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SHOULDER
Subacromial impingement
What Is It?
At the top of the humerus (upper arm bone), there is a small, confined space where the rotator cuff muscles and the long head of the biceps tendon pass through. This space is formed between the coracoacromial arch and the greater tuberosity of the humerus. When these tendons move within this limited area, they can sometimes rub against the arch, causing irritation, inflammation, and what is commonly referred to as shoulder impingement.
How Does It Present?
Shoulder impingement typically causes pain at the front and outer part of the shoulder. The discomfort often worsens when lying on the affected side or when lifting the arm overhead. This is because raising the arm narrows the subacromial space even more, increasing the likelihood of tendon compression and aggravating the symptoms.
Why Has It Happened?
This condition is commonly caused by repetitive overhead movements, such as those seen in certain sports, jobs, or daily activities. It can also develop due to muscle imbalances, particularly if the rotator cuff or other shoulder-supporting muscles are weak or not functioning correctly. Poor movement patterns or posture, such as restricted motion in the thoracic spine, can further contribute to shoulder strain and impingement.
How Can We Help?
Rehabilitation often focuses on strengthening the rotator cuff muscles to improve stability and function in the shoulder joint. Additionally, addressing any mobility restrictions in areas like the thoracic spine or correcting postural imbalances can relieve strain on the shoulder. Through a combination of manual therapy, targeted exercises, and education, we aim to restore proper movement and reduce the risk of further injury.
Rotator cuff tear
What Is It?
The rotator cuff is a group of four muscles and their tendons that work together to stabilise the shoulder joint and allow for internal and external rotation of the arm. These muscles—supraspinatus, infraspinatus, teres minor, and subscapularis—are crucial for shoulder movement. Like any other muscles, they can suffer from tears or strains, often caused by direct trauma, sports-related injuries, or sudden, unguarded movements.
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How Does It Present?
A rotator cuff injury often mimics the symptoms of subacromial impingement. Common signs include pain when lifting the arm overhead or when performing internal and external rotations, such as rotating the shoulder inward or outward. Pain is typically worse with resistance during these movements, and it may be accompanied by weakness or limited range of motion in the affected shoulder.
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Why Has It Happened?
Rotator cuff injuries are common because the shoulder is designed for maximum mobility, but this flexibility comes at the cost of stability. The rotator cuff muscles play a crucial role in maintaining this balance, and when they are weakened or overused, they become prone to injury. Repetitive overhead movements, such as those seen in certain sports or occupations, can wear down the rotator cuff, making it more susceptible to tears or inflammation. Weakness in the rotator cuff muscles, combined with poor shoulder mechanics, also increases the risk of injury.
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How Can We Help?
Effective treatment for a rotator cuff injury requires addressing both the strength of the rotator cuff muscles and the function of related areas, such as the upper back and neck, which also play a role in shoulder stability. After a thorough assessment, we will develop a treatment plan that focuses on strengthening weak muscles and stretching or releasing any tight or dysfunctional areas. This comprehensive approach aims to restore proper function and prevent further injury, while also considering lifestyle adjustments to avoid aggravating the condition.
Glenoid labral tear
What Is It?
The labrum is a ring of cartilage that surrounds the socket of the shoulder joint (glenoid), providing stability and a smooth surface for the head of the humerus (upper arm bone) to move within the joint. It acts like a cushion, helping to keep the arm bone securely in place while allowing a wide range of motion. When the labrum is torn, it disrupts the normal function of the shoulder, often leading to pain, instability, and limited movement.
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How Does It Present?
A torn labrum typically causes deep pain within the shoulder, which may extend down to the elbow. People with this condition often report a sense of locking, catching, or a feeling of instability in the shoulder, particularly during overhead movements or when lifting. The severity and specific symptoms depend on the location and extent of the tear. In some cases, you might also hear clicking or popping sounds when moving the shoulder.
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Why Has It Happened?
Labral tears can occur for various reasons. Acute trauma, such as a fall or impact, can cause the head of the humerus to be forcibly displaced, leading to a tear. This is especially common in shoulder dislocations. Repetitive overhead motions, often seen in athletes like swimmers or throwers, can also contribute to labral damage. Additionally, the labrum can deteriorate over time due to age-related wear and tear, where the cartilage thins and becomes more prone to tearing, even with normal daily activities.
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How Can We Help?
Since the labrum has a limited blood supply, it doesn’t heal easily on its own, and untreated tears may worsen over time. However, conservative management can be effective in many cases. Strengthening the surrounding shoulder muscles, particularly the rotator cuff and scapular stabilizers, can help support the joint and reduce symptoms. We can design a personalised rehabilitation program focused on building strength, improving stability, and providing guidance on daily activities to avoid aggravating the injury.
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In some instances, when conservative measures don’t provide relief or if the tear is severe, surgical repair may be necessary. This procedure can help restore the normal function of the shoulder and prevent further damage.
Adhesive Capsulitis (Frozen shoulder)
What Is It?
Commonly referred to as frozen shoulder, this condition involves the thickening and stiffening of the shoulder joint capsule, resulting in a significant reduction in shoulder mobility. The primary symptom is difficulty in moving the arm, particularly when trying to raise it, and this is often accompanied by pain during movement. The condition usually develops gradually over time and is frequently misdiagnosed as a muscle strain or ligament sprain in its early stages. While the exact cause is unknown, it is believed to be linked to a combination of factors, including inflammation and the formation of scar tissue within the joint capsule.
How Does It Present?
Frozen shoulder typically presents with pain and stiffness in the shoulder, making movement challenging. In the early stages, it may feel similar to a muscle or ligament injury, leading to confusion in diagnosis. The most noticeable restriction is in overhead movements, particularly when trying to lift the arm or rotate it externally (away from the body). As the condition progresses, the shoulder becomes increasingly immobile, and even everyday tasks like reaching or dressing can become difficult and painful.
Why Has It Happened?
The exact cause of frozen shoulder is still unclear, but there are several factors that may increase the likelihood of developing the condition. People with diabetes, pregnant women, or those who have experienced previous shoulder trauma—especially if the shoulder has been immobilised for a period—are at greater risk. Additionally, those who have undergone shoulder surgery or have had long periods of inactivity due to injury are more prone to developing frozen shoulder. Other risk factors include thyroid disorders, autoimmune diseases, and prolonged immobility.
How Can We Help?
Treating frozen shoulder can be a long process, often taking several months to a few years for full recovery. A combination of consistent prescribed exercises and professional therapy is key to improving mobility and reducing pain. Patients need to regularly perform stretching and strengthening exercises tailored to their condition to maintain and improve range of motion. Therapists can support the recovery process by manually mobilising the joint, reducing stiffness, and addressing underlying muscular imbalances. Patience and persistence are essential, as progress can be slow but gradual improvement is typical with the right care and dedication.
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