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Patient Guide to Frozen Shoulder

Frozen shoulder, also known as adhesive capsulitis, is a condition characterized by stiffness and pain in your shoulder joint. Signs and symptoms typically begin gradually, worsen over time and then resolve, usually within one or two years.

Your risk of developing frozen shoulder increases if you’re recovering from a medical condition or procedure that affects the mobility of your arm — such as a stroke or a mastectomy.

Treatment for frozen shoulder involves stretching exercises and, sometimes, the injection of corticosteroids and numbing medications into the joint capsule. In a small percentage of cases, surgery may be needed to loosen the joint capsule so that it can move more freely.

SYMPTOMS OF FROZEN SHOULDER

Frozen shoulder typically develops slowly, and in three stages. Each of these stages can last a number of months.

  • Painful stage. During this stage, pain occurs with any movement of your shoulder, and your shoulder’s range of motion starts to become limited.
  • Frozen stage. Pain may begin to diminish during this stage. However, your shoulder becomes stiffer, and your range of motion decreases notably.
  • Thawing stage. During the thawing stage, the range of motion in your shoulder begins to improve.

For some people, the pain worsens at night, sometimes disrupting normal sleep patterns.

CAUSES OF FROZEN SHOULDER

The bones, ligaments and tendons that make up your shoulder joint are encased in a capsule of connective tissue. Frozen shoulder occurs when this capsule thickens and tightens around the shoulder joint, restricting its movement.

Doctors aren’t sure why this happens to some people and not to others, although it’s more likely to occur in people who have recently experienced prolonged immobilization of their shoulder, such as after surgery or an arm fracture.

RISK FACTORS OF FROZEN SHOULDER

Although the exact cause is unknown, certain factors may increase your risk of developing frozen shoulder.

Age and sex
People 40 and older are more likely to experience frozen shoulder. Most of the people who develop the condition are women.

Immobility or reduced mobility
People who have experienced prolonged immobility or reduced mobility of their shoulder are at higher risk of developing frozen shoulder. Immobility may be the result of many factors, including:

  • Rotator cuff injury
  • Broken arm
  • Stroke
  • Recovery from surgery

Systemic diseases
People who have certain medical problems appear to be predisposed to develop frozen shoulder. Examples include:

  • Diabetes
  • Overactive thyroid (hyperthyroidism)
  • Underactive thyroid (hypothyroidism)
  • Cardiovascular disease
  • Tuberculosis
  • Parkinson’s disease

TESTS AND DIAGNOSIS:

During the physical exam, your doctor may ask you to perform certain actions, to check for pain and evaluate your range of motion. These may include:

  • Hands up. Raise both your hands straight up in the air, like a football referee calling a touchdown.
  • Opposite shoulder. Reach across your chest to touch your opposite shoulder.
  • Back scratch. Starting with the back of your hand against the small of your back, reach upward to touch your opposite shoulder blade.

Your doctor may also ask you to relax your muscles while he or she moves your arm for you. This test can help distinguish between frozen shoulder and a rotator cuff injury.

Frozen shoulder can usually be diagnosed from signs and symptoms alone. But your doctor may suggest imaging tests — such as X-rays or an MRI — to rule out other structural problems.

TREATMENTS AND DRUGS:

Most frozen shoulder treatment involves controlling shoulder pain and preserving as much range of motion in the shoulder as possible.

Medications
Over-the-counter pain relievers, such as aspirin and ibuprofen (Advil, Motrin, others), can help reduce pain and inflammation associated with frozen shoulder. In some cases, your doctor may prescribe stronger pain-relieving and anti-inflammatory drugs.

Therapy
A physical therapist can teach you stretching exercises to help maintain as much mobility in your shoulder as possible.

Surgical and other procedures
Most frozen shoulders get better on their own within 12 to 18 months. For persistent symptoms, your doctor may suggest:

  • Steroid injections. Injecting corticosteroids into your shoulder joint may help decrease pain and improve shoulder mobility.
  • Joint distension. Injecting sterile water into the joint capsule can help stretch the tissue and make it easier to move the joint.
  • Shoulder manipulation. In this procedure, you receive a general anesthetic so you’ll be unconscious and feel no pain. Then the doctor moves your shoulder joint in different directions, to help loosen the tightened tissue. Depending on the amount of force used, this procedure can cause bone fractures.
  • Surgery. If nothing else has helped, you may be a candidate for surgery to remove scar tissue and adhesions from inside your shoulder joint. Doctors usually perform this surgery arthroscopically, with lighted, tubular instruments inserted through small incisions around your joint.

PREVENTION OF FROZEN SHOULDER:

One of the most common causes of frozen shoulder is the immobility that may result during recovery from a shoulder injury, broken arm or a stroke. If you’ve had an injury that makes it difficult to move your shoulder, talk to your doctor about what exercises would be best to maintain the range of motion in your shoulder joint.

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Patient Guide to Shoulder Pain

Shoulder pain should not be ignored. Early treatment can prevent further injury and chronic shoulder problems. Pain in the shoulder may also be referred from other areas of the body, e.g. disc problems the neck.

The Shoulder Joint

The structure of the shoulder joint allows more range of motion than any other joint in the body.

The shoulder actually has several joints that work together to allow a wide range of motion. Most injuries occur at the “main” shoulder joint, where the head of the upper arm meets the shoulder blade; the term “shoulder joint” refers to this joint. The other smaller shoulder joints are referred to by their specific names.

The head of the upper arm bone sits on a very small and shallow socket in the shoulder blade. This allows for the shoulder’s wide range of motion but makes it susceptible to injury. Because there is little bony stability, the shoulder relies greatly on connective tissue (e.g. ligaments, tendons, muscles) to hold the bones of the joint together and to stabilize the joint.

Causes of Shoulder Pain

The Most Common Cause of shoulder joint pain is rotator cuff tendonitis – injury and inflammation of the tendons (rotator cuff tendons) that envelope the shoulder joint. The most common cause of rotator cuff tendonitis is overuse of the shoulder, though the rotator cuff tendons may be injured suddenly as a result of a fall or accident.

Muscle strain is common in the muscles that run over the shoulders to the neck . It is often the result of holding the shoulders in a raised position for long periods of time. The muscles between the shoulder blades are often strained from slouching from long periods of time. Muscle strain varies in severity.

Other painful shoulder conditions, such as frozen shoulder, may occur for no apparent reason. (The risk of frozen shoulder increases when the shoulder is not used enough after a painful injury). The cause of calcium deposits in the shoulder, which may trigger episodes of acute inflammation of the tendons, is also unclear. Arthritis sometimes occurs in a previously injured shoulder joint.

Slap Lesion

Slap Lesion

Risk Factors

WEAK ROTATOR CUFF MUSCLES

Weak or fatigued rotator cuff muscles can lead to soft tissue injury. If the muscles that stabilize the shoulder joint (mainly the rotator cuff muscles) are weak or fatigued, the muscles fail to fully stabilize the joint. If the head of the upper arm bone is not kept in place in its socket, abnormal force is placed upon tissue surrounding the shoulder joint and can lead to injury. Shoulder tendonitis and bursitis are common.

OVERUSE

Shoulder pain is frequently caused by chronic overuse of the shoulder. The shoulder may become injured suddenly from a blow or fall, but gradual injury from chronic overuse of the shoulder is more common. Repetitive lifting, pushing, pulling, throwing, and especially overhead activities may lead to injury. Pain may be mild and intermittent in the beginning and worsen over time. Combining repetitive overhead activities with force increases the risk of injury further (e.g. stacking heavy objects on a high shelf).

Repetitive overhead activities can be particularly damaging. When the arm is raised overhead, the head of the upper arm bone migrates upward on the shoulder socket somewhat and rotator cuff tendons come into contact with the roof of the shoulder blade. Repeated contact and friction of the rotator cuff tendons often leads to irritation and inflammation of the tendons (tendonitis).

A strong rotator cuff helps keep the head of the upper arm bone from riding up excessively but some contact between the rotator cuff and bones in the joint still occurs with overhead activity. The bursa that lies under the roof of the shoulder blade may also be affected and become inflamed (bursitis). Shoulder bursitis often occurs along with shoulder tendonitis.

AGING

Aging is a major factor in rotator cuff injuries Tendons lose elasticity with aging and they become more susceptible to injury. Muscle mass also decreases with age. Both the rotator cuff muscles and tendons can be strengthened with resistance exercises.

Prevention of Shoulder Pain

Overuse shoulder injuries often can be prevented.

Weak rotator cuff muscles may be unable to adequately stabilize the shoulder joint. Rotator Cuff Exercises can help. Building up strength of the rotator cuff through exercise helps to stabilize the shoulder joint to prevent abnormal pressure on the soft tissues surrounding the joint. The muscles that control the shoulder blade also play a role in stabilizing the shoulder joint.

Avoid repetitive overhead activities. If you are involved in activities that involve repetitive overhead movements, take frequent breaks. Fatigued rotator cuff muscles lose the ability to keep the shoulder stabilized.

Avoid doing too much too soon. If you are going to engage in any overhead activity you haven’t done for a long time, such as getting back into playing tennis, endurance must be built up slowly. Exercises to strengthen the muscles you will be using in an activity reduce the chance of injury.

Warm up before engaging in sports such as swimming, tennis or throwing sports that require overhead movement.

Proper form for your sport should be learned and practiced to prevent injury.

Maintain proper posture. Muscles over the shoulders become strained from holding the shoulders in a raised position for long periods of time. Muscles in the upper back, between the shoulder blades, become strained as a result of slouching.

Treatment of Shoulder Pain

Prevent major problems by treating minor problems early. If a minor injury is not given a chance to heal before it is subjected to the same activity, pain and inflammation may become chronic.

Treatment of shoulder pain depends on the cause – seek a proper diagnosis from a qualified physician. Most shoulder injuries heal with conservative treatment. Healing takes time. The time it takes to recover depends upon several factors, e.g. the severity of injury, the type of injury, how quickly one heals, how early one begins treatment.

Typical treatment of shoulder pain (for most conditions) involves a combination of rest (not complete rest), exercise, anti-inflammatory medication, applying cold or heat to the shoulder joint and, in some cases, an injection of steroids into the shoulder joint.

Doing activities that aggravate shoulder pain often cause further damage, delay healing, and may lead to long-term problems. However, not using the shoulder at all weakens the shoulder and leaves it more vulnerable to injury. Immobilizing the shoulder may also lead to frozen shoulder. Stretching exercises help prevent this condition.

Strengthening exercises for the muscles that support the shoulder, particularly the rotator cuff (the muscles and tendons that dynamically stabilize the main shoulder joint) are a major part of treatment for most shoulder injuries, but strength training before adequate healing has taken place may cause further pain and injury. A physician or physical therapist can determine when the shoulder is ready for strengthening exercises. Shoulder Exercises can prevent injury from recurring.

Massage therapy is also used to treat many soft tissue injuries. From muscle strain to tendonitis to frozen shoulder, massage therapy increases circulation, speeds healing, improves range of motion and relieves pain.

Most shoulder pain improves with conservative treatment; however, surgery may occasionally be required (depending upon the type of and severity of the injury). Surgery may be performed to tighten loose ligaments, repair a torn tendon, remove a calcium deposit, trim a damaged tendon, etc. when conservative treatment doesn’t adequately resolve symptoms.

Diagnosis of Shoulder Pain

Many shoulder conditions have similar symptoms and it may be difficult to diagnose the problem from symptoms alone. A physician, often an orthopedist, diagnoses the cause of shoulder pain by taking into consideration the patient’s symptoms and medical history, findings of a physical examination and sometimes diagnostic testing, such as x-rays, a CT scan, or an MRI.


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Shoulder Tendonitis

What is shoulder tendonitis/bursitis?

Shoulder bursitis and tendonitis are common causes of shoulder pain and stiffness. They indicate swelling (inflammation) of a particular area within the shoulder joint.

The shoulder joint is kept stable by a group of muscles called the rotator cuff as well as the bicipital tendon (the tendon that keeps the upper arm bone within the shoulder socket). When the rotator cuff tendon or the bicipital tendon becomes inflamed and irritated it is called rotator cuff tendonitis or bicipital tendonitis.

An area called the subacromial bursa lies in the space between the shoulder tendons. The bursa is what protects these tendons. Subacromial bursitis occurs when the bursa becomes inflamed.

Both conditions (shoulder bursitis and tendonitis) can cause pain and stiffness around the shoulder and may exist together.

What causes shoulder tendonitis/bursitis?

Tendonitis occurs as a result of sports injuries, by repetitive minor impact on the affected area, or from a sudden, more serious injury. For instance, professional baseball players, swimmers, tennis players, and golfers are susceptible to tendonitis in their shoulders, arms, and elbows. Improper technique in any sport is one of the primary causes of overload on tissues including tendons, which can contribute to tendonitis. But you don’t have to be a professional athlete to develop this condition. Anyone can get tendonitis, but it is more common in adults, especially those over 40 years of age. As tendons age, they tolerate less stress, are less elastic, and tear more easily.

Shoulder tendonitis/bursitis typically results from one or more of these factors:

  • Age: 40 and over
  • Frequent use of the arm in an overhead position or throwing motion, as in:
    • tennis or other racquet sports
    • swimming
    • baseball
  • Jobs such as overhead assembly work, butchering, or using an overhead pressing machine, heavy lifting
  • Direct blow to the shoulder area or falling on an outstretched arm
  • Other diseases or conditions that weaken shoulder muscles, such as rheumatoid arthritis, gout, psoriasis, or an unusual drug reaction
  • Infection (rare)

How is shoulder tendonitis/bursitis treated?

Treatment goals include reduction in pain and inflammation, as well as preserving mobility and preventing disability and recurrence.

The treatment recommendations may include a combination of rest, splints, heat and cold application. You may need more advanced treatments including:

  • Corticosteroid injections from your health care provider. They work quickly to decrease the inflammation and pain.
  • Physical therapy that includes range of motion exercises and splinting. This can be very beneficial.
  • Surgery, if you are not responding to other treatments.

When should you seek medical advice?

Most cases of tendonitis go away on their own over time. It may take weeks to months to recover, depending on the severity. See your doctor if you experience pain that interferes with your normal day-to-day activities, have soreness that doesn’t improve despite self-care measures, if you have recurrence, or if you have a fever and the area affected by tendonitis appears red or inflamed (swollen, warm). These signs and symptoms may indicate that you have an infection.

In addition, see your doctor if you have other medical conditions that may increase your risk of an infection, or if you take medications that increase your risk of infection, such as corticosteroids or immunosuppressants.

How can you prevent shoulder tendonitis/bursitis?

Because most cases of tendonitis are caused by overuse, the best treatment is prevention. It is important to avoid or modify the activities that cause the problem. Underlying conditions such as improper posture or poor technique in sports or work must be corrected.

Apply these basic rules when performing activities:

  • Take it slow at first and gradually build up your activity level.
  • Use limited force and limited repetitions.
  • Stop if unusual pain occurs.

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Patient Guide to Shoulder Pain and Shoulder Injury

Shoulder pain is very common in individuals who play ‘overhead’ sports such as baseball, tennis and volleyball. In this group of athletes injury may be the result of an isolated traumatic event such as a fall or through repeated sporting-use causing micro-trauma to the shoulder region.

The shallow anatomical design of the shoulder joint surface is what makes it inherently unstable and prone to these types of injuries. This lack of bony support increases the dependency on the muscles and other soft tissues for stability. Any alterations in how these tissues function will raise the risk of shoulder injuries.

Rotator Cuff Tendonitis

Rotator Cuff Tendonitis

Two common structural injuries in this group of athletes are the rotator cuff and the labrum.

  • The rotator cuff is a group of muscles which extend from the shoulder blade to the arm. It insures dynamic shoulder stability by maintaining the proper relationship between the arm and the shoulder blade.
  • The shoulder joint is comprised of a ball and socket. The labrum is a fibrous tissue at the edge of the shoulder blade which extends to cover the ball at the top of the arm bone. It functions to increase the shoulder’s stability by deepening the socket
  • Typically, you are more prone to injure the labrum at a younger age. This tearing injury is called a SLAP lesion which is an acronym, (Superior Labrum extending Anterior to Posterior), referring to the location of the injury. It is a fairly common diagnosis for overhead athletes complaining of shoulder pain. Some studies have found it to be present in 83% to 91% of these athletes who require shoulder surgery.
  • Injuries to the rotator cuff are more likely to happen as we get older. Repetitive micro-trauma to these tissues results in inflamed tendons (tendonitis) and tears.

Tightness in the tissues at the back of the shoulder and weakness in the shoulder blade muscles are factors that are known to increase your risk for these injuries. An assessment by a physiotherapist can be beneficial in determining which of these factors are present and designing a program to correct these imbalances before you have pain.

If you have discomfort and pain every time you cock your arm to throw or serve, or have experienced the sudden onset of sharp pain or a loss of strength and power, you may already have an injury. Ignoring these warning signs and continuing to play through the pain can cause damage. If you are experiencing symptoms a physiotherapist can determine whether a program of stretches for the back of the shoulder and exercises to strengthen your shoulder blade muscles will allow you to return to your sport with more power to serve or throw, lowering your chance of re-injury. The earlier you seek therapy the better will be the result.

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Frozen Shoulder

Frozen shoulder, also known as adhesive capsulitis, is a condition characterized by stiffness and pain in your shoulder joint. Signs and symptoms typically begin gradually, worsen over time and then resolve, usually within one or two years.

Your risk of developing frozen shoulder increases if you’re recovering from a medical condition or procedure that affects the mobility of your arm such as a stroke or a mastectomy.

Treatment for frozen shoulder involves stretching exercises and, sometimes, the injection of corticosteroids and numbing medications into the joint capsule. In a small percentage of cases, surgery may be needed to loosen the joint capsule so that it can move more freely.

Symptoms:

Frozen shoulder typically develops slowly, and in three stages. Each of these stages can last a number of months.

  • Painful stage. During this stage, pain occurs with any movement of your shoulder, and your shoulder’s range of motion starts to become limited.
  • Frozen stage. Pain may begin to diminish during this stage. However, your shoulder becomes stiffer, and your range of motion decreases notably.
  • Thawing stage. During the thawing stage, the range of motion in your shoulder begins to improve.

For some people, the pain worsens at night, sometimes disrupting normal sleep patterns.

Causes:

The bones, ligaments and tendons that make up your shoulder joint are encased in a capsule of connective tissue. Frozen shoulder occurs when this capsule thickens and tightens around the shoulder joint, restricting its movement.

Doctors aren’t sure why this happens to some people and not to others, although it’s more likely to occur in people who have recently experienced prolonged immobilization of their shoulder, such as after surgery or an arm fracture.

Risk Factors:

Although the exact cause is unknown, certain factors may increase your risk of developing frozen shoulder.

Age and sex
People 40 and older are more likely to experience frozen shoulder. Most of the people who develop the condition are women.

Immobility or reduced mobility
People who have experienced prolonged immobility or reduced mobility of their shoulder are at higher risk of developing frozen shoulder. Immobility may be the result of many factors, including:

  • Rotator cuff injury
  • Broken arm
  • Stroke
  • Recovery from surgery

Systemic diseases
People who have certain medical problems appear to be predisposed to develop frozen shoulder. Examples include:

  • Diabetes
  • Overactive thyroid (hyperthyroidism)
  • Underactive thyroid (hypothyroidism)
  • Cardiovascular disease
  • Tuberculosis
  • Parkinson’s disease

Diagnosis:

During the physical exam, your doctor may ask you to perform certain actions, to check for pain and evaluate your range of motion. These may include:

  • Hands up. Raise both your hands straight up in the air, like a football referee calling a touchdown.
  • Opposite shoulder. Reach across your chest to touch your opposite shoulder.
  • Back scratch. Starting with the back of your hand against the small of your back, reach upward to touch your opposite shoulder blade.

Your doctor may also ask you to relax your muscles while he or she moves your arm for you. This test can help distinguish between frozen shoulder and a rotator cuff injury.

Frozen shoulder can usually be diagnosed from signs and symptoms alone. But your doctor may suggest imaging tests such as X-rays or an MRI to rule out other structural problems.

Cure Your Frozen Shoulder Today. Call +65 6471 2744 or SMS to: +65 92357641 for Appointment

A Patient’s Guide to Cuff (Rotator) Tear Arthropathy

The rotator cuff is a unique structure in the shoulder that is formed by four tendons. These four tendons attach to four muscles that help keep the shoulder stabilized in the socket (or glenoid) and help rotate the upper arm inward and outward. If the rotator cuff is torn and is not repaired, a type of wear and tear arthritis of the shoulder can develop over time. This condition is sometimes called arthropathy and the term cuff tear arthropathy is used to describe this type of arthritis of the shoulder that develops when the rotator cuff is damaged. If you develop this condition, your shoulder will be painful. Movement and strength of the shoulder will be decreased. Moving the arm away from the body and raising it over your head can be especially difficult.

This guide will help you understand

  • what parts of the shoulder are involved
  • what causes this condition
  • how doctors diagnose the condition
  • what treatment options are available

Anatomy

What parts of the shoulder are involved?

The bones of the shoulder are the humerus (the upper arm bone), the scapula (the shoulder blade), and the clavicle (the collar bone). The roof of the shoulder is formed by a part of the scapula called the acromion. The shoulder joint is also called the glenohumeral joint. One of the bones of the glenohumeral joint is the humerus (the long bone of the upper arm). It has a ball, called the humeral head on the top end. The humeral head fits into a small, shallow cup called the glenoid fossa. It makes up the other part of the glenohumeral joint. The glenoid fossa is part of the shoulder blade. A large ligament runs from the front of the acromion to another part of the shoulder blade called the coracoid process. This ligament is called thecoracoacromial ligament. It adds stability to the front of the shoulder.

The rotator cuff is made up of tough, fibrous tissue. It forms a cuff (or capsule) covering the shoulder joint. There are four tendons that help form the rotator cuff. The muscles that form the tendons are the supraspinatusinfraspinatusteres minor, and subscapularis. These muscles rotate the shoulder outward and inward. Along with another muscle, the deltoid, they also help lift the arm away from the body.

The rotator cuff slides between the humeral head and the acromion as we raise our arm. As this sliding occurs over and over, the rotator cuff tendons will often be pinched as you use the shoulder everyday. This pinching is called impingement. Over time this pinching can lead to damage and weakening of the rotator cuff tendons.

Causes

What causes this condition?

Dr. Charles Neer actually described rotator cuff tear arthropathy (RCTA) in 1977. Today, doctors generally refer to this as simply cuff tear arthropathy. Cuff tear arthropathy is actually a type of wear and tear, or degenerative arthritis of the shoulder that develops over time after the rotator cuff is damaged.

Normally, when the rotator cuff muscles contract, they pull the head of the humerus tightly into the socket of the shoulder. This stabilizes the shoulder and allows the the large deltoid muscle to raise the arm over the head as it rotates the humeral head like a pulley. This motion needs the rotator cuff and deltoid muscles to work together – in balance. When the rotator cuff is torn, the shoulder becomes unbalanced. The deltoid muscle pulls the head of the humerus up into the acromion in a sliding motion. When the top of the humerus hits the underside of the acromion, the deltoid may be able to pull the arm part way up as it levers against the underside of the acromion. But, over time this abnormal sliding motion causes wear and tear on the joint surfaces. Arthritis develops and any motion becomes painful. The shoulder becomes weaker and weaker until you can no longer raise the arm above the head.

Rotator cuff tears are very common. Trauma, such as falls, lifting, and pulling forcefully can also cause a rotator cuff tear. When this happens, it is called an acute tear. Although the rotator cuff can be damaged from a single traumatic injury, damage to the rotator cuff usually occurs gradually. Age can be a factor. As we age, the tendons of the rotator cuff become weaker and more likely to be injured. The blood supply to the tendons diminishes with age. Rotator cuff tears are much more likely to occur after the age of 40.

Certain activities can increase the wear and tear on the rotator cuff. Repetitive overhead activity such as painting, plastering, racquetball, weightlifting, and swimming can cause wear and tear of the rotator cuff.

Surgeons generally will recommend surgery to repair a rotator cuff tear when it occurs. A successful surgical repair of a torn rotator cuff tear can make the development of cuff tear arthropathy much less likely. But, sometimes a rotator cuff tear cannot be repaired. The tissue is simply too damaged and cannot fixed. This is not an uncommon situation in older patients with rotator cuff tears. In other cases, the patient simply elects not to have surgery to repair a rotator cuff tear and chooses to simply live with the discomfort. Over several years, both of these situations can result in the later development of rotator cuff arthropathy.

Symptoms

What does this condition feel like?

The most common symptom of rotator cuff tear arthropathy is pain in and around the shoulder. The pain can also radiate into your neck, arm, even into your wrist or hand. The shoulder can be especially painful when trying to lift the arm, or rotate it outward. The pain is usually worse at night. It can interrupt your sleep, especially if you try to sleep on the affected shoulder. If untreated, the pain can be nearly continuous and can be severe.

Weakness of the shoulder makes it difficult, if not impossible to lift the arm overhead. Often, even starting this motion can be difficult. The tendency is to shrug the shoulder in order to lift the arm part of the way. With time, weakness of the rotator cuff muscles will worsen. Range of motion can be quite limited. You will often find it difficult to do routine things, like reaching behind your back, reaching into a cabinet, or combing your hair. You may notice a crackling or popping sensation. When there is arthritis of the glenohumeral joint, there is often a creaking or grating sound.

Diagnosis

How do doctors diagnose this condition?

Your doctor will want to do a history and physical examination. He will ask you about activities or trauma that could have injured your shoulder. He will want to know the level of your pain, and what limitations you have. A physical examination is done. Range of motion and strength of the shoulder muscles will be evaluated. Your doctor will want to look at your shoulder to see if there is bony deformity, or atrophy (shrinkage) of the muscles. With a complete rotator cuff tear, moving the arm away from the body can be nearly impossible. If your doctor lifts your arm for you, and you cannot hold it up, this is called a positive Drop Arm Test. This usually means the rotator cuff is torn.

Other areas such as the neck may also need evaluation. A pinched nerve in the neck can mimic a rotator cuff tear. A neurological examination to include checking reflexes and sensation may be included. Your doctor may want you to have anelectromyogram (EMG). This checks the function of the muscles of the shoulder. An EMG uses a small needle in the muscle being tested. It measures the electrical activity of the muscle at rest, and when tightened.

Your doctor will request X-rays of your shoulder. X-rays show the shape of the bones and joints. When the rotator cuff is torn, the shoulder will often ride high, meaning that it sits higher in the joint than it should. It can also show how much damage ahs occurred to the joint surfaces.

Magnetic resonance imaging (MRI) allows your doctor to look at slices of the area in question. The MRI machine uses magnetic waves, not X-rays to show the muscle, tendons, and ligaments of the shoulder. MRIs will show tears of the rotator cuff tendons. Atrophy of the muscles can also be evaluated with MRI. A computerized tomography (CT) scan shows slices of bone. Like X-rays, it uses radiation. A CT scan can help to more accurately determine the degree of damage of the glenohumeral joint. A CT scan is especially useful to plan surgery if an artificial shoulder replacement is considered for treatment.

Treatment

What treatment options are available?

Nonsurgical Treatment

Conservative care that includes physical therapy, ice, heat, and anti-inflammatories is tried first. The goal of treatment is to reduce pain, and increase range of motion and function. Corticosteroid injection into the shoulder joint is also sometimes helpful. Steroids are very powerful anti-inflammatory medications that can reduce pain temporarily. These injections will not heal the tear but may give pain relief for several weeks to months. If arthritis of the shoulder is advanced, and pain is continuous and severe, surgery may be the best option available.

Surgery

Cuff tear arthropathy is the result of long standing lack of rotator cuff function. In almost all cases, repair of the rotator cuff tear is no longer an option. Surgery for cuff tear arthropathy is done when pain and decreased motion continue after conservative care. The simplest surgical procedure to try and improve the situation is a debridement. During a debridement, the surgeon will surgically remove (debride) any inflammed tissue, bones spurs and loose flaps of tendon tissue that may be catching in the joint and causing pain. This procedure may reduce pain, however, it does not always improve range of motion, strength, or function of the shoulder.

Patients with this type of arthritis would seem to be good candidates for a shoulder replacement, but replacing the shoulder in the typical fashion has not been successful. Replacing the shoulder with a special type of artficial shoulder joint is becoming more popular. This procedure is called a reverse shoulder replacement.

The “normal” artificial shoulder was designed to copy our real shoulder. The glenoid component (the socket) was designed to replace our normal shoulder socket with a thin, shallow plastic cup. The humeral head component was designed to replace the ball of the humerus with a metal ball that sits on top of the glenoid. This situation has been compared to placing a ball on a shallow saucer. Without something to hold it in place, the metal ball simply slides around on the saucer. In the shoulder that something is the rotator cuff and the muscles that attach to the tendons. Without a rotator cuff to hold the metal ball centered in the plastic socket, the metal quickly wore out the plastic socket and the joint became painful once again. The answer to this dilemma was to rethink the mechanics of the shoulder joint and design an artificial shoulder that worked differently than the real shoulder joint. The solution was to reverse the socket and the ball, placing the ball portion of the shoulder where the socket use to be and the socket where the ball or humeral head use to be. This new design led to a much more stable shoulder joint that could function without a rotator cuff. The artificial joint itself provided more stability by creating a deeper socket that prevented the ball from sliding up and down as the shoulder was raised. The large deltoid muscle that covers the shoulder could be used to more effectively lift the arm, providing better function of the shoulder. The final result is a shoulder that functions better, is less painful and can last for years without loosening.

Rehabilitation

What should I expect after treatment?

Nonsurgical Rehabilitation

Your physical therapist will show you how to use ice or heat to help with pain. You will also be instructed in exercises to strengthen your shoulder girdle as much as possible. Showing you joint protection tips, or motion that you can expect to do safely without causing more harm to your shoulder is also important. The goal is to reduce pain, increase range of motion and function, and prevent further arthritis.

After Surgery

A physical or occupational therapist will see you the day after surgery to begin your rehabilitation program. Therapy treatments will gradually improve the movement in your shoulder. Your therapist will go over your exercises and make sure you are safe getting in and out of bed and moving about in your room.

When you go home, you may get home therapy visits. By visiting your home, your therapist can check to see that you are safe getting around in your home. Treatments will also be done to help improve your range of motion and strength. In some cases, you may require up to three visits at home before beginning outpatient therapy.

Out patient therapy at a facility can often more effective and is often preferred over home physical therapy. The first few outpatient treatments will focus on controlling pain and swelling. Ice and electrical stimulation treatments may help. Your therapist may also use massage and other types of hands-on treatments to ease muscle spasm and pain. Continue to use your shoulder sling as prescribed.

As the rehabilitation program evolves, more challenging exercises are chosen to safely advance the shoulder’s strength and function. Finally, a select group of exercises can be used to simulate day-to-day activities, like grooming your hair or getting dressed.

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Shoulder Bankart Repair Surgery

What is a Bankart Repair?

The aim of a Bankart repair operation is to restore stability to the shoulder. The operation is suitable for people who have detached the labrum and ligaments at the front of the shoulder as a result of an original violent dislocation. Usually the shoulder has remained unstable and may have dislocated on a number of further occasions.

After the operation you should not suffer further dislocations and have much reduced pain.

bankart_repair1

What does Bankart Repair involve?

Bankart Repair surgery is performed under general anaesthetic and takes around an hour and a half.  Usually the nerves to the whole arm are also numbed with local anaesthetic which lasts for sixteen to twenty-four hours. This technique is called a regional block and is similar to the idea of an epidural anaesthetic frequently used in childbirth. This regional block not only means that a lighter general anaesthetic is required, reducing postoperative sickness and nausea, but also provides excellent pain relief afterwards.

The operation is carried out as a conventional open operation through an incision at the front of the shoulder, or telescopically through a number of small incisions around the shoulder.  The aim is to restore the labrum and ligaments to their original position on the edge of the socket and encouraged to heal there. The first step in the operation is to mobilise and re-position the labrum and ligaments and to create an environment in which healing can occur. Little harpoons or anchors are then inserted into the bone on the edge of the socket, which gain a good grip. Stitches on these anchors are then used to suture the labrum and ligaments back into place. The anchors and sutures then hold everything in the right place while natural healing occurs.

The incisions are closed with stitches and waterproof dressings are applied.

When will I recover?

The operation requires a one night stay in hospital and your stitches will come out at one to two weeks after the surgery. Your arm is placed into a special shoulder-immobilising sling and exercises and physiotherapy start on the day of surgery.  Your physiotherapist will teach you all you need to know for the first couple of weeks before your discharge from hospital.

As a general guideline your sling will be retained for a period of four weeks during which time you will be quite one-handed. At four weeks the sling generally goes and increased exercises and movement are encouraged. Most people can return to driving a car at around six weeks and will have regained good ordinary use of the shoulder by eight to ten weeks.

Physiotherapy and exercises continue for four to six months and sports that do not impose too much stress on the shoulder, such as running, can start again at around eight to ten weeks. Activities such as golf and swimming can be resumed at around three months. Contact sports, such rugby and football and other high demand sports such as surfing and climbing can be reintroduced at six months.

In addition to regular treatment with the physiotherapist, follow up is required with your surgeon. This is to monitor and guide progress and to look out for complications which are fortunately all rare.

What risks should I know about?

Bankart Repair is a very successful operation but there are some potential complications you should be aware of even though they are uncommon.

  • Infection can occur although it is rare and infection rates are at 1%.
  • Shoulder dislocation can occur although this risk is minimised by having the operation done very carefully and adhering to the physiotherapy regime.

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Rotator Cuff Injury

Your rotator cuff is made up of the muscles and tendons in your shoulder. These muscles and tendons connect your upper arm bone with your shoulder blade. They also help hold the ball of your upper arm bone firmly in your shoulder socket. The combination results in the greatest range of motion of any joint in your body.

A rotator cuff injury includes any type of irritation or damage to your rotator cuff muscles or tendons. Causes of a rotator cuff injury may include falling, lifting and repetitive arm activities — especially those done overhead, such as throwing a baseball or placing items on overhead shelves.

About half of the time, a rotator cuff injury can heal with self-care measures or exercise therapy.

Symptoms:

Rotator cuff injury signs and symptoms may include:

  • Pain and tenderness in your shoulder, especially when reaching overhead, reaching behind your back, lifting, pulling or sleeping on the affected side
  • Shoulder weakness
  • Loss of shoulder range of motion
  • Inclination to keep your shoulder inactive

The most common symptom is pain. You may experience it when you reach up to comb your hair, bend your arm back to put on a jacket or carry something heavy. Lying on the affected shoulder also can be painful. If you have a severe injury, such as a large tear, you may experience continuous pain and muscle weakness.

When to see a doctor
You should see your doctor if:

  • You’re experiencing severe shoulder pain
  • You’re unable to use your arm or feel weak in the arm
  • You have shoulder pain that’s lasted more than a week

Causes:

Four major muscles (subscapularis, supraspinatus, infraspinatus and teres minor) and their tendons connect your upper arm bone (humerus) with your shoulder blade (scapula). A rotator cuff injury, which is fairly common, involves any type of irritation or damage to your rotator cuff muscles or tendons, including:

  • Tendinitis. Tendons in your rotator cuff can become inflamed due to overuse or overload, especially if you’re an athlete who performs a lot of overhead activities, such as in tennis or racquetball.
  • Bursitis. The fluid-filled sac (bursa) between your shoulder joint and rotator cuff tendons can become irritated and inflamed.
  • Strain or tear. Left untreated, tendinitis can weaken a tendon and lead to chronic tendon degeneration or to a tendon tear. Stress from overuse also can cause a shoulder tendon or muscle to tear.

Common causes of rotator cuff injuries include:

  • Normal wear and tear. Increasingly after age 40, normal wear and tear on your rotator cuff can cause a breakdown of fibrous protein (collagen) in the cuff’s tendons and muscles. This makes them more prone to degeneration and injury. With age, you may also develop calcium deposits within the cuff or arthritic bone spurs that can pinch or irritate your rotator cuff.
  • Poor posture. When you slouch your neck and shoulders forward, the space where the rotator cuff muscles reside can become smaller. This can allow a muscle or tendon to become pinched under your shoulder bones (including your collarbone), especially during overhead activities, such as throwing.
  • Falling. Using your arm to break a fall or falling on your arm can bruise or tear a rotator cuff tendon or muscle.
  • Lifting or pulling. Lifting an object that’s too heavy or doing so improperly — especially overhead — can strain or tear your tendons or muscles. Likewise, pulling something, such as a high-poundage archery bow, may cause an injury.
  • Repetitive stress. Repetitive overhead movement of your arms can stress your rotator cuff muscles and tendons, causing inflammation and eventually tearing. This occurs often in athletes, especially baseball pitchers, swimmers and tennis players. It’s also common among people in the building trades, such as painters and carpenters.

Risk Factors:

The following factors may increase your risk of having a rotator cuff injury:

  • Age. As you get older, your risk of a rotator cuff injury increases. Rotator cuff tears are most common in people older than 40.
  • Being an athlete. Athletes who regularly use repetitive motions, such as baseball pitchers, archers and tennis players, have a greater risk of having a rotator cuff injury.
  • Working in the construction trades. Carpenters and painters, who also use repetitive motions, have an increased risk of injury.
  • Having poor posture. A forward-shoulder posture can cause a muscle or tendon to become irritated and inflamed when you throw or perform overhead activities.
  • Having weak shoulder muscles. This risk factor can be decreased or eliminated with shoulder-strengthening exercises, especially for the less commonly strengthened muscles on the back of the shoulder and around the shoulder blades.

What you can do in the meantime
In the days before your appointment, you can make yourself more comfortable by:

  • Resting your shoulder. Avoid movements that aggravate your shoulder and give you more pain.
  • Applying cold packs to reduce pain and inflammation.
  • Taking pain medications, if necessary.

If your injury appears to be severe or your doctor can’t determine the cause of your pain through physical examination, he or she may recommend diagnostic imaging tests to better delineate your shoulder joint, muscles and tendons. These may include:

  • X-rays
  • A magnetic resonance imaging (MRI) scan
  • An ultrasound scan

Treatments:

Most of the time, treatment for rotator cuff injuries involves exercise therapy. Your doctor or a physical therapist will talk with you about specific exercises designed to help heal your injury, improve the flexibility of your rotator cuff and shoulder muscles, and provide balanced shoulder muscle strength. Depending on the severity of your injury, physical therapy may take from several weeks to several months to reach maximum effectiveness.

Other rotator cuff injury treatments may include:

  • Injections. Depending on the severity of your pain, your doctor may use a corticosteroid injection to relieve inflammation and pain.
  • Surgery. If you have a large tear in your rotator cuff, you may need surgery to repair the tear. Sometimes during this kind of surgery doctors may remove a bone spur or calcium deposits. The surgery may be performed as an open repair through a 2 1/2- to 4-inch (6- to 10-centimeter) incision, as a mini-open repair through a 1 1/4- to 2-inch (3- to 5-centimeter) incision, or as an arthroscopic repair with the aid of a small camera inserted through a smaller incision.
  • Arthroplasty. Some long-standing rotator cuff tears over time may contribute to the development of rotator cuff arthropathy, which can include severe arthritis. In such cases, your doctor may discuss with you more extensive surgical options, including partial shoulder replacement (hemiarthroplasty) or total shoulder replacement (prosthetic arthroplasty).

A unique treatment option now available involves the use of a reverse ball-and-socket prosthesis. This reverse shoulder prosthesis is most appropriate for people who have very difficult shoulder problems. These include having arthritis in the joint, along with extensive tears of multiple muscles and tendons (rotator cuff) that support the shoulder, or having extensive rotator cuff tears and a failed previous shoulder joint replacement.

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Prevent and Treat Shoulder Injuries

Advanced bodybuilders and weightlifters subject their bodies to tremendous amounts of stress. In many cases, the stress produced by training with extremely heavy weight leads to some type of injury, everything from mild muscle pulls and tendinitis to server sprains and tears.

Certain structures in the body are likelier to suffer damage under the assault of heavy training than others, and one of the areas most vulnerable to injury is the shoulder joint. The shoulder is the most complex and most mobile joint in the body, but this mobility is gained at the cost of instability and it is this inherent skeletal instability that renders the shoulder so susceptible to injury.

STRUCTRE OF THE SHOULDER

To understand why this is so, what sort of shoulder injuries bodybuilders are likely to encounter, how to prevent them and what to do about these injuries once they have occurred, let’s start by examining the anatomy of the shoulder. To begin with, the fundamental structure of the shoulder girdle includes the scapula, which is the large triangular shoulder blade situated on either side of the upper back, and the clavicle, the collarbone, which attaches at one end to the sternum, the upper part of the ribcage at the center of the body and at the outer end to a structure at the top of the scapula called the acromion, which forms the bony top or point of the shoulder.

To render the entire shoulder girdle mobile, as well as allowing the arm virtually 360 degrees of rotation at the shoulder, there is not one joint involved, but three joints, plus one “articulation.” These are:

1) The Glenohumeral Joint. This is the ball-and-socket joint that most people think of as the shoulder. The top of the humerus, the upper arm bone, fits into a shallow cavity or socket situated below the acromion called the glenoid.
2) The Acromioclavicular Joint. This is the point at which the outer end of the clavicle is joined to the acromion at the top of the shoulder.
3) The Sternoclavicular Joint. This is where the inner end of the clavicle attaches to the sternum.
4) The Scapula. The shoulder blade is attached to the thorax by a variety of muscles and other tissues that allow it movement in relationship to the trunk. It forms a joint with the arm at the glenohumeral joint and with the clavicle at the acromioclavicular joint.

Injuries can occur to any of these areas, but the most common problems encountered by bodybuilders and weightlifters involve the glenohumeral joint and the acromioclavicular joint.

INJURIES TO THE GLENOHUMERAL JOINT

The glenohumeral, ball-and-socket joint of the shoulder is very different from a ball-and-socket joint such as the hip in that, as described above, it has a tremendous amount of additional mobility It achieves its mobility from the fact that there is very little bony contact between the head of the humerus and the glenoid socket. At any given position, only about one quarter of the head of the humerus is in contact with the glenoid, which is what makes this joint so inherently unstable.

What stability it has comes from the surrounding ligamentous tissue that holds the joint together. Particularly the capsule, which is a fibrous envelope that attaches circumferentially around the glenoid, and is reinforced anteriorally by the glenohumeral ligaments.

Reinforcing the capsule and ligaments is the rotator cuff a musculotendinous support structure overlying and intimately attached to the capsule. The most important part of this structure in terms of frequency of injuries is the supraspinatus tendon.

Injuries to the glenohumeral joint almost always involve some damage to one or more of the ligaments, the associated tendons and muscles, or the glenoid labrum, a fibrocartilaginous structure at the rim of the glenoid cavity. The most frequent types of glenohumeral injuries are:

1) Damage to the capsule and ligaments, commonly where they attach to the rim of the glenoid. Tears or ruptures of these tissues result in pain and eventually in loss of mobility.
2) Damage resulting in anterior (meaning to the front) instability, in which sufficient stretching or tearing of the tissue allows the end of the humerus to come out of the glenoid cavity Subluxation is when the head of the humerus temporarily slips onto the rim of the glenoid and then spontaneously slips back into the socket; dislocation occurs when the head of the glenoid slips out over the glenoid rim and stays in this position.
3) Damage to the rotator cuff, usually as a result of impingement syndrome, a chronic, inflammatory process of the rotator cuff and the suhdeltoid hursa as these structures repeatedly impinge, are pressed and squeezed against the underside of the roof of the shoulder joint. Repetitive microtrauma and overuse of this nature may result in inflammation, partial tearing and thickening of the rotator cuff.
4) Bursitis, inflammation of a hursa, which is a sack that allows for the smooth gliding motion between the rotator cuff and the upper end of the humerus and the overlying deltoid muscle and the roof of the shoulder joint.

INJURIES TO THE ACROMIOCLAVICULAR JOINT

The most common injuries to bodybuilders and weightlifters in the area of the acromioclavicular joint involve damage to the ligamentous tissue surrounding and stabilizing the joint and arthritis degeneration of the joint itself.

A shoulder separation involves a situation in which some degree of subluxation or dislocation occurs between the clavicle and the acromion in the area of the AC joint. This type of injury, often caused by falling on the point of the shoulder, is more common to athletes like football players than to bodybuilders.

The two exercises that I see causing the greatest frequency of injuries to the AC joint in bodybuilders are heavy bench presses and dips. These movements frequently cause cumulative microtrauma to the distal or outer end of the clavicle, resulting in destruction of the bony tissue in this area leading to degeneration of the joint.

HOW SHOULDER INJURIES OCCUR

While the shoulder joint is a skeletally unstable structure, it is connected to some of the most powerful muscles of the body. For example, a main function of the pectorals is to pull the shoulder girdle forward, while muscles of the back such as the rhomboids, latissimus dorsi and trapezius work to pull the shoulder girdle up, down and to the rear.

The joints of the shoulder are involved in almost all upper body movements. Stress is put on the shoulder not only when you’re training the deltoids, but during chest, back and arm workouts as well. Therefore, one of the primary causes of shoulder problems is simply overuse. When you overuse an area of the body there is a resulting degree of microtrauma. This damage, although small, can be cumulative. If you keep training in spite of fatigue and mild pain, the damage is made worse and eventually leads to inflammation or more serious damage and the likelihood of chronic or incapacitating problems in the area.

Damage can also be done by a single incident of momentary overstress, such as lifting too heavy a weight or a multiplication of stress that comes from using poor technique. Faced with a sudden stress the shoulder is not prepared to deal with, the ligaments and musculotendinous structures of the shoulder can stretch, tear or rupture. However, it is possible that what may appear to be an injury resulting from a single incident of overstress may actually be the result, in part, of cumulative microtrauma in the injured area due to repeated overuse of which you were unaware.

Certain exercises are likelier to cause shoulder injuries than others. For example, a lot of bodybuilders I’ve treated have sustained glenohumeral injuries from doing heavy bench presses. Advanced bodybuilders, who have built up a great deal of strength, are capable of lifting enormous amounts of weight, 500 pounds and more in the bench press, and this puts enormous amounts of stress on the shoulder joint stress that the inherently unstable shoulder joint was not designed to cope with. If the bodybuilder attempts this kind of lift when the shoulder joint is already weakened by overuse, or when it has become overly fatigued during a workout, the glenohumeral joint and its surrounding tissue may not be able to bear up under the demands of that much weight and he or she may experience some degree of acute injury

Also, certain exercises appear to be more biomechanically unsound than others, which means they must be approached with a great deal of care. For example, while I’ve never had a patient with a shoulder injury that could be directly traced to doing behind-the-neck barbell presses, this movement does put a lot of stress on the shoulder while it’s in its least stable position. A conventional military or dumbbell press involves a combination of abduction and external rotation, which puts the head of the humerus against the weaker part of the shoulder joint, forcing it forward. Pressing behind the neck adds the element of extension, putting even more stress on the head of the humerus and causing it to bear large amounts of stress while in its relatively weakest and most vulnerable position.

But no matter what exercise you are performing, you are courting injury if you use poor technique or bad judgment. Bodybuilders who bounce too heavy a weight off their chest doing barbell bench presses, jerk the weight around and let it get out of control performing movements like barbell shoulder presses or dumbbell presses and flyes are simply asking for trouble. So are the ones who train too hard when they’re already tired, or who fail to adequately stretch and warm up before a heavy workout.

PREVENTION OF SHOULDER INJURIES

Prevention of shoulder injuries involves nothing more for the most part than avoiding the mistakes outlined in the previous section. This involves:

1) Proper stretching, keeping the structures flexible so that a sudden elongation due to pull of heavy weight will not create damage.
2) Proper warm-up to allow the structures maximum ability to deal with stress.
3) Using proper technique – controlling the weight, not letting stress become magnified by out-of-control inertial forces.
4) Avoiding overtraining – both short and long term. Short-term overtraining means that you are stressing a fatigued area; long-term overtraining means that you are in danger of “overuse syndrome.”
5) Avoiding pain. If you feel pain, avoid whatever movement is causing it. Try something else – incline instead of flat, for example, dumbbells instead of barbells. But don’t continue to do anything that causes you pain.
6) Avoid biomechanically unsound exercises. If a movement involves putting stress on the joints at an especially awkward angle or when they’re in an unstable position, the exercise should be approached with care.

Remember, when it comes to overuse and overtraining, that the shoulder is involved in virtually all upper body movements, not just deltoid training. While bench presses and behind-the-neck presses are the exercises most often associated with shoulder injuries, doing movements like heavy dumbbell flyes or laterals, weighted behind-neck chins or heavy pulldowns can also contribute to the wear and tear of the shoulder joints that can lead eventually to serious injury.

TREATMENT OF SHOULDER INJURIES

There are numerous specific programs of therapy appropriate to each of the various kinds of specific shoulder problems, such as bursitis, bicipital tendinitis, impingement syndrome, rotator cuff tears, labral tears, capsular disruption, or arthritic degeneration of the glenohumeral joint or the AC joint. However, while there are differences in how each of these conditions is treated, there are certain general therapeutic principles that apply to virtually all of them. These are:

1) Rest
2) Treatment of inflammation
3) Stretching and restoration of range of motion
4) Strengthening
5) Avoidance of reinjury

The first step in rehabilitation of any shoulder injury is rest and avoiding the particular activity that caused the problem in the first place. I can’t stress this enough. The idea of “training through the pain” is disastrous when it comes to physical injury. When a damaged structure is put under stress you only make the injury worse, prolong the period needed for recovery and possibly limit the degree of recovery you will ultimately be able to achieve.

In the event of inflammation caused by severe tendinitis or bursitis, the use of an oral anti-inflammatory drug may be indicated. But in cases where anti-inflammatory injections are administered, they must be used on a limited basis — once, twice or, at the most, three times spaced out over a period of time. If the anti-inflammatory injections are going to be effective, you usually expect to see a response in the first few days after their introduction. Repeat injections of anti-inflammatory drugs are not recommended, since they have a deleterious effect on collagen tissue.

Once the acute inflammation has subsided the next step is muscular and capsular stretching, a restoration of full flexibility in all the structures involved within the limits of pain. Stretching is important to avoid such problems as capsular adhesions. If range of motion is not restored, the result can be adhesive capsulitis, a severe restriction in the range of motion of the shoulder also called “frozen shoulder. However, in cases of glcnohumeral instability, you should avoid further capsular stretching in the same direction as the instability.

Following restoration of range of motion with problems such as interior instability, the next step is for strengthening such things as the internal rotators, the adductors, the anterior deltoid and the prime scapular stabilizers. Obviously, the specific exercises required for rehabilitation depend to a large degree on the nature of the injury itself. But whatever the particular therapy called for, the initial steps in strengthening involve very low weight, high-rep exercises, isolating the specific muscles you want to work — such as the subscapularis, the internal rotator of the shoulder or the anterior deltoid. Since extreme isolation of a given bodypart is often necessary, this is a situation in which a variety of specialized exercise machines is extremely valuable.

In the event of impingement syndrome and/or anterior instability, the restoration of strength is a particular priority. However, I recommend a substantial period of light, high-repetition rehabilitative exercise before going on to train with heavier weights — although in some cases the patient may never be able to regain pre-injury strength levels.

Dealing with most of my health-oriented patients, I have no great problem convincing them to go slowly and not to rush into heavy training too quickly. With bodybuilders, however, this is almost always a struggle. Bodybuilders and weightlifters are notorious for believing they know more than their doctors. Their instinct is to jump into heavy training at too early a stage, and they need to be constantly reminded that a few extra weeks of going slow will ultimately save them months or years in the rehabilitative process.

And when I say heavier resistance, I mean progressively heavier resistance. You don’t go in one day from light training to heavy, one-rep maximum repetitions. The area to be rehabilitated needs to be strengthened gradually over a period of time. Remember, not only are you trying to rehabilitate an injury, you are dealing with a structure that was inherently weak enough to be injured in the first place. So gradual and careful escalation of poundages is an absolute necessity to avoid re-injury.

One important factor in understanding the process of rehabilitation of shoulder injuries is that the healing process can take a considerable period of time, depending on the severity of the injury. Really serious conditions such as severe anterior instahlity or substantial damage to the rotator cuff may involve as much as six months, nine months or even a year. However, less serious conditions such as mild inflammation are reversible within a relatively short period of time.

SURGERY

Although most injuries respond to the kind of conservative treatment described above, there are times when surgical intervention is called for, especially for professional athletes and young people with complete tears.

For example, in the case of a young pitcher or tennis player with a complete rotator cuff tear, you’d want to go in there immediately. In the event of extreme shoulder separation, sometimes it’s necessary to go in and reattach the distal end of the clavicle to the acromion to restore the AC joint. In the case of arthritis of the AC joint, when conservative treatment is not sufficient, the surgical remedy is to cut away a small portion of the distal end of the clavicle.

Arthroscopic surgery, which is currently so widely used in knee injuries, has not as yet developed to the same degree in dealing with injuries to the shoulder. The arthroscope is used for diagnosis, and for procedures such as resecting torn portions of the lahrum, but not for rotator cuff repair. In terms of state-of-the-art orthopedics, there is nothing to replace standard open surgical procedures for rotator cuff tears.

THE LONG-TERM PROGNOSIS FOR SHOULDER TRAINING

The human body is not something that lasts forever. It is subject to cumulative damage from long-term wear and tear, and it eventually wears out. And when you subject the body to excessive amounts of stress, the degeneration and attrition are accelerated.

Bodybuilding for health and fitness can give you a body that is 10 or 20 years younger than that of a more sedentary person, given the variations inherent in individual heredity. But bodybuilding or weightlifting pursued as a serious sport takes a tremendous toll on the body, particularly on the joints. Especially the inherently unstable shoulder joint.

A race car, for example, can in a few hours wear out a set of tires that would last years on a regular car, and a high-performance dragster requires an engine rebuilding after every run. When you increase performance, you also increase stress, and the rate of wear and tear becomes vastly accelerated.

Most individuals don’t begin to experience the problems associated with physical attrition until middle or old age. Serious athletes, particularly bodybuilders, often experience these kinds of problems earlier on. In fact, virtually every competition bodybuilder and weightlifter I’ve treated, even if quite young, has already experienced some physical problems, limitations of motion or chronic damage to the musculotendinous structures, joints or ligaments that in some way limited their ability to do certain movements or bear up under particular kinds of stress.

Most good competitors learn to ‘train around” chronic problems. If it hurts them to do bench presses, they substitute dumbbell presses, or incline presses or something else. If a lower back problem prevents them from doing barbell rows, they switch to one-arm dumbbell rows or heavy cable rows, whatever it takes to work around the affected area.

When you’ve been training a considerable amount of time, training around a physical problem is usually possible because you already have gotten most of your growth and developed about the maximum amount of strength you’re capable of. And since it’s always easier to maintain a level of development than it was to achieve it in the first place, you may be able to get away with training around a considerable amount of damage and limitation.

But this is not always the case. Sometimes an injury to an area such as the shoulder is so great that you just have to quit heavy training. Stop completely, not for a rest, but forever. You only get to be a virgin once, and any time you sustain a serious injury, especially if surgery is required, no matter how much of your pre-injury physical ability you are able to regain, the injured area will never be “as good as new.” And areas that have been injured in the past usually degenerate at an accelerated rate over time compared to noninjured areas.

But the real lesson this implies, I believe, is that bodybuilders who do not have any competitive ambitions should avoid the kind the damaging, heavy training that would-be World and Mr. Olympia competitors have to put themselves through. There’s a physical price to be paid for pushing your body to its limits, and no reason to pay that price unless there is some commensurate reward to be gained for doing so.

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Neck and Shoulder Pain

Are you experiencing neck and shoulder pain that is not getting better? You are at the right place. Cure your neck and shoulder pain today. Call us +65 64712744 or SMS to +65 92357641 to schedule for an appointment today.

Neck and shoulder pain can be classified in many different ways. Some people experience only neck pain or only shoulder pain, while others experience pain in both areas.

Neck Pain

Neck Pain

What causes neck pain?

Causes of neck pain include abnormalities in the bone or joints, trauma, poor posture, degenerative diseases, and tumors. Pain in the soft tissues (muscles, tendons, and ligaments) is the most common cause of neck pain and usually occurs as a result of an acute or a chronic muscle strain. The neck is very mobile, which means it is less stable than other areas of the body and more easily injured.

What causes shoulder pain?

The shoulder is a ball and socket joint with a large range of movement. Such a mobile joint tends to be more susceptible to injury. Shoulder pain can stem from one or more of the following causes:

  • Strains from overexertion
  • Tendonitis from overuse
  • Shoulder joint instability
  • Dislocation
  • Collar or upper arm bone fractures
  • “Frozen” shoulder
  • Pinched nerves (also called radiculopathy)

How are neck and shoulder pain diagnosed?

  • X-rays can be helpful in diagnosing neck and shoulder pain. Plain X-rays can reveal disc space narrowing, rheumatologic disease, destructive lesions, slippage, stenosis, fractures, and instability with flexion-extension views.
  • Magnetic resonance imaging (MRI) is a non-invasive procedure that can reveal the detail of neural (nerve-related) elements.
  • Myelography/CT scanning is sometimes used as an alternative to MRI.
  • Electrodiagnostic studies—electromyography (EMG) and nerve conduction velocity (NCV)also might aid in the diagnosis of neck and shoulder pain, arm pain, numbness, and tingling.

How are neck and shoulder pain treated?

The treatment of soft tissue neck and shoulder pain includes the use of anti-inflammatory medicine. Pain also might be treated with a local application of moist heat or ice. A local injection is often helpful for arthritis of the shoulder. For both neck and shoulder pain movement exercises can have positive results. For cases in which nerve roots or the spinal cord are involved, surgical procedures might be necessary.

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