Treating Shoulder Problems

Nearly 8 million people per year seek treatment for shoulder problems.  They account for over 40% of all baseball injuries reported to the NCAA.   Although many of them are diagnosed as the well known “rotator cuff” issue, sometimes it is not so simple.  With the involvement of the clavicle (collar bone), scapula (shoulder blade), thoracic spine (ribcage), and humerus (long bone of the arm) all contributing to the function of the shoulder, myriad dysfunctions can arise.

Many athletic activities that involve excessive, repetitive, overhead motion, such as volleyball, swimming, tennis, pitching, and weightlifting can cause shoulder injury.  Many leisure activities such as skiing and rock climbing also account for similar problems.  Even everyday activities such washing walls and windows, hanging curtains, painting, and gardening can lead to shoulder discomfort that can become chronic if left unaddressed.

Some shoulder problems are related to muscles. The strength of the surrounding components determines whether the joint has the stability, strength and free motion for daily activities to be performed. There are also problems related to the alignment (positioning) and congruence (surface contact) of the multiple bones involved.

Please see the glossary below for descriptions of common diagnoses that are effectively treated by a movement specialist, your Physical Therapist.

Glossary of Shoulder Diagnoses

Rotator cuff tear: A partial or full tear in the muscles that form a cuff or cover across the top of the head of the humerus (knob at top of arm bone). The cuff holds the bone in place against the other components of the joint, stabilizes, and rotates the arm. Depending on severity, a tear may be treated conservatively with therapy or may ultimately require surgery.

Bursitis/Tendonitis: Shoulder bursitis and rotator cuff tendonitis both refer to inflammation of a soft tissue structure within the shoulder joint complex that results in a strikingly similar set of symptoms. The actual cause of these symptoms is ‘impingement syndrome’. The tendons are the rope-like structures connecting a muscle to bone and the bursa is a slippery pad that protects tendons from bony prominences that they slide over.

Impingement: This term refers to the trapping of soft structures between two bones. External impingement occurs when the tendons or muscle associated with the rotator cuff become trapped in the space below the far end of the clavicle where it extends out over the humerus becoming the “tip” of the shoulder. Internal impingement refers to the pinching of rotator cuff structures created by humeral head instability (shifting) due to weakness.

Scapular Dyskinesia: When the shoulder blade does not move smoothly, with good strength and timing, shoulder dysfunction results. This problem can be very subtle but results in many secondary symptoms and indicates other shoulder problems are present.

Shoulder separation: More properly termed AC joint dislocation, this is usually the result of trauma. This joint, at the far end of the collarbone, connects with part of the shoulder blade that juts internally to meet in front. Fractures, dislocations, and arthritis can occur at this joint. Sometimes, the joint is poorly formed since birth, but issues only arise later in conjunction with other shoulder problems.

Although pain or stiffness seems to be localized in the shoulder, it may actually be none of the diagnoses listed above. Weakness in core muscles can lead to improper movement patterns and compensations. Poor posture and the muscle shortening that accompanies it can impact scapular motion. Even a problem in the neck can cause changes in movement and strength that result in shoulder pain. Looking at the entire kinetic chain, how the body works together smoothly in a sequence from head to toe, is a vital part of comprehensive shoulder evaluation and treatment.