Frozen Shoulder (Adhesive Capsulitis)
Your shoulder joint is surrounded by a fibrous capsule that helps keep the shoulder in place and prevents excessive motion of the arm. With adhesive capsulitis (frozen shoulder), this capsule becomes thickened and tightens, causing decreased motion and shoulder pain. There are two types of frozen shoulder: primary and secondary. In the primary diagnosis, the cause of the stiffening is unknown but with secondary, the cause is related to previous injury or immobilization. There are four stages of frozen shoulder; early phase, freezing phase, frozen phase, and thawing phase. Pain and range of motion loss are usually the worst in the freezing and frozen phase. From beginning to end, symptoms can take 15-24 months to fully resolve. Physical therapy interventions are going to depend on what stage of frozen shoulder the patient is currently in. Early on, the focus is on non-irritating interventions such as light stretching, strengthening, soft tissue mobilization, and joint mobilization. Later on, as the joint is less sensitive, interventions are more intensive with the goal of regaining full range of motion and any lost muscular strength.
Postoperative Shoulder Care
There are many types of surgical procedures for the shoulder including rotator cuff repair, biceps tendon repair, labral repair, subacromial decompression, AC joint repair, and shoulder replacement. Regardless of the specific procedure, the primary goal is to regain your function without re-injury. With physical therapy, your therapist will help you return to your prior level of function by improving your range of motion and strength. They will also educate you on how to protect your surgical repair to prevent against the risk of re-injury.
Rotator Cuff Injury
Your rotator cuff refers to the four muscles around your shoulder called the Subscapularis, Supraspinatus, Infraspinatus, and Teres Minor. These muscles work together to stabilize your shoulder by keeping the humeral head (ball) in the glenoid fossa (socket) of your shoulder blade. The rotator cuff can become injured either due to trauma, such as a fall, or over time due to repetitive motions and overuse. This can cause either inflammation of the tendon (tendinitis) or a tear. Tendinitis can progress to a tear if left untreated for a long period of time. Symptoms of rotator cuff injuries include feelings of pain, weakness, and stiffness in the shoulder. You may have challenges with everyday activities like reaching into a high cabinet, brushing your hair, getting dressed, and scratching your back. Your physical therapist will help by improving your strength, range of motion, and posture to promote better movement strategies, decrease your pain and return you to your prior level of function or better.
Shoulder impingement is a condition that occurs when the muscles of your rotator cuff or the bursa in the shoulder (fluid filled cushions that helps reduce friction) rub against the bony arch formed by the top part of your shoulder blade called the acromion. This occurs when you raise your arm overhead, decreasing the space between the acromion and the rest of the structures within the shoulder. Symptoms of impingement include pain with lifting your arm overhead (known as a painful arc), weakness in the shoulder, and tenderness along the front of your shoulder. This can either occur due to the shape of your acromion or from faulty movement patterns and muscular imbalances within your shoulder girdle. Physical therapy can help by restoring joint range of motion, promoting tissue extensibility, strengthening weak or underactive muscles, and providing education on proper posture and better movement strategies.
Shoulder Labral Tear
The labrum is a cartilaginous structure in the glenoid socket of the shoulder blade. This structure helps increase the depth and reinforce the socket making for better contact with the humeral head. There are two common types of labral injuries that can occur in the shoulder: Bankart tears and SLAP (superior labral tear from anterior to posterior). Bankart injuries occur more in the front of the shoulder and occur from dislocations and repeated subluxations. SLAP tears occur most often from falling on an outstretched arm, forceful tractioning of the arm, and overuse. Symptoms for both include non-specific pain that is more noticeable during overhead and reaching activities, painful clicking or popping, feeling of instability in the shoulder, weakness, and decreased muscular endurance. Physical therapy can help by improving your ability to move and reach overhead without pain, increase stability by strengthening the muscle around the joint, mobilize any soft tissue restrictions, and educate you on tasks and activities that may exacerbate symptoms.