SHOULDER PAIN

Shoulder joint (Glenohumeral joint) is a multi axial synovial   ball and socket joint. The head of humerus articulates with the glenoid cavity of scapula and form Glenohumeral   joint. The ligaments, capsule, labrum , rotator cuff muscles(Subscapularis, Supraspinatus, Infraspinatus and Teres minor) provide stability to the joint.

CAUSE

Shoulder pain can be broadly classified in four major categories on the basis of causes:

• Tendon inflammation (tendonitis or bursitis)
• Arthritis
• Instability
• Fracture ( trauma)

TENDONITIS

Muscle is attached to bone via a chord like structure called Tendon .Whenever inflammation in the tendons around the shoulder joint occurs, it is called as Tendonitis. It is of two types:

• Acute –excessive overhead activities during work or overthrow activities in sports can cause acute tendonitis.
• Chronic –Microtrauma or repetitive wear and tear, degenerative diseases like arthrosis (due to age ),can cause chronic tendonitis.

      Inflammation can occur either in the biceps tendon or in the rotator cuff tendons

      

      BURSITIS

Inflammation occurs in small, fluid filled sacs in the shoulder joint (bursae).Subacromial bursitis , most of the times, associated with shoulder tendonitis.

Symptoms

• While moving the shoulder joint clicking sound or painful arc is experienced by the patient.
• Pain increases with the shoulder movement either upwards or backwards .Lying on the sore shoulder can also increase pain and sometimes it is so painful that patient awakes from sleep also. If tendonitis increases patient experiences pain even at rest.
• Swelling can also be seen at the joint.
• Tendonitis can lead to loss of mobility and strength of the affected arm.

Treatment

Medical treatment

To relieve pain and inflammation, anti inflammatory and analgesic drugs are given, like ibuprofen , naproxen etc.

Steroid Injections on the area having tenderness and pain

.

Physical Therapy

• Rest and support should be given to the affected joint. Avoid those activities and positions which increase pain.
• Taping – relieves pain by supporting the tendon.  Stress and load on the tendon decreases.
• Ice packs-Ice will help in reducing pain and inflammation.
• Ultrasound – it will reduce pain and inflammation.

When pain and inflammation reduces, progressive exercises to restore strength and flexibility of the joint should be started.

Surgical treatment

 First conservative treatment is given. Surgery is an indicated when conservative measures fail .Different surgical procedures are performed depending on the severity of problem.

ARTHRITIS

Arthritis affects joints , ligaments and can also cause muscle weakness. The patient complains of pain and limited joint ROM (Range of motion).Arthritis in shoulder can be:

• Osteoarthritis
• Rheumatoid Arthritis
• Post traumatic Arthritis
• Rotator cuff  tear Arthropathy
• Avascular Necrosis

Treatment

Medical treatment

To relieve pain and inflammation, anti inflammatory and analgesic drugs are given, like ibuprofen , naproxen etc.

Steroid Injections on the area having tenderness and pain

Physical Therapy

• Rest and change in daily routine activities (modify so that pain provoking activities can be avoided).
• Ice pack or moist heat will help in reducing pain and inflammation.

Exercise Therapy

Aim of exercise therapy  

• To increase the ROM of shoulder joint.
• To increase the strength of shoulder joint .
• Retrain the upper extremity and improve movement mechanics of shoulder joint .

Techniques to achieve desired aims are:

• Manual Therapeutic Technique (MTT ) - to increase joint ROM and mobility.

          Soft tissue manipulation
           Joint  mobilization.
            Stretching

• Therapeutic Exercise (TE)-to regain joint ROM and strength and reduce stress on affected joint.

          Flexibility exercises
          Strengthening

• Neuromuscular Re-education (NMR) - Retrain the upper extremity and improve movement mechanics of shoulder joint .It will also restore stability.

          Improve movement techniques like reaching, lifting, Overhead movements etc.

Surgical Treatment

When nonsurgical   measures fail, surgery is done. Different surgical procedures are:

• Arthroscopy
• Arthroplasty(Joint replacement)

1.        Hemiarthroplasty
2.        Total shoulder arthroplasty
3.        Reverse total shoulder arthroplasty

• Resection arthroplasty

Recovery and rehabilitation depends on the type of surgery performed.