Impingement Syndrome of the Shoulder

What is it?
Impingement syndrome occurs when the muscles of the rotator cuff become compressed against the structures of the upper portion of the shoulder. This portion of the shoulder is called the subacromial space. This space eventually becomes smaller in impingement syndrome causing the tendons to rub against the bones that make up the space. The impingement of these structures will eventually cause pain and lead to inflammatory conditions such as tendinitis, bursitis, and/or small tears to the tendons of the rotator cuff. If the impingement becomes advanced it can lead to bone spurs in the subacromial space causing even more pain to the shoulder.

What Causes it?
Prolonged periods of forward posture can lead to impingement syndrome; such as those who work at computer 8+ hours a day. The forward/rounded shoulders when using a computer can cause a narrowing of the sub-acromial space.

Repeated stress or overuse activities such as frequent overhead work or overhead throwing.

Trauma to the shoulder; especially a direct fall onto the shoulder.

Symptoms of Impingement Syndrome
Pain to the anterior front of the shoulder that can radiate to the mid-portion of the arm

Pain with overhead and reaching activities; pain with reaching behind

Pain with throwing and lifting activities

Feeling of weakness when raising the arm overhead

Treatment of Impingement Syndrome
It is important to initially treat the symptoms that can be causing inflammation with this condition in order to help reduce pain. This is followed be general strengthening of the rotator cuff and stretching activities that can help increase the subacromial space. If left untreated it can lead to more serious conditions such as bone spurs and ruptures to the rotator cuff tendon.

If you suspect you have impingement syndrome you should contact your orthopedic or local physical therapist to begin treatment immediately to prevent the condition from worsening.

This is what you should expect during physical therapy:
Manual range of motion exercises performed by your physical therapist to increase range of motion.
Joint mobilizations by your physical therapist to reduce pain and swelling and increase range of motion.
Range of motion and strengthening/stability exercises that will be prescribed by your physical therapist to regain normal function of your shoulder.

Labral Tears of the Shoulder

The shoulder is a large complex joint. The labrum is part of the shoulder and plays an important role. The labrum helps provide stability to an already unstable joint. Overuse or traumatic injuries play a role in tearing of the labrum. An injury involving a dislocation of the shoulder can also result in a tear of the labrum.

There are two common types of labral tears. Since the labrum surrounds the glenohumeral joint of the shoulder the injury can be to the superior (upper) or inferior (lower) labrum. A superior labral tear, also known as a SLAP lesion can involve the nearby biceps tendon. The inferior tear, also known as a Bankart’s lesion can involve the inferior glenohumeral ligament.

Causes
A direct blow to the shoulder
A direct fall into the shoulder
A fall onto an outstretched arm as if trying to break your fall
Overuse activities
Lifting a heavy object overhead
Reaching to the back of your car to pull forward a heavy bag/book bag

Symptoms
Pain with overhead motions
A popping or grinding sensation with shoulder movements
Pain when sleeping on the involved shoulder
Loss of motion to the shoulder
Feeling of weakness with movement of the shoulder

Treatment Options
A CT scan or MRI to show if there is a tear

Conservative treatment such as physical therapy or arthroscopic surgery. Physical therapy may be prescribed before surgery to restore strength/ROM before surgery to have an easier recovery after surgery.

What to Expect in Physical Therapy
Usually after a labral Repair you will remain in a sling up to 4 weeks. You will not be able to perform certain movements of your shoulder that your MD and physical therapist will explain to you. You may also have limitations in how far you can reach while the labrum is healing. Your physical therapist will prescribe a series of range of motion, stretching, and strengthening exercises based on your post-op surgical protocol in order to regain your ability to function.

Remember if you are in pain before/after surgery ICE your shoulder 10 minutes at a time every hour as needed.

Rotator Cuff Tears of the Shoulder (RTC)

The rotator cuff is a very complex part of the shoulder. It contains 4 muscles: supraspinatus, infraspinatus, teres minor, and subscapularis. The tendons of these muscles run through the subacromial space to insert onto the humerus. If there is a narrowing of this space it can lead to an impingement which can cause excessive friction on the rotator cuff tendons and eventually lead to a tear of the rotator cuff. A tear can also come from a fall onto an outstretched arm.

What does the rotator cuff help me do?

Helps with rotation of the humerus, raising the arm overhead, and allows for stabilization of the shoulder when muscles around it contract.

What can cause a tear?

Falling onto an outstretched arm, repetitive movements of the shoulder such as pitching in baseball, and bone spurs causing friction on the tendons.

Symptoms of a tear

1. Pain or Pain free. Pain free!? Yes a total tear will result in no pain and inability to raise the arm due to a feeling of weakness.

2. Pain with overhead activities

3. Unable to sleep on the side of which the RTC is torn.

4. Difficulty with reaching behind

5. Muscle atrophy and feeling of weakness with shoulder movement

Treatment options

Unfortunately a tear is tear and can only be fixed with surgery. You may have pre-operative physical therapy to restore some range of motion before surgery for an easier recovery after surgery. After surgery you can expect to start physical therapy as early as the next day. You will be in a sling for about 4 weeks. Post-operative physical therapy lasts about 4-5 months.

What happens in Physical Therapy

Typically physical therapy protocol is 0-6 weeks you perform PASSIVE RANGE OF MOTION ONLY. This means the therapist will move your arm for you and you are not allowed to move your arm on your own, even at home.

6-8 weeks begins active assistive range of motion, meaning you can assist your arm with movements, but still cannot move the arm independently.

8-12 weeks you will begin active range of motion and move the arm independently.

12+ weeks, begin strengthening and return to functional activities.

HOWEVER, this protocol may vary depending on your MD and if your MD has their own protocol.

 

 

Breast Cancer and Physical Therapy

Unfortunately the incidence of breast cancer has almost become an epidemic today. Almost everyone knows someone or knows someone who knows someone (you get the idea) who has had breast cancer or passed away from it. Most women who have breast cancer undergo some type of surgery. They usually undergo one or more of the following surgeries:

• Breast biopsy
• Lymph node biopsy or removal
• Breast conservation surgery (lumpectomy)
• Mastectomy
• Breast reconstruction

After one of these surgeries it can be difficult and painful to move your shoulder and arm. The surgery can result in pain, loss of motion, and weakness which leads to limitations in arm movement. It can effect the person’s ability to reach overhead, get dressed, brush their hair, or even have a difficult time bathing.

Aside from surgery patients will undergo chemotherapy and/or radiation. These two types of treatment can affect joints and soft tissues causing further restriction. For example, if you have right-sided breast cancer and receive radiation treatment than the right side of your shoulder can become restricted.

How Physical Therapy Can help

It is important to begin physical therapy when your MD clears you following any type of breast cancer surgery. It will help in a quicker recovery and return to function of your everyday activities.

A person is usually recommended to physical therapy after breast cancer surgery if they do not have full function of their arm 3-4 weeks after surgery. If this is the case, then a physical therapist will evaluate you and design a specific program tailored to your needs. The patient will usually start with range of motion and stretching exercises initially before initiating strengthening exercises to regain full use of the affected arm.

In the meantime, it is important to begin using your arm as you would for everyday activities. It will be normal for it to feel tight, restricted and painful. However, it is also very important that you do not keep your arm immobile while recovering. This can lead to further tightening and restriction of the affected arm/shoulder.

I will make a post in the next few days of some gentle stretching exercises that can be performed at home. Feel free to contact me with any questions.

Frozen Shoulder Syndrome

Frozen shoulder syndrome, also known as adhesive capsulitis can be very debilitating for some.  It literally results in the shoulder being felt as “frozen” resulting in significant pain and loss of motion. The condition can cause with no onset or can be a result of an injury to the shoulder.

So, what is it? Well, it’s an inflammatory condition to the shoulder where the capsule becomes inflamed and constricts the joint to be able to move. During this process muscles can also shorten around the shoulder resulting in a further loss of motion. Again, this causes significant pain and can result in a significant loss of motion as well as overall weakness to the affected arm.

What causes it? An overuse injury such as tendinitis, or those who perform repetitive overhead motions (swimmers, baseball, or work related activities), or even a sudden fall onto the shoulder. This can also be a result of what can happen after a shoulder surgery from being immobilized in a sling or from not regaining appropriate shoulder motion within a certain period after surgery. In rare cases, a frozen shoulder can be the result of Diabetes if the person does not control their blood sugar levels well.

Can physical therapy help? Of course! Typically after your initial evaluation your therapist will perform passive range of motion to your shoulder as well as joint mobilizations to help loosen up the capsule around the shoulder in order to re-gain motion. Your therapist will also instruct you in several range of motion and strengthening exercises in order to regain the ability to perform your activities of daily living with improved ability. You can expect physical therapy to last anywhere from 2-6 months depending on the severity of your symptoms.

What’s the worst case scenario? A frozen shoulder can take up to 2 years to “un-freeze” If adequate motion is not gained during physical therapy than your doctor may decide to perform a manipulation under anesthesia. This will allow your doctor to break up any scar tissue surrounding your shoulder joint in order to improve overall motion to your joint.