How We Sorted Annie's Shoulder Pain

When Annie first came to PhysioWorks she reported a painful shoulder that she just could lie on and do simple things like reaching into a kitchen cupboard.

She tried a dose of anti-inflammatory tablets but there was little change.Her GP arranged a scan for her shoulder which identified a shoulder impingement. Then she was referred to PhysioWorks for some TLC and shoulder treatment. 

Annie's physio confirmed shoulder impingement and set to shoulder treatment to address her issues. After just a few physio sessions, Annie's shoulder pain disappeared and she was able to lie upon her shoulder and start playing tennis and swim again. Yahoo!

Here's some more info about Shoulder Impingement.

What is Shoulder Impingement Syndrome?

Shoulder impingement syndrome is a condition where your shoulders rotator cuff tendons are intermittently trapped and compressed during shoulder movements This causes injury to the shoulder tendons and bursa resulting in painful shoulder movements.

Impingement (impact on bone into rotator cuff tendon or bursa) should not occur during normal shoulder function. When it does happen, the rotator cuff tendon becomes inflamed and swollen, a condition called rotator cuff tendonitis. Likewise if the bursa becomes inflamed,shoulder bursitis will develop.

Both these conditions can co-exist or be present independently.

While a traumatic injury can occur eg fall, it is repeated movement of your arm into theimpingement zone overhead that most frequently causes the rotator cuff to contact the outer end of the shoulder blade (acromion). When this repeatedly occurs, the swollen rotator cuff is trapped and pinched under the acromion.

Injuries vary from mild tendon inflammation (tendonitis), bursitis (inflammed bursa), calcific tendonitis (bone forming within the tendon) through to partial and full thickness rotator cuff tendon tears, which may require surgery.

What Causes Shoulder Impingement?

The shoulders rotator cuff tendons are protected from simple knocks and bumps by bones (mainly the acromion) and ligaments that form a protective arch over the top of your shoulder.

In between the rotator cuff tendons and the bony arch is the subacromial bursa (a lubricating sack), which helps to protect the tendons from touching the bone and provide a smooth surface for the tendons to glide over.

However, nothing is foolproof. Any of these structures can be injured, whether they be your bones, muscles, tendons, ligaments or bursas.

Shoulder impingement has primary (structural) and secondary (posture & movement related) causes.

Read full article about Shoulder Impingement.

What is Frozen Shoulder?

Frozen shoulder or adhesive capsulitis is a common source of shoulder pain. 

While frozen shoulder is commonly missed or confused with a rotator cuff injury, it has a distinct pattern of symptoms resulting in severe shoulder pain, loss of shoulder function and eventually stiffness.

The more precise medical term for a frozen shoulder is "adhesive capsulitis". 

In basic terms, it means that your shoulder pain and stiffness is a result of shoulder capsule inflammation (capsulitis) and fibrotic adhesions that limit your shoulder movement.

What Causes Frozen Shoulder?

Unfortunately, there is still much unknown about frozen shoulder. One of those unknowns is why frozen shoulder starts. There are many theories but the medical community still debates what actually causes frozen shoulder.

What is Known about Frozen Shoulder?

Frozen shoulder causes your shoulder joint capsule to shrink, which leads to pain and reduced range of shoulder movement. Your shoulder capsule is the deepest layer of soft tissue around your shoulder joint, and plays a major role in keeping your humerus within the shoulder socket.

What are Frozen Shoulder Symptoms?

Frozen shoulder has three stages, each of which has different symptoms. 

The 3 Stages are:

1. Freezing – characterised by pain around the shoulder initially, followed by a progressive loss of range of movement. Known as the RED phase due to the capsule colour if you undergo arthroscopic surgery.
2. Frozen – minimal pain, with no further loss or regain of range. Known as the PINK phase due to the capsule colour if you undergo arthroscopic surgery.
3. Thawing – gradual return of range of movement, some weakness due to disuse of the shoulder. Known as the WHITE phase due to the capsule colour if you undergo arthroscopic surgery.

Each stage can last on average 6 to 8 months if left untreated.

How is Frozen Shoulder Diagnosed and Treated?

Frozen shoulder can be diagnosed in the clinic from your clinical signs and symptoms. 

A clinical diagnosis of frozen shoulder can be determined by a thorough shoulder examination. Your physiotherapist will ask about what physical activities you are having difficulty performing. 

Read more about: Frozen Shoulder

What is your Scapulohumeral Rhythm? Why is it important?

Your shoulder-scapula joint motion has a normal functional motion patterns known as scapulohumeral rhythm - to provide you with pain-free and powerful shoulder function. When elevating your shoulder overhead roughly one-third of your shoulder motion occurs at your scapulothoracic joint and two-thirds at the glenohumeral joint. However, it is the timing and coordination of your shoulder muscles and how they control your scapulohumeral rhythm that is the most important factor. Alteration of this normal scapulohumeral movement pattern results in shoulder injuries, pain and impingement. Read full article here: Scapulohumeral Rhythm http://bit.ly/19Jfz4d What are the Symptoms or Abnormal Scapulohumeral Rhythm? Poor shoulder blade stability results in abnormal tipping and rotation of your scapular, which causes your acromion (bone) to pinch down into the subacromial structures (eg bursa and tendons) causing impingement leading to swelling or tears. Typically signs of abnormal scapulohumeral rhythm includes shoulder pain, instability and clicking. Researchers have identified abnormal scapulohumeral rhythm as a major cause of rotator cuff impingement. Your shoulder physiotherapist is an expert in the assessment of scapulohumeral rhythm. They will observe your shoulder motion and perform strength and control tests to assist their diagnosis. X-rays, MRI’s, ultrasound scans and CT scan are unable to determine scapulohumeral rhythm dysfunction. Scapulohumeral Rhythm Correction Read full article here: Scapulohumeral Rhythm Contact PhysioWorks or Book Online Helpful Products Available Online Shoulder Injuries Acromioclavicular Joint Injury Bicep Tendonitis Fibromyalgia Fractured Shoulder (Broken Shoulder) Frozen Shoulder (Adhesive Capsulitis) Muscle Pain: Strains or Tears Overuse Injuries Pinched Nerve Rotator Cuff Calcific Tendinitis Rotator Cuff Injury Rotator Cuff Tear RSI - Repetitive Strain Injury Shoulder Arthritis Shoulder Bursitis Shoulder Dislocation Shoulder Impingement Shoulder Tendonitis Stress Fracture Swimmer's Shoulder

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Is it Biceps Tendonitis, Tendinitis, Tendinopathy, Tendinosis or Tenosynovitis that You are Suffering?

You're feeling shoulder pain and someone told you that its biceps tendonitis. Are you sure it's actually tendonitis? Knowing what "exactly" it is does alter your treatment.  It should vary depending upon the exact diagnosis. What is Bicep Tendonitis / Tendinitis / Tendinopathy? Bicep tendonitis / tendinitis / tendinopathy / tendinosis / tenosynovitis  are all common terms that describes pain or injury to one of your shoulder's bicep tendons. Biceps tendinopathy is the umbrella term for biceps injuries that include: biceps tendonitis/tendinitis (inflammed tendon). biceps tendinosis (non-inflammed degenerative tendon). biceps tenosynovitis (inflammed tendon sheath). ruptured biceps tendon (secondary to degeneration or tear). Having said that, old habits die hard, and the conditions have for many years been commonly referred to as biceps tendonitis or tendinitis. Your up-to-date physiotherapist or sports doctor will refer to this group of injuries as biceps tendinopathies or the specific injury itself after they have diagnosed the injury thoroughly. What Exactly is Your Biceps Tendon? Read full article... http://bit.ly/1etLb1i What Causes Biceps Tendinopathy? Read full article... http://bit.ly/1etLb1i What are the Symptoms of Biceps Tendinopathy? Read full article... http://bit.ly/1etLb1i How is Bicep Tendinopathy Diagnosed? Read full article... http://bit.ly/1etLb1i Bicep Tendinopathy Treatment Read full article... http://bit.ly/1etLb1iSpecial Considerations Summary There is no specific time frame for when to progress from each stage to the next. Your injury rehabilitation status will be determined by many factors during your physiotherapist’s clinical assessment. You’ll find that in most cases, your physiotherapist will seamlessly progress between the rehabilitation phases as your clinical assessment and function improves. It is also important to note that each progression must be carefully monitored as attempting to progress too soon to the next level can lead to re-injury and frustration. For more specific advice about your biceps tendinopathy, please contact your PhysioWorks physiotherapist. Contact PhysioWorks or Book Online Helpful Products for Bicep Tendonitis Related Injuries Acromioclavicular Joint Injury Biceps Tendonitis Fibromyalgia Fractured Shoulder (Broken Shoulder) Frozen Shoulder (Adhesive Capsulitis) Muscle Pain: Strains or Tears Rotator Cuff Calcific Tendinitis Rotator Cuff Injury Rotator Cuff Tear RSI - Repetitive Strain Injury Shoulder Arthritis Shoulder Bursitis Shoulder Dislocation Shoulder Impingement Shoulder Tendonitis Swimmer's Shoulder

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What is a Rotator Cuff Injury? What's the Treatment?

Shoulder rotator cuff injury  is very common shoulder injury. What is your Rotator Cuff? The shoulder joint is a relatively unstable ball and socket joint. It is often likened to a golf ball on a tee. The subscapularis, supraspinatus, infraspinatus and teres minor are your small rotator cuff muscles that stabilise and control your shoulder movement on your shoulder blade (scapula). Collectively, these four muscles are known as the rotator cuff. Each rotator cuff muscle has a contractile muscle belly (red) and a tendon (white) that inserts into the bone (head of humerus). What Rotator Cuff Injuries are Common? Your rotator cuff muscles and tendons are vulnerable to full and partial tears, tendinopathies and impingement related disorders. Rotator cuff injuries vary from mild tendon inflammation (tendonitis), bursitis (inflammed bursa), calcific tendonitis (bone forming within the tendon) through to partial and full thickness tendon tears, which may require surgery. Some shoulder rotator cuff injuries are more common than others.  These include: Rotator Cuff Impingement Syndrome Rotator Cuff Tendonitis / Tendinopathies Shoulder Bursitis (fluid-filled sac that provides a cushion between a bone and tissues) Calcific Tendonitis Rotator Cuff Tears Bicipital Tendonitis Where are your Rotator Cuff Muscles? Your rotator cuff muscles hold you arm (humerus) onto your shoulder blade (scapula).  Most the the rotator cuff tendons are hidden under the bony point of your shoulder (acromion), which as well as protecting your rotator cuff can also impinge into your rotator cuff structures. What Causes a Rotator Cuff Injury? Your rotator cuff tendons are protected from simple knocks and bumps by bones (mainly the acromion) and ligaments that form a protective arch over the top of your shoulder. In between the rotator cuff tendons and the bony arch is the sub-acromial bursa (a lubricating sack), which helps to protect the tendons from touching the bone and provide a smooth surface for the tendons to glide over. However, nothing is fool-proof. Any of these structures can be injured - whether they be your bones, muscles, tendons, ligaments or bursas. Rotator cuff impingement syndrome is a condition where your rotator cuff tendons are intermittently trapped and compressed during shoulder movements This causes injury to the shoulder tendons and bursa resulting in painful shoulder movements. What are the Symptoms of Rotator Cuff Injury? While each specific rotator cuff injury has its own specific symptoms and signs, you can suspect a rotator cuff injury if you have: an arc of shoulder pain or clicking when your arm is at shoulder height or when your arm is overhead. shoulder pain that can extend from the top of your shoulder to your elbow.  shoulder pain when lying on your sore shoulder. shoulder pain at rest (in more severe rotator cuff injuries). shoulder muscle weakness or pain when attempting to reach or lift. shoulder pain when putting your hand behind your back or head. shoulder pain reaching for a seat-belt. How is a Rotator Cuff Injury Diagnosed? Your physiotherapist or sports doctor will suspect a rotator cuff injury based on your clinical history and the findings from a series of clinical tests. A diagnostic ultrasound scan is the most accurate method to diagnose the specific rotator cuff injury pathology. MRI’s may show a rotator cuff injury but have also been known to miss them. X-rays are of little diagnostic value when a rotator cuff injury is suspected. How to Treat a Rotator Cuff Injury? Once you suspect a rotator cuff injury, it is important to confirm the exact type of your rotator cuff injury since treatment does vary depending on the specific or combination of rotator cuff injuries. Your rotator cuff is an important group of control and stability muscles that maintain “centralisation” of your shoulder joint. In other words, it keeps the shoulder ball centred over the small socket. This prevents injuries such as impingement, subluxations and dislocations. We also know that your rotator cuff provides subtle glides and slides of the ball joint on the socket to allow full shoulder movement. Plus, your shoulder blade (scapula) has a vital role as the main dynamically stable base plate that attaches your arm to your chest wall. Researchers have concluded that there are essentially 7 stages that need to be covered to effectively rehabilitate these injuries and prevent recurrence.  These are: Early Injury Protection: Pain Relief & Anti-inflammatory Tips Regain Full Range of Motion Restore Scapular Control Restore Normal Neck-Scapulo-Thoracic-Shoulder Function Restore Rotator Cuff Strength Restore High Speed, Power, Proprioception & Agility Return to Sport or Work For more specific advice about your rotator cuff injury, please contact your PhysioWorks physiotherapist. Contact PhysioWorks or Book Online More Information about Rotator Cuff Injury What is Rotator Cuff Impingement Syndrome? What is the Impingement Zone? What Causes Rotator Cuff Impingement? Your PhysioWorks physiotherapist is an expert in the assessment and correction of shoulder rotator cuff injuries. Any deficiencies that they detect during your assessment will be an important component of your rehabilitation. Your physiotherapist will be able to guide you in the appropriate treatment and exercises for your rotator cuff injury after their thorough assessment. Contact PhysioWorks or Book Online Common Rotator Cuff Injury Treatments Early Treatment Avoid the HARM Factors What are the Healing Phases for a Soft Tissue Injury? What to do after a Muscle Strain or Ligament Sprain Acupuncture and Dry Needling What is Sub-Acute Soft Tissue Injury Treatment? Scapular Stabilisation Exercises Rotator Cuff Strengthening Exercises Shoulder Stretching Exercises Biomechanical Analysis Proprioception & Balance Exercises Agility & Sport-Specific Exercises Medications? Soft Tissue Massage Electrotherapy & Local Modalities Heating Pads Joint Pain Relief Techniques Kinesiology Taping Neurodynamics / Neuro Mobilisation Physiotherapy Instrument Mobilisation (PIM) Prehabilitation Strengthening Exercises Stretching Exercises Support Brace Supportive Taping & Strapping TENS Machines Contact PhysioWorks or Book Online FAQs about Rotator Cuff Injury What is Pain? Physiotherapy & Exercise When Should Diagnostic Tests Be Performed? What are the Different Massage Styles and their Benefits? How Does Kinesiology Tape Reduce Swelling? How Much Treatment Will You Need? How to Stretch? Sports Injury? What to do? When? What are the Common Massage Therapy Techniques? What are the Early Warning Signs of an Injury? What Causes Rotator Cuff Impingement & Bursitis? What is a Tendinopathy? What is Chronic Pain? What is Scapulo-humeral Rhythm? What is Sports Physiotherapy? What is the Correct Posture Standing? What is the Shoulder Impingement Zone? What is Your Rotator Cuff? What Pillow Do Physiotherapists Recommend? When Can You Return to Sport or Work? Contact PhysioWorks or Book Online Helpful Products for Rotator Cuff Injury Related Rotator Cuff Injuries Acromioclavicular Joint Injury Biceps Tendonitis Muscle Pain: Strains or Tears Overuse Injuries Rotator Cuff Calcific Tendinitis Rotator Cuff Impingement Rotator Cuff Injury Rotator Cuff Tear Shoulder Arthritis Shoulder Bursitis Shoulder Dislocation Shoulder Tendonitis Swimmer's Shoulder

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AC Joint Injury? What's the Symptoms? How to Best Manage?

What is an Acromioclavicular Injury? An acromioclavicular joint injury (also known as an AC ioint injury)  is commonly referred to as"shoulder separation" and should not be confused with a shoulder dislocation.  Your acromioclavicular joint (or AC Joint) is the joint at the top of your shoulder between your clavicle (collarbone) and your scapula (shoulder blade). The AC joint is important in allowing overhead and across the body movements of your arm, as well as transmitting forces from the arm to the rest of the body during activities such as pushing, pulling and lifting. There are a number of ligaments which help to stabilise this joint. An acromioclavicular joint sprain refers to an injury where the ligaments supporting the acromioclavicular joint are overstretched. The degree of AC joint ligament damage can vary from a mild strain of one or more of the surrounding ligaments to complete ligament tears and deformity. What is the Acromioclavicular (AC) Joint? The shoulder joint is formed at the junction of three bones: the collarbone (clavicle), the shoulder blade (scapula), and the arm bone (humerus). The scapula and clavicle form the socket of the joint, and the humerus has a round head that fits within this socket. The end of the scapula is called the acromion, and the joint between this part of the scapula and clavicle is called the acromioclavicular joint. When the acromioclavicular joint is disrupted, it is called a shoulder separation and can form a "step" if displaced. Another name for this injury is an acromioclavicular joint separation, or AC separation or an AC joint sprain. The ligaments that hold the joints together are the acromioclavicular,coracoacromial and coracoclavicular (trapezoid and conoid) ligaments. What Causes an Acromioclavicular (AC) Joint Injury? Direct forces can injure your AC joint when a person collides with a solid object or surface such as a fall from a bicycle or during a football tackle where the shoulder hits the ground. You acromioclavicular joint may also be injured indirectly when a person falls on an outstretched arm. The contact force is transmitted up through the arm, which forces a separation of the acromion and clavicle. The ligaments are overstretched and damaged in the process. What are the Symptoms of an AC Joint Injury? Your physiotherapist will suspect an acromioclavicular ligament sprain when you report:  Pain on the top of the shoulder aggravated by heavy lifting, overhead and across body movements. Swelling +/- bruising. Loss of shoulder movement. Sometimes a hard, visible lump may also be present on the top of the shoulder, indicating displacement of the clavicle (collar bone). AC joint injury is graded by severity from Grade I (minimal joint disruption) to Grade III (severe injury). If the injury is the more severe, Grade III, a bump caused by the separated AC joint may be seen or felt at the tip of the shoulder bones. The diagnosis of shoulder separation is often quite apparent from hearing a story that is typical of this injury, and a simple physical examination. X-rays should be performed to ensure there is no fracture of these bones. Clavicle fractuires from falls are particularly common. If the diagnosis is unclear, X-rays while holding a weight in your hand may be helpful. When this type of X-ray is performed, the force of the weight will accentuate any AC joint instability and better show the effects of the separated shoulder. What is the Treatment for Acromioclavicular Joint Injury? Physiotherapy Most patients with acromioclavicular joint injury start to feel better within a few days or a week of the injury. However, full ligament healing will take at least six weeks. During this time it is important to protect your AC joint ligaments from overstretching the immature scar tissue. It can be helpful to use a sling, taping or a shoulder brace that de-loads your AC joint. Your physiotherapist's treatment will aim to: Reduce pain and inflammation. Normalise joint range of motion. Strengthen your shoulder. Improve your shoulder blade and shoulder alignment. Normalise your muscle lengths. Improve your upper limb proprioception. Improve your technique and function eg lifting, overhead activities. Minimise your chance of re-injury as you return to sport or work. Surgery In severe cases, some patients choose to undergo AC joint surgery to pin the AC joint or repair the damaged ligaments surrounding the AC joint. Post-operative rehabilitation is one of the most important, yet too often neglected, aspects of surgery. The quickest and most successful outcomes result from the guidance and supervision of an experienced shoulder physiotherapist. Your rehabilitation following shoulder surgery focuses on restoring full shoulder motion, strength, power and endurance. You will also require proprioception and functional-based retraining that is individualised towards your specific needs. Risks of surgery include infection, persistent instability and pain, stiffness, and difficulty returning to your previous level of activity. Return to Sports with Acromioclavicular Joint Sprain? When returning to sport, it is important that you undergo a graduated transition to avoid the risk of injury recurrence. This includes the completion of a full individually designed rehabilitation program aimed at improving strengthening, flexibility and proprioception in your upper limbs. For more information, please ask the advice of your physiotherapist. Contact PhysioWorks or Book Online Common AC Joint Injury Treatments Immediate Injury Treatment Avoid the HARM Factors What are the Healing Phases for a Soft Tissue Injury? What to do after a Muscle Strain or Ligament Sprain Acupuncture and Dry Needling What is Sub-Acute Soft Tissue Injury Treatment? Scapular Stabilisation Exercises Rotator Cuff Strengthening Exercises Shoulder Stretching Exercises Biomechanical Analysis Proprioception & Balance Exercises Agility & Sport-Specific Exercises Medications? Soft Tissue Massage AC Joint Treatment Electrotherapy & Local Modalities Heating Pads Joint Pain Relief Techniques Kinesiology Taping Physiotherapy Instrument Mobilisation (PIM) Prehabilitation Strengthening Exercises Support Brace Supportive Taping & Strapping TENS Machines Contact PhysioWorks or Book Online FAQs about AC Joint Injuries What is Pain? Physiotherapy & Exercise When Should Diagnostic Tests Be Performed? How Does Kinesiology Tape Reduce Swelling? How Much Treatment Will You Need? How to Stretch? Sports Injury? What to do? When? What are the Common Massage Therapy Techniques? What are the Early Warning Signs of an Injury? What Can You Do To Help Arthritis? What is Sports Physiotherapy? What is the Correct Posture Standing? What is the Shoulder Impingement Zone? When Can You Return to Sport or Work? When Should You Use a Shoulder Posture Brace? Why Does Heat Feel So Good? Contact PhysioWorks or Book Online Helpful Products for AC Joint Injuries Related Injuries Biceps Tendonitis Broken Shoulder (Fracture) Frozen Shoulder (Adhesive Capsulitis) Muscle Pain: Strains or Tears Rotator Cuff Calcific Tendinitis Rotator Cuff Impingement Rotator Cuff Injury Rotator Cuff Tear Rotator Cuff Tendonitis Shoulder Arthritis Shoulder Bursitis Shoulder Dislocation Swimmer's Shoulder

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