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The Shoulder

The Shoulder. Introduction. Components of the shoulder Most common joint pathology Rotator cuff Biceps Tendon Fractured neck of Femur Dislocation Adhesive Capsulitis. 3 components. The glenohumeral joint The acromiclavicular joint The scapular. Diagnosis. History Range of Movement

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The Shoulder

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  1. The Shoulder

  2. Introduction • Components of the shoulder • Most common joint pathology • Rotator cuff • Biceps Tendon • Fractured neck of Femur • Dislocation • Adhesive Capsulitis

  3. 3 components • The glenohumeral joint • The acromiclavicular joint • The scapular

  4. Diagnosis • History • Range of Movement • Palpation • Pain • Diagnostic tests (there are 65 that can be performed!)

  5. Most common joint pathology

  6. Shoulder or cervical nerve root? • Is there loss of shoulder ROM? YES = SHOULDER • Are the reflexes reduced? YES = CERVICAL

  7. Rotator Cuff • Stabilise the head of the humerus while the other major muscles around the shoulder are actively moving the arm. Eg. When deltoid is abducting. They also initiate most movements

  8. 3 main types of rotator cuff lesions • Tendonitis • Partial rupture • Complete rupture

  9. Tendonitis

  10. Treatment of tendonitis

  11. Rotator cuff rupture

  12. Rotator Cuff strengthening Sidelying Lateral Rotation

  13. Rotator Cuff strengthening Prone Horizontal Abduction

  14. Rotator cuff strengthening Lateral rotator strengthening with resistance band

  15. Biceps Tendon

  16. Fractured neck of femur • Pain on early movement • Upper arm swelling • Need to be investigated early especially following a fall in the elderly • Should be kept moving as much as possible

  17. Ghjt disclocation • Carries a very specific history of trauma - anterior dislocation (abduction, extension and lateral rotation) • Usually involves tear of labrum • Physio aims to strengthen rotator cuff • After 3rd dislocation surgery is usually necessary

  18. Adhesive Capsulitis/Frozen shoulder • inflammation of the shoulder capsule and synovial membrane leading to adhesion formation. This causes a thickening in the capsule and constriction of the glenohumeral joint due to the scar tissue forming in the capsule

  19. Diagnosis • Age 40+ • Cause ? Unknown Possible: trauma, wrench, dislocation. CVA, heart conditions, diabetes, viral. Can also be secondary to cx spondylosis or to tendonitis.

  20. Clinical features

  21. Clinical features • Increasing dull ache over a few months duration. • Sharp pain when reaching the end of pain free movement • Loss of movement in a capsular pattern – lateral rotation – abduction - flexion Most reduced >>>>>>>>>Least reduced • Elevation and protraction of shoulder girdle

  22. Clinical features cont’ • Pain over A/C joint and deltoid muscle – can spread to neck and/or elbow • All G/H movement often painful, not specific planes • Pain worse at night

  23. Clincial features cont’ • Muscle spasm in pectoralis major and latissimus dorsi • Wasted deltoid  • Associated posture • Dowagers hump • Poke chin

  24. Prognosis • 18 months to 3 years 3 phases • Freezing –painful phase (worse at night and when lying on it) • Frozen – stiff phase • Thawing- stiffness gradually eases

  25. Physiotherapy • Reduce pain with electrotherapy, TENS and acupuncture until patient is able to sleep and function day to day • Taping to rest the joint • Static strengthening exercises for the shoulder • Introduce stretching in sub acute phase

  26. Exercises to increase rom

  27. Other treatment • Antiinflamatories • Muscle relaxants • Hydrocortisone injection • Nerve block • Surgery – Manipulation/Arthroscopic capsular release

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