The shoulder is comprised of several joints that combine with muscle tendons and ligaments to allow for wide range of motion in the arm.
Shoulder pain may be due to muscle imbalance which may result in instability or impingement of the soft tissue or bony structure, abnormal posture or reduced motion of the shoulder resulting in pain.
ANATOMY OF SHOULDER JOINT
Shoulder joints are made up of the upper arm bone (Humerus), bone of shoulder blade (Scapular), and collarbone (Clavicle) as the frame and muscles of the neck, chest, thorax, arm and lower back serve as the mover, ligaments and tendons as the attachment for stability during the motions. The head of upper arm bone fits into a rounded socket (glenoid) on shoulder blade. A combination of muscles, tendons and capsule keep the upper arm bone in the shoulder socket. These muscles are called the rotator cuff. They cover the head of upper arm bone and attach to the shoulder blade.
CAUSE OF SHOULDER PAIN
Common cause of shoulder pain can be one of the following: Arthritis, Rotator cuff strain or tears, Heart attack, Auto accident, Tumor, Bursitis, Impingement, Avascular necrosis (death of bone tissue due to limited blood supply), Brachial plexus injury, Broken bone, Cervical Radiculopathy, Separated shoulder, Frozen shoulder, Thoracic outlet syndrome, Tendon rupture, Rheumatoid arthritis, Polymyalgia rheumatic, Dislocated shoulder, Strains and Sprain, and Septic arthritis.
- Medications are the first line of care. Sometimes anti inflammation medicine can resolve the inflammation and stop the pain. Remember the cause of the pain is still not treated.
- Physical therapy to treat muscle imbalance, abnormal posture, sprain and strain
- Surgery if is the broken bone or conditions that cannot be treated with medication and therapy.
In this article I am only going to discuss the physical therapy treatment option for shoulder pain.
Examination starts with history taken from patient of how and when your shoulder pain started. Is your shoulder pain motor vehicle accident or sport related? When is your pain worse? What relieves your pain? After history is the observation of the whole body in standing to check the shoulder joint in relation to neck, trunk, and chest and d thorax. Is shoulder blade close to the thoracic or wing out, is shoulder forward, backward, down or up. We move to palpation of the muscles from neck, thoracic, chest, shoulder and arm. Next is to check for the motions from neck, shoulder, shoulder blade, collarbone, thoracic, elbow flexion/extension, pronation and supination and wrist joint. Check for muscle strength and finally move to special tests.
The information we collect from the above examination will give us an impression or diagnosis of the condition and what will be the appropriate treatment plan for the condition.
If the condition is acute (very recent) you may apply ice to the shoulder or combine ice and heat (contrast bath) and manual therapy (myofascial release to be precise) can be used to resolve the inflammatory reaction.
Therapeutic exercise with slow gentle stretching technique and later follow with strengthening technique with low weight and high repetitions to improve muscle endurance first ( between 30%-45% of 1 RM) later move to 50%-75% of 1RM for strength and 100% of 1RM for power if desire. Warning posture is very important when doing /performing exercise. Exercising with wrong posture will do more harm than good.
Joint mobilization can be used to increase joint kinematic and improve circulation. Soft tissue mobilization to the appropriate muscle and myofascial release can be used. These will release restricted fascia to increase neurovascular bundle motility, increase blood circulation, increase muscular fiber motility, and improve breathing.
Neuromuscular reeducation can be used to improve the muscle imbalance.
Therapeutic activities will be performed to improve function with ergonomic.
ADL can be used to improve activities of daily functions.
Ultrasound with continuous mode with frequency of 1MHz and appropriate intensity in W/cm2 can be used if the pain is localized.
The kind of physical therapy treatment procedures use will depend on the condition and understanding of the physical therapist.