Conditions
Rotator Cuff Tear
The rotator cuff is a group of four muscles that hold your humerus in place and allow your shoulder to move. These muscles can be torn traumatically such as with a fall or lifting something awkwardly, or atraumatically usually from age or repetitive activities. Fortunately, rotator cuff tears are often treated non-operatively with excellent results through a combination of mobility exercises and strengthening. Exercise is crucial to strengthen the remainder of the rotator cuff along with the surrounding muscles to allow for support of the shoulder. Read more about rotator cuff tears in our blog here. You can also read about rotator cuff tears specifically in baseball players here.
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Instability
The shoulder is the most common joint for instability due to the fact that it relies on muscular support more than any other joint. The ball-in-socket joint of the shoulder is actually closer to a golf ball on a tee, and the surrounding muscles are crucial to hold the bones in place. If there is laxity at the joint, usually from general hypermobility, then the muscles must be even more supportive to allow for movement without pain. Manual therapy is crucial to allow muscles to relax, but then an aggressive strengthening program gives the best results. It is important to allow for full return to sport or activity with exercises progressed in physical therapy, as you want to strengthen the shoulder in numerous positions. Read about shoulder instability including thrower's shoulder and batter's shoulder here.
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Labral (SLAP) Tear
The labrum is non-contractile tissue that enhances joint stability by supporting the bones of the joint. It essentially creates a vacuum that allows the humerus to adhere to the socket of the shoulder blade. A tear in the labrum can be painful, but it can also de-stabilize the joint and create pinching or loss of motion. Labral tears have a great success rate being treated non-operatively and many times people have no pain or symptoms! SLAP tears are Superior Labral Anterior to Posterior tears, usually involving the biceps tendon. They are common in throwing athletes, particularly in baseball pitchers due to the repetitive stress of throwing. They require manual therapy to decrease the pain, exercises to load the tissue, and a gradual return to throwing program. Read more about SLAP tears here.
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Shoulder Impingement
Shoulder impingement is referring to the idea that something, usually your supraspinatus tendon, is being compressed with a motion, usually going overhead. Research shows that this diagnosis is usually not the actual case, as there is enough room for the tendon to move. However, physical therapy involves examining the surrounding tissues for any limitations that would lead to difficulty reaching overhead. Activities may need to be temporarily modified, but the goal is to gradually get stronger and reach further overhead. Trigger point dry needling can be helpful if surrounding muscles are limiting active movement.
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Arthritis
Arthritis refers to inflammation of the joint and the shoulder can be a possible location. Arthritis can be a normal part of aging and is usually accompanied by other pathologies if pain or disability are present. It is important to decrease joint stress by making sure that other joints and muscles are moving as they should along with strengthening surrounding areas. Wear and tear at one segment is typically due to other segments not taking their share of the load, and sometimes gaining mobility elsewhere is all that is needed to resolve symptoms.
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Dislocation/Subluxation
Dislocation involves the head of the humerus coming apart from the joint and remaining out of place. Subluxation occurs when the humerus goes out of place but spontaneously returns. Dislocations are serious medical issues and should be addressed by a health professional, as nerve damage is possible. Rehabilitation from these injuries involves strengthening the surrounding tissue to hold the shoulder in place while decreasing compensatory muscle guarding with techniques such as cupping or scraping.
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Little League Shoulder
Little League shoulder refers to irritation of the growth plate at the top of the humerus, usually due to throwing a baseball. When we are young and still growing, we have growth plates at the end of our longer bones like the humerus, these areas are weaker than the rest of the bone because they are generating new bone. If someone overuses their arm, the growth plate is typically the weakest point and will be damaged causing pain, loss of motion, and weakness. Physical therapy involves manual therapy for mobility, exercise progression for strengthening, and a well thought out out return to throwing program for gradual buildup. Read more about Little League shoulder here.
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Postoperative
Shoulder surgery is always intimidating. Rehabilitation after surgery can also be stressful, as you want to assure that the surgery went well. We have worked with hundreds of clients after shoulder surgery so we are familiar with how the experience should progress. We are available to answer any questions, even when you do not have an appointment scheduled. We are also intimately familiar with healing timelines and can give you ideas of what your return to activity should look like. Read more about postoperative physical therapy in our blog.
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Frozen Shoulder (Adhesive Capulitis)
Frozen shoulder is a poorly understood diagnosis that is most common in women over the age of 40. There are theories about what is occurring, such as the shoulder capsule shrinking, but studies are inconclusive. Symptoms involve severe mobility restrictions, particularly in elevation and rotating your shoulder outwards that are eventually accompanied by pain. Gentle mobility exercises along with manual therapy are beneficial in the early stages, with eventual progression to more aggressive stretching as your body allows it.