of the general population and are more commonly seen in males. The most common mechanisms of injury causing a labral tear are falling on an outstretched arm or if a patient is a throwing athlete, such as a baseball pitcher, who is throwing repetitively. Patients will have non-specific pain with overhead motions. They will usually describe a catching, or popping in the shoulder as well as generalized weakness and instability1. Some patients may feel a deep vague pain in the shoulder joint.
Stopping throwing activities is usually advised when treating labral tears. Your physician might also recommend use of medication to help decrease pain and inflammation. Physical therapists can help treat labral tears by focusing on individualized strengthening and stretching exercises to help improve range of motion and functional ability. The sleeper stretch is usually effective in helping to stretch the shoulder in patients with labral tears. Physical therapists will then progress the patient to functional overhead exercises and for throwing athletes a structured throwing program with a focus on proper mechanics will be initiated.
The rotator cuff is comprised of the supraspinatus, infraspinatus, teres minor, and subscapularis muscles. Rotator cuff strains generally occur when the related tendons become weak from inflammation or fraying. Strains or sometimes tears often result from slow, progressive damage over time, usually without a known injury. In older, less active adults, even simple movements such as lifting something slightly heavy can cause a severe strain or tear. However, a sudden strain or tear may occur while playing sports such as basketball or volleyball, or after being involved in an accident or a severe fall. This condition can also be seen in people with work tasks that required their arm to be above shoulder height for an extended period of time.
Patients with rotator cuff strains will usually report dull, aching pain. Pain is usually located over the front and outside of the shoulder. A rotator cuff tear can present with sudden, sharp pain. Some other common symptoms include:
Physical therapists can help treat shoulder strains/rotator cuff strains by offering techniques, such as targeted massaged and joint mobilizations, to help reduce pain and improve range of motion. Individualized strengthening and stretching exercises will be provided to each patient to help improve range of motion and functional ability. A focus on strengthening unaffected surrounding muscles and exercises to help increase range of motion in a safe manner will be provided. Surgery may be required for severe rotator cuff tears. Physical therapists will help rehabilitate patients after a rotator cuff repair surgery based on the surgeon’s protocol.
Impingement syndrome is a condition in which shoulder pain is associated with the pathologic narrowing of the sub acromial space that leads the tendons of the rotator cuff (usually the supraspinatus tendon) to become irritated and inflamed as they pass through the sub acromial space. Patients with impingement syndrome usually include athletes (baseball pitching, swimming, volleyball) and persons with occupations requiring repetitive overhead activity1. Patient will usually describe a deep, dull aching pain in the front or outside of their shoulder. A catching sensation may be felt with overhead movements. Patients will usually describe symptoms that started without any particular injury and progressively worsen over time1.
To treat impingement syndrome, your physician may prescribe medications and will usually prescribe physical therapy. Ice can also be used. With severe cases, a physician may do corticosteroid injections1. Physical therapists can help treat impingement syndrome by offering techniques, such as targeted massaged and joint mobilizations, to help reduce pain and improve range of motion. Individualized strengthening and stretching exercises will be provided to each patient to help improve range of motion and functional ability. A focus on strengthening unaffected surrounding muscles and exercises to help increase range of motion in a safe manner will be provided. Physical therapists can also help with modifying a patient’s activities in order to promote pain free range of motion and improved functional ability.
Shoulder Instability is abnormal symptomatic motion of the glenohumeral joint that affects kinematics and results in pain, subluxation or dislocation of the shoulder. Patients with this condition might report “slipping” or “popping out” of their shoulder during overhead tasks. With this condition, pain is usually not severe and is more of a dull general shoulder pain. The patient may complain of weakness, clicking, or grinding in their shoulder. Patients who participate in repetitive overhead activities are more at risk for developing shoulder instability1.
Physical therapists can help treat this condition by incorporating specific strengthening exercises for rotator cuff muscles and scapular stabilizing muscles. Shoulder stability training exercises will also be incorporated at the appropriate time. Postural taping with kinesiotape may also be included to help treat this condition. Exercises focused on improving range of motion where necessary will be incorporated as needed. Physical therapists can also help with modifying a patient’s activities in order to promote pain free range of motion and improved functional ability2.
Shoulder arthritis may occur in either the glenohumeral joint or the acromioclavicular joint. The shoulder pain associated with arthritis is usually gradual in onset. Pain, swelling, and decrease range of motion may cause difficulty with overhead activities such as throwing, putting away dishes, lifting children, and putting luggage in an overhead compartment.
Physical therapists can help treat shoulder arthritis by offering techniques, such as targeted massage and joint mobilizations, to help reduce pain and improve range of motion. Individualized strengthening and stretching exercises will be provided to each patient to help improve range of motion and functional ability. A focus on strengthening all shoulder muscles and exercises to help increase range of motion in a safe manner will be provided. Rest and ice may also be helpful.