PHYSIOTHERAPY FOR SHOULDER INJURIES
The shoulder joint is very prone to injuries in sport. These may be traumatic injuries such as shoulder dislocation or acromioclavicular (AC) joint sprain or as a result of overuse such as rotator cuff muscle injuries.
A shoulder dislocation involves the ball of the shoulder joint coming out of the socket of the joint. It is usually a traumatic injury caused by a fall or heavy impact such as in a rugby tackle. In approximately 95% of cases the ball comes in a forward or anterior direction and so is called an anterior dislocation.
Symptoms will include severe pain in the shoulder and an inability to move the shoulder. The contours of the shoulder will also appear to look different to the other side.
After a dislocation the shoulder should be x-rayed to determine if there are any fractures around the shoulder joint, and the shoulder is “reduced” or put back in place. The arm will then be put into a sling to allow healing to occur.
Rehabilitation post shoulder dislocation is extremely important. This is because during dislocation, the ligaments around the shoulder joint are damaged thereby causing instability in the joint and making reccurrence of the dislocation a high possibility. For this reason, the ligaments are often surgically repaired.
Treatment following a shoulder dislocation will involve manual therapy to restore full range of movement to the joint, rotator cuff strengthening to improve the control of the joint and sports specific rehabilitation to allow the athlete to return to sport at their previous level of participation.
ACROMIOCLAVICULAR (AC) JOINT SPRAINS
The acromioclavicular joint is the joint at the very top of the shoulder between the collar bone and the shoulder blade. It is most commonly injured by a fall onto an outstretched hand or by a direct blow to the shoulder. There will be a lot of pain at the time of the injury and arm movement will be limited. The shoulder should be x-rayed to rule out any fracture in the joint.
Treatment and recovery time will depend on severity of the injury. Some injuries may require surgical repair. The arm is usually rested in a sling initially for pain relief. Gentle exercises and manual therapy will help to restore full range of movement to the joint. Strengthening of the rotator cuff and surrounding muscles is important before returning to sport in order to reduce the risk of re-injury.
ROTATOR CUFF INJURIES
The rotator cuff muscles are a group of four muscles which very closely surround the shoulder joint and are extremely important in controlling the movement of the joint.
These muscles are often injured over time in sports which involve repetitive movements such as swimming or tennis, and tears can develop within the muscles. Early diagnosis and treatment of shoulder pain can often prevent complete tears of the muscles.
Symptoms of a rotator cuff injury will include pain in the shoulder, particularly with overhead activities, difficulty sleeping on the shoulder at night and often weakness in the arm when lifting objects.
Examination of the mechanics of the shoulder joint will identify any muscle imbalances which may be placing more stress on the rotator cuff and these can be addressed through a specific rehabilitation programme. It may also be necessary to examine sporting technique such as a swimming stroke to identify any technical problems which may be predisposing the rotator cuff to injury.