Physiotherapy for the Shoulder

The gleno-humeral joint, known in lay terms as the shoulder, is a vital part of the links in the upper limb and responsible for our ability to place our hands where we can see them to perform activities. Because flexibility is a prime requirement the shoulder is a less stable joint with moderate muscle power and a large range of motion. It is described as a “soft tissue joint”, implying that the joint’s functional ability is dependent on its soft and not its hard components. Physiotherapists are closely involved in treating and rehabilitating the shoulder, dealing with the muscles, ligaments and tendons.

The shoulder joint is constructed from the socket of the scapula and the humeral head, the ball at the top of the upper arm bone. The head of the upper arm is a large ball and important tendons insert onto it to move and stabilise the shoulder, but the shoulder socket, the glenoid, is small in comparison and very shallow. A cartilage rim, the labrum of the glenoid, deepens the socket and adds to stability. The acromio-clavicular joint lies above the shoulder joint proper and provides dynamic stability during arm movements, being made up from part of the scapula and the outer end of the clavicle.

A great many muscles act on the shoulder joint and on the other joints in the shoulder girdle, the acromioclavicular, sternoclavicular and scapulothoracic joints. The glenohumeral and scapulothoracic joints are acted upon by the major stabilisers and movers in the area, varying from power muscles which allow forceful work to stability muscles such as serratus anterior and the rotator cuff to smaller movement muscles such as deltoid. The muscles must keep the relationship between the shoulder blade and the thorax and ribcage steady and under control for the glenohumeral joint to also enjoy stability and precise movement.

The rotator cuff is a group of four small muscles which originate from the scapula and insert around the ball of the humeral head, the teres minor, subscapularis, infraspinatus and supraspinatus. The cuff tendons form a sheet around the ball of the arm bone and allow forces to be exerted on the humeral head by the shoulder girdle muscles. If the rotator cuff is not functioning normally the more powerful muscles tend to make the humeral head slide upwards on the socket, interfering with normal function and making a person unable to lift their arm up above their head.

The rotator cuff degenerates with age, small tears appearing across its substance which can progress to massive tears, completely interfering with muscular function of the shoulder. Rotator cuff tears are often painful but it is not clear exactly why, as many older people have tears and do not have pain. Physiotherapists work to strengthen the rotator cuff or by exercising the main shoulder muscles without gravity resistance and gradually increasing the effort. Physios also work on rehabilitation after rotator cuff surgery for rotator cuff tears, following the detailed protocols for small, medium, large or massive rotator cuff tears.

The shoulder joint is not typically affected by OA (osteoarthritis) but when it is physiotherapists treat arthritic shoulders by joint mobilisations, muscle strengthening and ranges of motion. Once physio has nothing else to offer, total shoulder replacement is one of the further options, with various surgical techniques involving replacing the humeral ball and the scapular socket either anatomically or in reverse. The shoulder is often called a “soft-tissue joint” as the soft tissues, their strength and balance, are vital to the function of the joint. Post-operative physio management is essential as the correct protocol must be closely followed to ensure success.

Many other shoulder conditions are managed by physiotherapists, such as hyper-mobility, dislocations and fractures, impingement and tendinitis. Physios manage shoulder hyper-mobility by patient education and stability training and abnormal muscle activity by teaching correct patterns by repetition and biofeedback. Physiotherapy for impingement involves rotator cuff strengthening, sub-acromial injection or surgical management by acromioplasty and tendinitis by local treatment and strengthening. Dislocations and fractures are managed according to the type and severity of injury and according to the trauma surgical and physiotherapy protocols.

Tagged as: alternative medicine, back injury, Back Pain, back pain relief, Frozen Shoulder, health, injury management, pain management, physical fitness, physiotherapists, physiotherapy, Piriformis Syndrome, sciatica