Rotator cuff related shoulder pain (RCRSP) is an over-arching term that encompasses a spectrum of shoulder conditions that include; subacromial pain (impingement) syndrome, bursitis, rotator cuff tendinopathy, and symptomatic partial and full thickness rotator cuff tears. This is by far the most common shoulder complaint we see at Optimise Physio.
HOW DO I KNOW IF I HAVE ROTATOR CUFF RELATED SHOULDER PAIN?
If you have rotator cuff related shoulder pain, you will experience pain, often intense pain, in the shoulder and upper arm. If you have injured your shoulder, the pain is acute and comes on quickly. If there was no injury, pain can come on gradually with repeated or sustained hand over head activities. You may have difficulty lifting your arm or you may have a painful arc of pain between 60 and 120o when you lift your arm out by your side. It is common to have a deep, dull ache in the shoulder and you may have difficulty sleeping, particularly if you are lying on that shoulder or on your back. Your arm may feel weak and you’ll have pain reaching for your seat belt or trying to brush your hair. To confirm whether you have torn your rotator cuff, your physiotherapist will perform a thorough examination and may send you for an ultrasound scan to confirm the diagnosis and determine the size of your tear.
HOW EFFECTIVE IS PHYSIOTHERAPY FOR TREATING ROTATOR CUFF RELATED SHOULDER PAIN?
Findings from high quality peer-reviewed research investigations suggest that a graduated and well-constructed exercise approach confers at least equivalent benefit as that derived from surgery for; subacromial pain (impingement) syndrome, rotator cuff tendinopathy, partial thickness rotator cuff (RC) tears and atraumatic full thickness rotator cuff tears. These findings are important for people experiencing rotator cuff related shoulder pain, clinicians, and health funding bodies, as considerable healthcare savings could be achieved if surgery was only considered for those not obtaining satisfactory benefit from non-surgical intervention.
Acromioclavicular (AC) joint injuries
WHAT IS THE ACROMIOCLAVICULAR (AC) JOINT?
The AC (acromioclavicular) joint is the pointy protrusion near the top, outer edge of the shoulder. The AC joint allows you to lift your arm up above your head. Technically speaking, it is the junction of the outside end of the collarbone (clavicle) and the acromion (bony projection) on the top of the shoulder blade (scapula). AC joint injuries are common in younger active individuals and often occur from a direct fall on your shoulder.
HOW DO I KNOW IF I HAVE AN ACROMIOCLAVICULAR (AC) JOINT INJURY?
AC joint injuries are diagnosed based on your medical history as well as by a physical examination. Your physiotherapist looks for a 'step' deformity of the joint, any swelling or bruising, and feels for any tenderness over the AC joint and outer edge of the collarbone. Range of motion of the shoulder will be limited because of pain. To test for an AC joint injury, your physiotherapist will lift your arm up to 90 degrees and take it passively across your chest with the elbow flexed (cross arm adduction). If the AC joint is injured, this test will cause pain. You may also be sent for an X-ray to see how severe the injury is.
HOW EFFECTIVE IS PHYSIOTHERAPY FOR ACROMIOCLAVICULAR (AC) JOINT INJURIES?
Physiotherapy is effective for managing type I and type II AC joint injuries, according to two 2014 scientific reviews. It is also effective for managing type III injuries, with studies showing that the rehabilitation time is shorter and just as effective as surgery, although the cosmetic outcome is worse. Surgery for AC dislocation can reduce the deformity, but this treatment has more complications and could in fact compromise the function of the shoulder. More severe grades of AC dislocation (types IV-VI) are treated more effectively with surgery. It is important that you get an early, thorough assessment to determine the best outcome for you.
WHAT IS THE FROZEN SHOULDER?
Frozen shoulder, also known as adhesive capsulitis, is an inability to lift your arm up above your head or move your arm in different directions, initially because of pain and later because of extreme stiffness. It has four phases with the natural course of recovery for a frozen shoulder (if you do nothing), is 2–3 years.
The first signs of frozen shoulder vary between women and men—a woman may have difficulty doing up her bra, or a man may have trouble getting his wallet out of the back pocket of his pants. Your shoulder may also be painful when you reach to put on a seat belt or to take the ticket from the machine in the car park. Frozen shoulder can occur after a shoulder or arm injury, particularly if the arm has been immobilised in a sling. It can also occur after shoulder surgery, open-heart surgery, or breast cancer treatment (either after the surgery or with radiotherapy treatment). But sometimes there is no obvious cause for the frozen shoulder.
HOW EFFECTIVE IS PHYSIOTHERAPY FOR FROZEN SHOULDER?
Physiotherapy is extremely effective at diagnosing frozen shoulder.
At certain stages of frozen shoulder, physiotherapy can play a key role. In particular, once the thawing stage is evident, physiotherapy can be a great strategy to regain as much movement as possible and to retrain muscles that have been under-used for many months. This will help you to achieve a healthy, strong and useful shoulder (and arm), while being careful not to overload this area. For an effective outcome, it is important that you get an accurate diagnosis of your condition and what stage of the recovery you are at.