Web viewIt is degeneration or wear and tear in the joints of the shoulder complex because of aging process, ... Lift the hand straight up without bending form spine or shoulder

Sancheti Physiotherapy and rehabilitation departmetn Shoulder club

SHOULDER JOINT

The shoulder joint is a ball-and-socket joint formed by the articulation between the

rounded head of the arm bone (humerus) and cup-like depression (glenoid fossa) of the

shoulder blade (scapula), called the glenoid fossa., also involving collar bone (clavicle).

The shoulder joint allows the arm to move in a circular rotation and also towards and

away from the body, thus is the most mobile joint of the body. The muscles, ligaments,

capsule and cartilage of the shoulder joint reinforce its structure and provide stability to

the joint.

Rotator cuff and its pathologies

The rotator cuff is made up of four muscles which connect the shoulder blade to the arm

bone. Thus rotator cuff muscles are important for stabilizing the shoulder joint specially

during motions. The other important role of the rotator cuff is to help with movement of

the arm, particularly overhead movements and rotation of the arm.

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Rotator cuff pathology has a wide spectrum of presentation including-bursitis, tendinitis,

rotator cuff fraying, partial rotator cuff tear, complete rotator cuff tear, and rotator cuff

tendinosis.

Bursitis- Above the rotator cuff there is a bursa, or bag of fluid, that covers and protects

the rotator cuff from friction as it comes into close contact with bones around the

shoulder. When the rotator cuff is injured or damaged, it can lead to inflammation of the

bursa, called bursitis.

Rotator cuff impingement- Impingement syndrome is where these tissues are

squeezed between the bones around the shoulder.

Rotator cuff tendinosis- While some rotator cuff injuries can occur in younger people

due to trauma, most injuries result from aging and degeneration of the rotator cuff,

mostly older than 40 years.

Rotator cuff tear- Damage to the rotator cuff can vary from minor strains or fraying to

complete tears.

Common Causes of rotator cuff pathologies :

Overuse- in the form of repitative overhead activities

Trauma- accidents, falls, direct blow.

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Degeneration of either rotator cuff tendon or Joint –older than 40 years of age

generally (osteoarthritis or rheumatoid arthritis)

Frozen Shoulder

Periarthritis of shoulder also commonly called Frozen shoulder/Adhesive

capsulitis Common in people over 45 years of age Onset-insidious, after trauma or surgery Commonly associated with Diabetes.

It has 3 stages namely:

i. Painful (pain is the main feature,which worsens at night)ii. Frozen (restriction of motion is more than pain) and

iii. Thawing (No pain, only restriction of motion)

Shoulder Instability and Dislocations

Shoulder Instability is a relatively common condition characterized by loosening of the ligaments and capsule surrounding the shoulder therefore allowing excessive movement resulting in an unstable joint.Types:Anterior (slipping popping or sliding may be present, apprehension with moving shoulder outwards and externally rotating the shoulder)Posterior (slipping or popping of the upper arm bone out the back, associated with moving shoulder forwards and internal rotation while the shoulder is under a compressive load.)Multidirectional instability with the anterior accounting for nearly 90%. (Looseness in all directions)

Causes: traumatic (fall or a direct blow to the shoulder) or could be non-traumatic.

Commonly associated with Ligamentous laxity.

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.

Shoulder Dislocation is caused due to severe instability in a particular direction.In this condition the arm pops out of the socket and the excessive mobility causes the shoulder to slip out of place and could result in chronic instability and weakness.

Approximately 25% of shoulder dislocations has associated fractures.

Arthritis

It is degeneration or wear and tear in the joints of the shoulder complex because of aging process, commonly affecting people over 40 years of age. Although less commonly seen in shoulder, but the symptoms are debilitating. If it is because of aging, it is known as osteoarthritis or else rheumatoid arthritis.

Common Symptoms seen in shoulder pathologies

Pain during overhead reaching for any object or during a particular range (mid-

range) while elevating arm

Weakness

Restricted motion

Catching/ locking

Feeling of instability - subluxation – dislocation

Inability to lift arm in case of tear

Loss of function

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The symptoms are usually aggravated in certain activities, such as reaching backwards

to fasten a seat belt or to reach to the back pocket or lifting with the arm outstretched.

Symptoms are worse when the arm is elevated overhead, especially if the elevated arm

is loaded.

Therefore strengthening of the shoulder cuff muscles is paramount in treatment of all

patients with shoulder problems.

Routine Management

(A) Conservative Management

Includes the following-

1) Medications- Analgesics, Anti-inflammatory drugs (pain killers), Muscle relaxants

2) Physiotherapy

Modalities- Ultrasound, Laser, IFT, etc.

Mobilization-Maitland’s mobilization, Kaltenborne mobilization, Mulligan’s manual

therapy

Taping-Kinesio taping, Rigid taping

Exercises- Strengthening, stretching and proprioceptive training exercises,

theraband exercises

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Ultrasound Therapy for shoulder pain Joint mobilization


(B) Injection for pain relief

(C) Surgical Management

Surgery is usually rare. It is advocated in cases of fractures around the shoulder,

complete tear of muscles and other major injuries, when patient doesn’t respond to

other treatment options.

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Kinesio Taping for painful shoulder


Early rehab. Exercises for post op. shoulder conditions:

PHASE 1 EXERCISES (MAXIMUM PROTECTION PHASE)

___ to___ weeks

_ ____ Repetitions

SHOULDER FLEXION- Sitting. Support your affected arm with your other hand under the elbow. Gently lean forward. Rock your hand backward and forward.

_____ Repetitions

SHOULDER ABDUCTION- Sitting. Support your affected arm with your other hand under the elbow. Gently lean forward. Rock your hand side to side.

____ Repetitions

SHOULDER LATERAL ROTATION:Sitting-keep your elbow at your side and hold affected arm’s wrist.gently move the hand to 90 degrees.do not move further than this.

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SHOULDER & SCAPULAREXERCISES


To prevent stiffness and weakness in adjacent muscles and joints (viz. neck, elbow and hand), following exercises should be involved in standard regimen of exercises

Neck exercises

---- Reps

Move your head front and back so as to touch your chin to your chest and backwards so as to take your

chin away from the chest.

---Reps

Move your neck sideways so as to touch your ear to your shoulders.

----Reps

Rotate your head to your right and left sides.

Elbow and wrist exercises

------Reps.

Move your hand towards your shoulder and straighten it.

------Reps.

Turn your hand facing downward and upward alternately.

-----Reps.

Bend your hand forward and backward alternately.

----- Reps.

Move your hand sideways.

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PHASE 2 & 3 EXERCISES(MODERATE and MINIMUM PROTECTION PHASE) ___ to___ weeks

Static strengthening exercises

reps hold

Shoulder flexors- Stand facing the wall. Attempt to push your fist forward to the wall.

reps hold

Shoulder extensors- Stand with your back to the wall. Attempt to press your elbow against the wall.

reps hold

Shoulder abductors- Stand with outside of your affected arm in contact with the wall, attempt to move the whole arm out to the side against the wall.

reps hold

Shoulder adductors- Stand with the small rolled up towel under your affected arm.attempt to squeeze the whole arm to the side.

reps hold

External rotators- Stand with outside of your affected hand against a wall. Attempt to move the affected hand outwards. Do not allow your elbow to move away from your side.

reps hold

Internal rotators- Stand with inside of your hand of the affected arm held against a wall. Attempt to move the affected inwards. Do not allow your elbow to move away from your side.

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times or mins

Stand while bending from hips with one arm supported on a table. Keep affected arm freely hanging. Shake it front and back and then in and out freely like a pendulum.

reps hold

Lie down on your stomach & lift your shoulder backwards. Now lift your hands up maintaining the shoulders. Head should be supported all the time.

reps hold

Stand in front of mirror. Take your shoulders backwards. Don’t lift shoulders up. Hands should be by the side of body.

reps hold

Stand in front of mirror take your shoulder backwards & bend your hand through elbow. Now rotate your hand outwards & inwards stretching the theraband.

reps hold

Stand in the corner of room. Spread your arms on the walls & try to push your chest into the corner. You should feel stretch over your chest.

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times

Hold stick as shown in figure in both hands. Take your hands upwards, both from front and sides till the point of pain without bending from elbow. Come down.

reps hold

Take towel in hand across back & with upper hand try to pull your lower hand upwards & vice versa.

reps hold

Stretch one arm with the help of other arm as shown in the figure while standing or sitting on a chair.

reps hold

Lie on your back. Keep the arm at right angle from body with elbows bend. Bring the hand down in the inner side rotating the shoulder. Do the same while taking hand outside.

reps hold

Stand holding on end of the band in one hand and putting other end under foot, measuring the length as much as your arm and forearm. Lift the hand straight up without bending form spine or shoulder.

reps hold

Place one hand on the opposite shoulder. With the other hand pull the elbow so as to feel a stretch in the shoulder as shown.

Lie on the affected side and keep the shoulder and elbow at 90 degrees. Hold the wrist with the other hand and pull it down as shown in the picture.

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Reps Hold

Reps Hold

Stand with the band held in both hands overhead and elbows at shoulder levels. Join both shoulder blades together and stretch the band as shown.

Reps Hold

Hold the center of band behind your upper back holding both the ends. Move hands forwards, stretching the band, joining the hands in front.

Reps Hold

Hook the band on front at shoulder level, elbows and shoulders at 90 degrees, rotate arm upwards maintaining the position.

Reps Hold

Stand with similar position as above, hook band behind at shoulder level. Rotate arm forward and downwards as shown.

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Reps Hold

Place center of band below the feet, holding the ends as shown. Lift both hands sideways from shoulder with elbows slightly bend.

Reps Hold

Hook center of band overhead. Hold both ends, pull shoulder blades back and down (inset).

Reps Hold

Hold both ends of band and hook the center in front at elbow level. Pull both elbows backwards, squeezing shoulder blades together.

Reps Hold

Lie on your stomach, both elbows bend at elbows at the side of the shoulders. Pull both elbows backwards squeezing both shoulder blades together.

PHASE 4 EXERCISES (RETURN TO ACTIVITY PHASE)

This comprises of exercises to bring the patient back to their normal activity level (pre-

injury state). That could be sports specific, recreational or sedentry for the patient.

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INSTRUCTIONS

DO’sUse slings and supports as per doctors’ advice.

Always maintain good posture.Take adequate breaks during the work.

DON’T’sDon’t sleep on the painful shoulder.Don’t lift anything heavy from affected shoulder.Don’t carry bags on the painful shoulders.Avoid forward neck posture.Avoid exercises in severe pain & contact your doctor and Physiotherapist.

Always carry heavy objects close to your body.

Use good body mechanics standing straight with your shoulders back.

Avoid undue pressure on the affected shoulder by lying on the other side.

Shoulder Club/Unit

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Shoulder unit is a unit equipped with all the modern modalities for treatment of

shoulder including sports specific rehabilitation. We have a team of specially trained

experienced physiotherpaist to supervise and guide you through the

healing/rehabilitation process.

Timings :Physiotherapy OPD : +912028999713

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Web viewIt is degeneration or wear and tear in the joints of the shoulder complex because of aging process, ... Lift the hand straight up without bending form spine or shoulder

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