Shoulder Injuries

The acromioclavicular (AC) joint sits on top of the shoulder and serves as the connection between the clavicle (collarbone) and scapula (shoulder blade). Injury to this joint most often occurs as a result of a fall onto the tip of the shoulder, causing damage to the AC ligament. Signs and symptoms include pain on top of the shoulder, limited motion, and possibly a “step deformity” in which the clavicle sits higher than the rest of the AC joint. In addition to rest, ice, and medications to reduce pain and inflammation, physical therapy is indicated to regain motion in the shoulder and strengthen surrounding muscles. On rare occasions, surgery may be necessary to repair more involved separations in which additional ligaments and muscles have been damaged.

The glenoid labrum is a thickened extension of the shoulder joint capsule that helps to deepen the “socket” and keep the “ball” in place by creating a suction effect to enhance stability. Many ligaments attach to the labrum, and injury to any of these structures can stress the labrum and cause a tear. Injury can occur via a direct blow to the shoulder (compression) or a sudden downward pull on the arm (traction). Labral tears are particularly common in throwing athletes due to stress from repetitive overhead motion. A SLAP lesion (Superior Labrum Anterior Posterior) occurs when the labrum tears front to back and involves the biceps tendon at its attachment to the labrum. Signs and symptoms include pain on the top or back of shoulder only with movement (no pain at rest), as well as popping or clicking with overhead activity. Surgery is usually indicated to repair the torn labrum, followed by intensive physical therapy to optimize healing, reduce pain and inflammation, and regain strength and range of motion in the shoulder.

The rotator cuff muscles attach to the shoulder and serve as one source of stability for the joint. The attachment points (tendons) of these muscles are enclosed in a small area known as the subacromial space. Tendonitis (inflammation of the tendons) may occur here as a result of predisposing genetic factors, repetitive overhead activities, improper movement patterns, and/or failure or fatigue of surrounding muscles. Inflammation takes up room in the subacromial space and can thus cause impingement (painful trapping or irritation of the tendons). Additionally, a tear to one of the rotator cuff tendons may occur as a result of an isolated traumatic incident or degeneration over time. Signs and symptoms of rotator cuff pathology include pain in the lateral shoulder and arm, weakness, and decreased range of motion. Pain may particularly be present in an arc of motion between 60? and 120? of arm elevation to the side; however, pain may be absent in a complete tear of the rotator cuff. Muscle weakness becomes more evident as the tendonitis, impingement, or tear worsens. In addition to rest, ice, and medications to reduce pain and inflammation, physical therapy is indicated to regain motion, strengthen surrounding muscles, and correct dysfunctional movement patterns. Surgery may be indicated in younger individuals with traumatic tears or for those patients who do not respond to therapy.

Joint pain in the shoulder is often caused by the degeneration of the protective layer of cartilage that covers the bones, which allows for the bones to move smoothly, in the glenohumeral joint. Patients with this condition often have complaints of stiffness and or pain within the joint, and limited range of motion. In addition to medications to provide symptomatic pain relief, physical therapy is indicated to strengthen the muscle surrounding the shoulder and correct dysfunctional movement patterns, all while improving the range of motion.

The glenohumeral (shoulder) joint is a ball-and-socket joint designed to maximize mobility; in doing so, some level of stability is sacrificed. The surrounding bones, muscles and ligaments all work together to allow for a large range of controlled movement. When any of these components fail, injury may result. Shoulder dislocation occurs when the head of the humerus (the “ball”) moves completely out of the glenoid fossa (the “socket”) and a healthcare provider must put it back in place (relocation). Shoulder subluxation occurs when the head of the humerus moves out of the glenoid but corrects itself spontaneously. Anterior dislocation or subluxation is most common and occurs when a force is applied to a shoulder that is abducted and externally rotated, causing the ball to move forward out of the socket. Posterior dislocation/subluxation is also possible, in which the ball moves backward out of the socket. This most commonly occurs with a fall on an outstretched hand. Signs and symptoms of dislocation/subluxation include pain, feelings of instability, and apprehension with movement. If dislocation has occurred, seek medical attention immediately to relocate the shoulder. In addition to rest, ice, and medications to reduce pain and inflammation, physical therapy is indicated for dislocation/subluxation to strengthen shoulder stabilizers and regain appropriate motion. Surgery may be indicated on occasions in which a dislocation caused damage to surrounding structures, or in the case of a shoulder that has a history of multiple dislocations/subluxations and is non-responsive to therapy.

If the non-surgical approach was not successful and a total shoulder replacement was performed physical therapy should begin shortly after surgery. A post operative treatment protocol is essential for your return to prior level of function and to optimize performance.