Prior to formulating the treatment most appropriate for any specific patient, the physical therapist needs to gather essential data to determine what type of shoulder injury the patients has, the structures involved, and the limitations the injury causes.

Many people with shoulder problems suffer needlessly because of a delay in treatment. Early symptoms of a shoulder problem that people often ignore are pain in the front or back of the shoulder, difficulty reaching into their back pocket, aching at night, or a sharp twinge when raising the arm.

Why can the shoulder potentially be problematic? The answer is that this complex joint is used all day as we go about our daily routines. Because of this it is often injured or overused. Unfortunately, by the time an individual feels pain or experiences any loss of function with the shoulder, the problem has progressed. Shoulder conditions present themselves in many different ways, with varying degrees of inflammation and functional restrictions.

Some common inflammatory shoulder conditions are:

1. Tendonitis (inflammation of the tendon)

2. Bursitis (inflammation of the “bursa” or a fluid-filled sack protecting the joint)

3. Arthritis (inflammation of the joint itself)

How Shoulder Injuries Happen

How do these inflammatory conditions occur in the first place? Well, the causes are primarily overuse, strain or injury. Painting a ceiling, playing too many tennis matches or lifting overhead excessively can lead to inflammation of the rotator cuff (the main muscles of the shoulder that control the motions of the joint).

Impingement (pinching) develops when chronic or long term inflammation persists, and structures are "caught" between the bones at the top of the shoulder joint (the acromium and the humeral head). This causes the tendons and other tissues to thicken, narrowing the space under the tip of the shoulder. The more inflamed the tissue becomes and the narrower the space, the more pinching occurs, causing significant pain especially when reaching the arm upwards and across the body. Left untreated, an impingement can progress to a “Frozen Shoulder” where an individual may lose significant shoulder motion and shoulder function.

Chronic wear and tear or an injury can lead to breakdown of the tissues of the shoulder complex. A rotator cuff tear occurs when the tendons of the rotator cuff are severely strained. Surgery is often needed to treat this condition. Traumatic injuries may also lead to shoulder instability, shoulder dislocation or shoulder separation.

Also, there are traumatic injuries and fractures that often require immediate surgery. Falling on an outstretched arm, direct trauma (for example: getting slammed into during a football game) or being involved in a motor vehicle accident are common causes of traumatic shoulder injuries.

Treatment

As you can see there are many different causes of shoulder pain and the treatment depends on the cause of the problem. Physical therapy is almost always recommended in the management of shoulder problems. Studies show that rest and medication alone are not nearly as effective as physical therapy intervention where the skilled provider identifies the faulty moving components, weak or tight muscles and restores normal function.

Our therapists find shoulder problems both challenging at the initial evaluation phase and rewarding as we see our patients making progress. We love treating shoulder problems! Following are some of the steps our physical therapists may use to help sort out a shoulder problem in a systematic fashion:

• Firstly, we need to know the specific symptoms the patient is experiencing. Is it a sharp pain, a dull ache, pain with movement or pain at rest? This valuable information helps us differentiate the type of injury the patient has.

• Then, we must find out where the patient is feeling the pain or discomfort. Is it in the front, at the side or top of the shoulder? Maybe the pain is primarily in the upper arm or perhaps in the shoulder blade area. And to rule out any neck problems, we need to know if the pain radiates into the arm and goes below the elbow. This information helps us focus on the specific structures involved.

• The next piece of the puzzle is when the symptoms occur and what exactly aggravates them. Is it better or worse with activity or motion? How does the patient feel at night? Is there one specific position or a group of motions that bring on the worst symptoms? Are there any activities the patient is no longer able to do? This gives us an idea of the functional impairment the injury has on the patient.

• To further isolate the cause of the problem, we perform some very specific tests to see if they can reproduce the patient’s symptoms. This tells us exactly what is producing the patient’s dysfunction, and where to focus our treatment. Addressing the cause of the problem ensures that the symptoms will not recur at a later stage.

• The last step is deciding how to treat the problem. This is the fun and rewarding part.  With all the information we have gathered, we can now decide on the right combination of hands-on manual therapy, movement re-education, modalities and exercises that will get the patient out of pain and back to full function. Unfortunately, most shoulder problems have no ‘quick fix’. They take the skill of the therapist to diagnose, but also the effort and persistence of the patient to fully resolve the problem.

Of course, the real satisfaction comes at the end of the treatments when we hear the great success stories of how physical therapy intervention has allowed our patients to return to the activities they love, without pain or limitations! Definitely a win-win situation!

Therapists at Avante Physical Therapy are skilled in helping you determine the cause of your shoulder pain and will work with you to develop a program that will help you to relieve your symptoms, and regain mobility.