Tag: shoulder pain

Fibromyalgia

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Fibromyalgia

Overview

Fibromyalgia is a complex medical condition that affects the musculoskeletal system and can cause chronic widespread pain, tenderness, and fatigue. The diagnosis, pathogenesis and treatment of of this condition are still being studied and remain a subject of debate in the medical community. Despite this, the American College of Rheumatology has established classification criteria that consider multiple tender points and chronic widespread pain to be the hallmark symptoms of the condition.
Fibromyalgia is a common condition that affects people of all ages and ethnicities, with a symptom prevalence ranging from 2% to 4% in the general population. However, the actual number of individuals who are diagnosed with fibromyalgia is much lower.
The pathogenesis of fibromyalgia is not well understood, but it is thought to be a result of a complex interaction between biological and psychosocial factors. There is no specific test for fibromyalgia.

Anatomy

Fibromyalgia affects the musculoskeletal system, including the muscles, tendons, and ligaments. It is also associated with the nervous system, as it affects the way the brain processes pain signals. People with fibromyalgia may experience widespread pain and tenderness in various parts of the body, including the neck, back, shoulders, and hips. Additionally, fibromyalgia can also cause symptoms such as fatigue, sleep disturbances, headaches, and cognitive dysfunction (often referred to as “fibro fog”).

Symptoms

Fibromyalgia symptoms include:
• Widespread pain
• Increased sensitivity to pain
• Muscle stiffness
• Difficulty sleeping, leading to fatigue
• “Fibro-fog” affecting mental processes such as memory and concentration
• Headaches
• Irritable bowel syndrome (IBS) with stomach pain and bloating
• Frustration, worry, or low mood.
Note: Fibromyalgia symptoms can be unpredictable and may worsen or improve suddenly.

Causes

The exact cause of fibromyalgia is unknown, but it is thought to be a combination of genetic, environmental, and psychological factors. For example, genetics may play a role in a person’s susceptibility to fibromyalgia, while stress, trauma, and infections may trigger the onset of symptoms. Additionally, some research suggests that fibromyalgia may be associated with imbalances in certain brain chemicals that regulate pain, sleep, and mood.

Diagnosis

The diagnosis of fibromyalgia can be challenging because its symptoms are often similar to those of other conditions, such as arthritis, lupus, and chronic fatigue syndrome. To diagnose fibromyalgia, a doctor will perform a thorough physical examination and ask about the patient’s medical history and symptoms. There are no specific tests to diagnose fibromyalgia, but a doctor may order imaging studies, such as X-rays, MRI, or CT scans, to rule out other underlying conditions.

Treatment

Treatment for this condition is aimed at managing the symptoms of the condition. There is no cure for fibromyalgia, but there are several effective treatments that can help relieve the pain and improve quality of life. Some common treatments for fibromyalgia include pain medications, such as nonsteroidal anti-inflammatory drugs (NSAIDs) and prescription pain relievers, as well as physical therapy, exercise, and other forms of therapy, such as cognitive behavioural therapy (CBT) and mindfulness-based stress reduction. Additionally, some people with fibromyalgia find relief from complementary therapies, such as massage, acupuncture, and chiropractic care.

Prevention

There is no known way to prevent this condition, but there are steps you can take to manage its symptoms and improve your quality of life. Maintaining a healthy lifestyle, including regular exercise and a balanced diet, can help reduce stress and improve sleep. Additionally, practicing stress-management techniques, such as meditation and mindfulness, can help reduce anxiety and depression, which are often associated with fibromyalgia.

In conclusion, fibromyalgia is a complex and poorly understood condition that affects the musculoskeletal system and nervous system. While there is no cure for fibromyalgia, there are several effective treatments that can help relieve the pain and improve quality of life. If you think you may have fibromyalgia, it is important to see a doctor for a proper diagnosis and treatment plan.

If you are suffering from this condition, our exercise professionals can help. Contact us through our email at info@livewellhealth.co.uk or call us on 0330 043 2501.

Shoulder Impingement

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Shoulder Impingement

Overview

Shoulder impingement is a common condition that occurs in both athletes and non-athletes and is more common in individuals over the age of 40. It is often accompanied by rotator cuff tendinitis, which is inflammation of the rotator cuff tendons. The prevalence of shoulder impingement varies depending on the population studied, but it is estimated to affect up to 25% of the general population and up to 50% of individuals over the age of 50. It is more common in athletes who participate in overhead sports such as baseball, tennis, and swimming.

The pathophysiology of shoulder impingement involves a combination of factors, including anatomical variations, overuse or repetitive motions, muscular imbalances, and age-related changes. The repeated overhead movements and stresses placed on the shoulder joint can lead to inflammation and irritation of the rotator cuff tendons and bursa, which can eventually lead to impingement. Additionally, structural abnormalities such as a hooked acromion or bone spurs can contribute to impingement.

Anatomy

Shoulder impingement, also known as subacromial impingement, is a condition that occurs when there is compression of the rotator cuff tendons and the bursa between the acromion and the head of the humerus. The rotator cuff is a group of four muscles and tendons that attach the humerus to the scapula, and acromion is a bony prominence that forms the roof of the shoulder joint. Impingement occurs when the space between the acromion and the head of the humerus becomes narrowed, causing the tendons and bursa to be compressed against the acromion.

Symptoms

• Pain in the front or side of the shoulder, especially when reaching overhead or behind the back
• Weakness or loss of strength in the shoulder, especially with overhead movements
• Limited range of motion in the shoulder joint
• Pain and discomfort when sleeping on the affected shoulder
• Swelling or tenderness in the shoulder area
• A clicking or popping sensation when moving the shoulder
• Numbness or tingling in the arm or hand, which may indicate nerve involvement in severe cases

Causes

Common causes of impingement include anatomic variations of the acromion, degeneration of the rotator cuff tendons, overuse and trauma. Factors such as obesity, smoking, and diabetes can also contribute to the development of impingement, resulting in pain and weakness in the shoulder.

Diagnosis

Shoulder impingement is diagnosed through a combination of a physical examination, patient history, and imaging studies. The orthopedic surgeon will assess range of motion, strength, and pain in the affected shoulder, and perform specific tests such as the Neer test or Hawkins-Kennedy test. Imaging studies like X-ray or MRI can reveal degenerative changes in the bones and inflammation or tears in the rotator cuff tendons. A diagnosis of impingement is typically made when the patient has pain and weakness in the shoulder, and the physical examination and imaging studies reveal evidence of impingement. In some cases, a diagnostic injection may be done to confirm the diagnosis and to help to determine the best course of treatment.
Treatment
Shoulder impingement treatment usually begins with conservative measures such as rest, ice, and physical therapy. Medication and corticosteroid injections may also be used to reduce pain and inflammation. In more severe cases, or cases that don’t respond to conservative treatment, surgery such as subacromial decompression may be necessary. This involves removing a small portion of the acromion to create more space for the rotator cuff tendons and bursa. Physical therapy and exercises are essential for recovery after surgery. The treatment of shoulder impingement depends on the underlying cause of the condition and the severity of the symptoms.

Exercises

• Pendulum exercises: This exercise helps to gently move the shoulder and improve range of motion. Stand with your good arm leaning on a table or wall for support, and let the affected arm hang down. Use your body weight to gently move the arm in small circles.
• Isometric rotator cuff exercises: These exercises involve contracting the rotator cuff muscles without moving the arm. An example is the “empty can” exercise, which involves holding a light weight with the arm at a 90-degree angle to the body and squeezing the shoulder blade towards the spine.
• Scapular stabilization exercises: These exercises help to strengthen the muscles that support the shoulder blade, such as the serratus anterior and the trapezius. An example is the “wall slide” exercise, which involves sliding the back against a wall while keeping the arms and elbows in contact with the wall.
• TheraBand exercises: This exercise helps to improve the strength of the rotator cuff muscles, such as the supraspinatus and the infraspinatus. An example is the “external rotation” exercise, which involves holding the TheraBand in one hand and turning the arm outwards against the resistance of the band.
• Strengthening exercises: To improve shoulder strength, it’s recommended to do exercises such as shoulder press, lat pulldown, and rows. These exercises can be performed with free weights or resistance bands.
It’s important to note that exercises should be performed under the guidance of a physical therapist or other healthcare professional, to ensure that they are performed correctly and to avoid further injury.

Prevention

• Maintain good posture: Keeping your shoulders back and down will help to reduce the stress on your rotator cuff tendons and decrease the risk of impingement.
• Strengthen the rotator cuff muscles: Performing exercises that target these muscles can help to improve their strength and stability, which in turn can help to prevent impingement.
Avoid repetitive overhead motions: Repetitive motions like throwing a ball or lifting weights over your head can put stress on the rotator cuff tendons and increase the risk of impingement.
• Take breaks when doing repetitive tasks: If you do a lot of overhead work or other repetitive tasks, take regular breaks to give your shoulders a rest.
• Use proper technique when lifting: Using proper form when lifting can help to reduce the stress on your shoulder and decrease the risk of impingement.
• Maintain a healthy weight: Being overweight can put extra stress on your shoulders and increase the risk of impingement.
• Avoid smoking: Smoking is associated with increased risk of impingement due to the decreased blood flow and oxygenation in the shoulder.
• Control chronic conditions: If you have a chronic condition such as diabetes, it’s important to control it to avoid the risk of impingement.
• Wear the right equipment: If you play sports or engage in other activities that put your shoulders at risk, wear the appropriate protective gear to help prevent injury.
• Listen to your body: if you experience pain or discomfort in your shoulder, it’s important to seek medical attention, rest the shoulder and avoid activities that exacerbate the pain.

If you are suffering from any shoulder pain or discomfort, our physiotherapists and exercise professionals are happy to help. You can contact by dropping us an email at info@livewellhealth.co.uk or phone us on 0330 043 2501

Glenohumeral Joint Instability

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Overview

The glenohumeral joint (GH) is a ball and socket joint that includes a complex, dynamic, articulation between the proximal humerus (“ball”) and the glenoid (“socket”) of the scapula. The static and dynamic stabilizing structures allow for extreme range of motion in multiple planes, that predisposes the joint to instability events. Shoulder instability often occurs when the capsule (lining of the shoulder joint), ligaments, or labrum becomes stretched, torn, or detached from the glenoid, commonly after shoulder trauma or repetitive motion. A genetic condition can also cause looseness and weakness in the joint. Exercise programs that aim to strengthen the rotator cuff and scapular muscles are often the primary treatment for instability, where full range of motion usually returns after 6-8 weeks.[/fusion_text][/fusion_builder_column][fusion_builder_column type=”1_2″ type=”1_2″ layout=”1_2″ spacing=”” center_content=”no” link=”” target=”_self” min_height=”” hide_on_mobile=”small-visibility,medium-visibility,large-visibility” class=”” id=”” hover_type=”none” border_color=”” border_style=”solid” border_position=”all” box_shadow=”no” box_shadow_blur=”0″ box_shadow_spread=”0″ box_shadow_color=”” box_shadow_style=”” background_type=”single” gradient_start_position=”0″ gradient_end_position=”100″ gradient_type=”linear” radial_direction=”center center” linear_angle=”180″ background_color=”” background_image=”” background_image_id=”” background_position=”left top” background_repeat=”no-repeat” background_blend_mode=”none” animation_type=”” animation_direction=”left” animation_speed=”0.3″ animation_offset=”” filter_type=”regular” filter_hue=”0″ filter_saturation=”100″ filter_brightness=”100″ filter_contrast=”100″ filter_invert=”0″ filter_sepia=”0″ filter_opacity=”100″ filter_blur=”0″ filter_hue_hover=”0″ filter_saturation_hover=”100″ filter_brightness_hover=”100″ filter_contrast_hover=”100″ filter_invert_hover=”0″ filter_sepia_hover=”0″ filter_opacity_hover=”100″ filter_blur_hover=”0″ first=”true” last=”false” padding_left=”” border_sizes_top=”0px” border_sizes_bottom=”0px” border_sizes_left=”0px” border_sizes_right=”0px” spacing_right=””][fusion_text columns=”” column_min_width=”” column_spacing=”” rule_style=”default” rule_size=”” rule_color=”” animation_type=”” animation_direction=”left” animation_speed=”0.3″ animation_offset=”” hide_on_mobile=”small-visibility,medium-visibility,large-visibility” class=”” id=””]

Anatomy

Structurally a ball and socket joint, that involves the humeral head with the glenoid cavity of the scapula, and it represents the major articulation of the shoulder girdle. The joint capsule and ligaments provide a passive restraint to keep the humeral head compressed against the glenoid. As one of the most mobile joints, the GH joint has stabilising elements, that are divided into static (capsule-labro-ligamentous complex) and active (rotator cuffs and bicep tendons). [/fusion_text][/fusion_builder_column][fusion_builder_column type=”1_2″ type=”1_2″ layout=”1_2″ spacing=”” center_content=”yes” link=”” target=”_self” min_height=”” hide_on_mobile=”small-visibility,medium-visibility,large-visibility” class=”” id=”” hover_type=”none” border_color=”” border_style=”solid” border_position=”all” box_shadow=”no” box_shadow_blur=”0″ box_shadow_spread=”0″ box_shadow_color=”” box_shadow_style=”” background_type=”single” gradient_start_position=”0″ gradient_end_position=”100″ gradient_type=”linear” radial_direction=”center center” linear_angle=”180″ background_color=”” background_image=”” background_image_id=”” background_position=”left top” background_repeat=”no-repeat” background_blend_mode=”none” animation_type=”” animation_direction=”left” animation_speed=”0.3″ animation_offset=”” filter_type=”regular” filter_hue=”0″ filter_saturation=”100″ filter_brightness=”100″ filter_contrast=”100″ filter_invert=”0″ filter_sepia=”0″ filter_opacity=”100″ filter_blur=”0″ filter_hue_hover=”0″ filter_saturation_hover=”100″ filter_brightness_hover=”100″ filter_contrast_hover=”100″ filter_invert_hover=”0″ filter_sepia_hover=”0″ filter_opacity_hover=”100″ filter_blur_hover=”0″ first=”false” last=”true” padding_bottom=”0px” margin_bottom=”0px” padding_left=”0px” element_content=”” align_content=”center” border_sizes_top=”0px” border_sizes_bottom=”0px” border_sizes_left=”0px” border_sizes_right=”0px”][fusion_imageframe image_id=”8169|full” max_width=”400PX” style_type=”” blur=”” stylecolor=”” hover_type=”none” bordersize=”” bordercolor=”” borderradius=”” align=”center” lightbox=”no” gallery_id=”” lightbox_image=”” lightbox_image_id=”” alt=”Glenohumeral Joint Instability” link=”” linktarget=”_self” animation_type=”” animation_direction=”left” animation_speed=”0.3″ animation_offset=”” hide_on_mobile=”small-visibility,medium-visibility,large-visibility” class=”” id=”” filter_hue=”0″ filter_saturation=”100″ filter_brightness=”100″ filter_contrast=”100″ filter_invert=”0″ filter_sepia=”0″ filter_opacity=”100″ filter_blur=”0″ filter_hue_hover=”0″ filter_saturation_hover=”100″ filter_brightness_hover=”100″ filter_contrast_hover=”100″ filter_invert_hover=”0″ filter_sepia_hover=”0″ filter_opacity_hover=”100″ filter_blur_hover=”0″]https://store.livewellhealth.co.uk/wp-content/uploads/2023/04/Glenohumeral-Joint-Instability.jpg[/fusion_imageframe][/fusion_builder_column][fusion_builder_column type=”1_1″ type=”1_1″ layout=”1_1″ spacing=”” center_content=”no” link=”” target=”_self” min_height=”” hide_on_mobile=”small-visibility,medium-visibility,large-visibility” class=”” id=”” hover_type=”none” border_color=”” border_style=”solid” border_position=”all” box_shadow=”no” box_shadow_blur=”0″ box_shadow_spread=”0″ box_shadow_color=”” box_shadow_style=”” background_type=”single” gradient_start_position=”0″ gradient_end_position=”100″ gradient_type=”linear” radial_direction=”center center” linear_angle=”180″ background_color=”” background_image=”” background_image_id=”” background_position=”left top” background_repeat=”no-repeat” background_blend_mode=”none” animation_type=”” animation_direction=”left” animation_speed=”0.3″ animation_offset=”” filter_type=”regular” filter_hue=”0″ filter_saturation=”100″ filter_brightness=”100″ filter_contrast=”100″ filter_invert=”0″ filter_sepia=”0″ filter_opacity=”100″ filter_blur=”0″ filter_hue_hover=”0″ filter_saturation_hover=”100″ filter_brightness_hover=”100″ filter_contrast_hover=”100″ filter_invert_hover=”0″ filter_sepia_hover=”0″ filter_opacity_hover=”100″ filter_blur_hover=”0″ first=”true” last=”true” element_content=”” padding_top=”1%” padding_right=”2″ padding_bottom=”” padding_left=”” border_sizes_top=”0px” border_sizes_bottom=”0px” border_sizes_left=”0px” border_sizes_right=”0px”][fusion_text columns=”” column_min_width=”” column_spacing=”” rule_style=”default” rule_size=”” rule_color=”” animation_type=”” animation_direction=”left” animation_speed=”0.3″ animation_offset=”” hide_on_mobile=”small-visibility,medium-visibility,large-visibility” class=”” id=””]

Symptoms

The symptoms of Glenohumeral Joint Instability include but may not be limited to:

  • Pain, tenderness, swelling, and/or bruising.
  • A loose feeling, or hearing a “pop” in the shoulder joint.
  • Repeated shoulder dislocation.
  • Tingling or burning sensation in the lower arm and hand.
  • Localised numbness of the skin overlying the deltoid muscle.
  • Decreased range of arm/shoulder motion.

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Causes

Glenohumeral joint instability can occur following a traumatic accident such as a fall or collision. It can also occur without significant trauma or injury, which is often genetic from those with hypermobility or connective tissue problems, or from a development of laxity in tissues of the shoulder joint. Other causes can be from repetitive motions, particularly from throwing sports, causing the shoulder to stretch over time, where normal muscle control is lost.[/fusion_text][/fusion_builder_column][fusion_builder_column type=”1_1″ type=”1_1″ layout=”1_1″ spacing=”” center_content=”no” link=”” target=”_self” min_height=”” hide_on_mobile=”small-visibility,medium-visibility,large-visibility” class=”” id=”” hover_type=”none” border_color=”” border_style=”solid” border_position=”all” box_shadow=”no” box_shadow_blur=”0″ box_shadow_spread=”0″ box_shadow_color=”” box_shadow_style=”” background_type=”single” gradient_start_position=”0″ gradient_end_position=”100″ gradient_type=”linear” radial_direction=”center center” linear_angle=”180″ background_color=”” background_image=”” background_image_id=”” background_position=”left top” background_repeat=”no-repeat” background_blend_mode=”none” animation_type=”” animation_direction=”left” animation_speed=”0.3″ animation_offset=”” filter_type=”regular” filter_hue=”0″ filter_saturation=”100″ filter_brightness=”100″ filter_contrast=”100″ filter_invert=”0″ filter_sepia=”0″ filter_opacity=”100″ filter_blur=”0″ filter_hue_hover=”0″ filter_saturation_hover=”100″ filter_brightness_hover=”100″ filter_contrast_hover=”100″ filter_invert_hover=”0″ filter_sepia_hover=”0″ filter_opacity_hover=”100″ filter_blur_hover=”0″ first=”true” last=”true” border_sizes_top=”0px” border_sizes_bottom=”0px” border_sizes_left=”0px” border_sizes_right=”0px”][fusion_text columns=”” column_min_width=”” column_spacing=”” rule_style=”default” rule_size=”” rule_color=”” animation_type=”” animation_direction=”left” animation_speed=”0.3″ animation_offset=”” hide_on_mobile=”small-visibility,medium-visibility,large-visibility” class=”” id=””]

Diagnosis

A physical examination can confirm the impression obtained from the history and help to determine if the shoulder is loose or unstable. Radiographs or imaging, such as X-rays, MRI, or a CT scan can help to provide confirmation of traumatic glenohumeral instability present from the damaged bones, cartilage, and rotator cuff. Mobility may be restricted for two weeks, followed by physical therapy to strengthen the muscles that stabilises the shoulder.

Classifications

Polar Type I (structural instability) – typically present with a positive apprehension (anterior direction) associated with rotator cuff weakness. Posture, single leg balance, and scapula control are often disturbed. Can begin to exhibit signs of poor scapula control, abnormal muscle activation, and altered trunk stability and balance, when moving towards type II and III poles.

Polar Type II – (atraumatic instability) – present with positive anterior apprehension test, with increased laxity and excessive external rotations, and muscular balance

Polar Type III – (neurological dysfunctional or muscle patterning) – shows abnormal activation of large muscles and suppression of the rotator cuff. Mostly occurs with a history of easy shoulder dislocation.

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Treatment

Treatment usually begins with physical therapy, designed to strengthen the shoulder, and maintain the joint in position.

Restricting activity that includes overhead motion may be advised to reduce symptoms. Full range of motion usually returns after 6-8 weeks.

If less invasive treatments don’t work, and in severe instances, open surgery is often necessary, where an incision is made over the shoulder and the muscles are moved to access the joint capsule, ligaments, and labrum. After surgery, full recovery often takes 4-6 months, and in some cases up to 12 months. At this stage some deep tissue massage and scar tissue work may be necesary!

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Exercises

  • Shoulder flexion (lying down)
  • Shoulder blade squeeze
  • Resisted rows
  • Internal rotator strengthening exercise
  • External rotator strengthening exercise (with arm abducted 90°)
  • Standing row (with resistance band)

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Prevention

Glenohumeral Joint Instability (GJI) is a condition that occurs when the ball and socket joint of the shoulder become dislocated or partially dislocated due to trauma or other underlying conditions. GJI can result in pain, weakness, and limited range of motion, making it difficult for people to perform their daily activities. In severe cases, surgery may be required to treat the condition. However, prevention is always better than cure, and there are several steps that individuals can take to prevent GJI.

Strengthen the Rotator Cuff Muscles:
The rotator cuff muscles are a group of muscles that attach the shoulder blade to the humerus bone and help stabilize the shoulder joint. Strengthening these muscles can help prevent GJI. Exercises that target the rotator cuff muscles include external and internal rotation exercises, scapular stabilization exercises, and shoulder blade squeezes.

Improve Shoulder Mobility:
Limited shoulder mobility can lead to increased stress on the shoulder joint, which can increase the risk of GJI. Stretching exercises that target the shoulder joint, such as shoulder circles and shoulder flexion stretches, can help improve shoulder mobility and prevent GJI.

Maintain Good Posture:
Poor posture can contribute to shoulder instability and increase the risk of GJI. Individuals should aim to maintain good posture by keeping their shoulders back and down and their chest open. Practicing good posture can help improve shoulder alignment and stability.

Avoid Overuse Injuries:
Overuse injuries can cause wear and tear on the shoulder joint, leading to increased instability and a higher risk of GJI. To avoid overuse injuries, individuals should practice proper form and technique when performing exercises and avoid repetitive overhead movements.

Wear Proper Protective Gear:
Individuals who participate in contact sports or activities that involve the risk of shoulder injuries should wear proper protective gear, such as shoulder pads or braces. Protective gear can help absorb the impact of a fall or collision, reducing the risk of GJI.

In conclusion, preventing GJI requires a combination of strengthening exercises, stretching, good posture, injury prevention strategies, and protective gear. By following these steps, individuals can help reduce the risk of GJI and maintain a healthy and stable shoulder joint. It is important to consult with a healthcare professional before starting any new exercise program or if experiencing any shoulder pain or discomfort. If you are unsure what to do, please contact us and one of our Personal Trainers or Sports Therapists can help.

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AC Joint Inury

Posted on

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Overview

The AC (acromioclavicular) joint is where the shoulder blade (scapula) meets the collarbone (clavicle). The highest point of the shoulder blade is called the acromion. Strong tissues called ligaments connect the acromion to the collarbone, forming the AC joint.

Most AC Joint injuries are treated conservatively using various combinations of strengthening exercises, following the immobilisation phase, once pain permits. Surgery is usually reserved for cases where there is a complete dislocation of the AC Joint (Grade 3), or in cases where a less severe injury fails to respond adequately to conservative treatment.

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Anatomy

The Acromioclavicular Joint, or AC Joint, is one of four joints that comprises the Shoulder complex. The AC Joint is formed by the junction of the lateral clavicle and the acromion process of the scapula and is a gliding, or plane style synovial joint. The AC Joint attaches the scapula to the clavicle and serves as the main articulation that suspends the upper extremity from the trunk.

The primary function of the AC Joint is:

To allow the scapula additional range of rotation on the thorax.

Allow for adjustments of the scapula (tipping and internal/external rotation) outside the initial plane of the scapula in order to follow the changing shape of the thorax as arm movement occurs.

The joint allows transmission of forces from the upper extremity to the clavicle.

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Symptoms

  • Pain at the end of the collar bone.
  • Pain may feel widespread throughout the shoulder until the initial pain resolves; following this, it is more likely to be a very specific site of pain over the joint itself.
  • Swelling often occurs.
  • Depending on the extent of the injury, a step-deformity may be visible. This is an obvious lump where the joint has been disrupted and is visible on more severe injuries.
  • Pain on moving the shoulder, especially when trying to raise the arms above shoulder height.

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Causes

An AC Joint injury often occurs as a result of a direct blow to the tip of the shoulder from, for example, an awkward fall, or impact with another person. This forces the Acromion Process downward, beneath the clavicle. Alternately, an AC Joint injury may result from an upward force to the long axis of the humerus (upper arm bone) such as a fall which directly impacts on the wrist of a straightened arm. Most typically, the shoulder is in an adducted (close to the body) and flexed (bent) position.[/fusion_text][/fusion_builder_column][fusion_builder_column type=”1_1″ type=”1_1″ layout=”1_1″ spacing=”” center_content=”no” link=”” target=”_self” min_height=”” hide_on_mobile=”small-visibility,medium-visibility,large-visibility” class=”” id=”” hover_type=”none” border_color=”” border_style=”solid” border_position=”all” box_shadow=”no” box_shadow_blur=”0″ box_shadow_spread=”0″ box_shadow_color=”” box_shadow_style=”” background_type=”single” gradient_start_position=”0″ gradient_end_position=”100″ gradient_type=”linear” radial_direction=”center center” linear_angle=”180″ background_color=”” background_image=”” background_image_id=”” background_position=”left top” background_repeat=”no-repeat” background_blend_mode=”none” animation_type=”” animation_direction=”left” animation_speed=”0.3″ animation_offset=”” filter_type=”regular” filter_hue=”0″ filter_saturation=”100″ filter_brightness=”100″ filter_contrast=”100″ filter_invert=”0″ filter_sepia=”0″ filter_opacity=”100″ filter_blur=”0″ filter_hue_hover=”0″ filter_saturation_hover=”100″ filter_brightness_hover=”100″ filter_contrast_hover=”100″ filter_invert_hover=”0″ filter_sepia_hover=”0″ filter_opacity_hover=”100″ filter_blur_hover=”0″ first=”true” last=”true” border_sizes_top=”0″ border_sizes_bottom=”0″ border_sizes_left=”0″ border_sizes_right=”0″][fusion_text columns=”” column_min_width=”” column_spacing=”” rule_style=”default” rule_size=”” rule_color=”” animation_type=”” animation_direction=”left” animation_speed=”0.3″ animation_offset=”” hide_on_mobile=”small-visibility,medium-visibility,large-visibility” class=”” id=””]

Diagnosis

Firstly, for the diagnosis of scapula winging your doctor will look at the shoulder blades for any clear obvious signs of winging. Some patient’s scapula bone may be more visible than others and have distinct scapula winging. The doctor may also ask you to perform arm/ shoulder movements to examine the range of movement and stability at the joint.

One of the main tests that are used to aid in the diagnosis of scapula winging is the serratus anterior test. This is where the patient is asked to face a wall, standing about two feet from the wall and then push against the wall with flat palms at waist level. This test is carried out to identify if any damage is done to the thoracic nerve causing the scapula to wing.[/fusion_text][/fusion_builder_column][fusion_builder_column type=”1_1″ type=”1_1″ layout=”1_1″ spacing=”” center_content=”no” link=”” target=”_self” min_height=”” hide_on_mobile=”small-visibility,medium-visibility,large-visibility” class=”” id=”” hover_type=”none” border_color=”” border_style=”solid” border_position=”all” box_shadow=”no” box_shadow_blur=”0″ box_shadow_spread=”0″ box_shadow_color=”” box_shadow_style=”” background_type=”single” gradient_start_position=”0″ gradient_end_position=”100″ gradient_type=”linear” radial_direction=”center center” linear_angle=”180″ background_color=”” background_image=”” background_image_id=”” background_position=”left top” background_repeat=”no-repeat” background_blend_mode=”none” animation_type=”” animation_direction=”left” animation_speed=”0.3″ animation_offset=”” filter_type=”regular” filter_hue=”0″ filter_saturation=”100″ filter_brightness=”100″ filter_contrast=”100″ filter_invert=”0″ filter_sepia=”0″ filter_opacity=”100″ filter_blur=”0″ filter_hue_hover=”0″ filter_saturation_hover=”100″ filter_brightness_hover=”100″ filter_contrast_hover=”100″ filter_invert_hover=”0″ filter_sepia_hover=”0″ filter_opacity_hover=”100″ filter_blur_hover=”0″ first=”true” last=”true” border_sizes_top=”0″ border_sizes_bottom=”0″ border_sizes_left=”0″ border_sizes_right=”0″][fusion_text columns=”” column_min_width=”” column_spacing=”” rule_style=”default” rule_size=”” rule_color=”” animation_type=”” animation_direction=”left” animation_speed=”0.3″ animation_offset=”” hide_on_mobile=”small-visibility,medium-visibility,large-visibility” class=”” id=””]

Treatment

The traditional literature supports non-operative treatment for grade I and II injuries. Patients with grade IV, V and VI injuries benefit from operative treatment, whereas the treatment of grade III injuries remains a controversial issue. 22 Numerous surgical procedures have been described, though there is currently no gold standard for the treatment of AC injuries. The main principle of surgical therapy is accurate reduction of the AC joint in both coronal and sagittal planes. This is achieved either by primary repair or by reconstruction of injured ligaments and maintaining stability to protect this repair or reconstruction. The traditional Weaver-Dunn CA ligament transfer procedure has largely fallen into disfavour today. If the AC joint injury presents within six weeks, it is considered acute. The main goal of treatment is acromioclavicular joint stabilization. Following techniques are used for stabilization and reduction of AC join[/fusion_text][/fusion_builder_column][fusion_builder_column type=”1_2″ type=”1_2″ layout=”1_2″ spacing=”” center_content=”no” link=”” target=”_self” min_height=”” hide_on_mobile=”small-visibility,medium-visibility,large-visibility” class=”” id=”” hover_type=”none” border_color=”” border_style=”solid” border_position=”all” box_shadow=”no” box_shadow_blur=”0″ box_shadow_spread=”0″ box_shadow_color=”” box_shadow_style=”” background_type=”single” gradient_start_position=”0″ gradient_end_position=”100″ gradient_type=”linear” radial_direction=”center center” linear_angle=”180″ background_color=”” background_image=”” background_image_id=”” background_position=”left top” background_repeat=”no-repeat” background_blend_mode=”none” animation_type=”” animation_direction=”left” animation_speed=”0.3″ animation_offset=”” filter_type=”regular” filter_hue=”0″ filter_saturation=”100″ filter_brightness=”100″ filter_contrast=”100″ filter_invert=”0″ filter_sepia=”0″ filter_opacity=”100″ filter_blur=”0″ filter_hue_hover=”0″ filter_saturation_hover=”100″ filter_brightness_hover=”100″ filter_contrast_hover=”100″ filter_invert_hover=”0″ filter_sepia_hover=”0″ filter_opacity_hover=”100″ filter_blur_hover=”0″ first=”true” last=”false” border_sizes_top=”0″ border_sizes_bottom=”0″ border_sizes_left=”0″ border_sizes_right=”0″ spacing_right=””][fusion_text columns=”” column_min_width=”” column_spacing=”” rule_style=”default” rule_size=”” rule_color=”” animation_type=”” animation_direction=”left” animation_speed=”0.3″ animation_offset=”” hide_on_mobile=”small-visibility,medium-visibility,large-visibility” class=”” id=””]

Exercises

  • Initially, complete rest, immobilization and regular application of ice or cold therapy are important to reduce pain and inflammation.
  • Mobility exercises can begin only once shoulder movement is pain-free. This will normally be 7-14 days for grades 1 and 2 sprains.
  • Grade 3 injuries are more frequently treated conservatively, without surgery, but will require an even longer rest/healing period.
  • If the shoulder has been immobilized for a period of time, then it may have lost mobility or range of motion.
  • Pendulum exercises can begin as soon as the ligament has healed, and pain allows. Gently swing the arm forwards, backward, and sideways whilst lying on your front or bent over as seen opposite.
  • Gradually increase the range of motion. Repeat this with your arm swinging from side to side as well. Aim to reach 90 degrees of motion in any direction.
  • Front shoulder stretch
  • External rotation stretch
  • Isometric exercises – Strengthening should initially be isometric. This means contracting the muscles without movement.
  • Resistance band exercises for AC joint sprain:
  • Internal Rotation
  • External Rotation
  • Abduction/lateral raise

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Prevention

  • Wearing protective strapping to support a previously injured AC Joint, particularly in contact sports or sports where full elevation of the arm is not so important. Protective padding is also used in sports such as rugby.
  • Warming up, stretching and cooling down.
  • Participating in fitness programs to develop strength, balance, coordination and flexibility.
  • Undertaking training prior to competition to ensure readiness to play.
  • Gradually increasing the intensity and duration of training.
  • Allowing adequate recovery time between workouts or training sessions.

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Frozen Shoulder

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Overview

Frozen shoulder (also known as adhesive capsulitis or periarthritis) is used to describe the condition where the glenohumeral joint of the shoulder is stiff and painful. It occurs in about 2-5% of the general population, with a higher prevalence among elderly individuals and those with diabetes. Frozen shoulder is a benign and self limiting condition, usually lasting for 1-3 years, in 20-50% of patients the stiffness and pain only partially resolve, which leads to long lasting effects of shoulder mobility impairment and reduction in sleep quality. Commonly patients who suffer persistent symptoms (over 4-5 years) only suffer mild long term effects.

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Anatomy

The hallmark pain and stiffness are caused by the formation of adhesions or scar tissue in the glenohumeral (GH) joint. The GH joint is a ball and socket joint between the scapula and humerus, connecting the upper arm to the trunk. Under normal conditions this joint is one of the most mobile in the human body, allowing for a large range of motion in multiple planes. In the case of frozen shoulder the adhesions limit this range of motion and make movement painful.[/fusion_text][/fusion_builder_column][fusion_builder_column type=”1_2″ type=”1_2″ layout=”1_2″ spacing=”” center_content=”yes” link=”” target=”_self” min_height=”” hide_on_mobile=”small-visibility,medium-visibility,large-visibility” class=”” id=”” hover_type=”none” border_color=”” border_style=”solid” border_position=”all” box_shadow=”no” box_shadow_blur=”0″ box_shadow_spread=”0″ box_shadow_color=”” box_shadow_style=”” background_type=”single” gradient_start_position=”0″ gradient_end_position=”100″ gradient_type=”linear” radial_direction=”center center” linear_angle=”180″ background_color=”” background_image=”” background_image_id=”” background_position=”left top” background_repeat=”no-repeat” background_blend_mode=”none” animation_type=”” animation_direction=”left” animation_speed=”0.3″ animation_offset=”” filter_type=”regular” filter_hue=”0″ filter_saturation=”100″ filter_brightness=”100″ filter_contrast=”100″ filter_invert=”0″ filter_sepia=”0″ filter_opacity=”100″ filter_blur=”0″ filter_hue_hover=”0″ filter_saturation_hover=”100″ filter_brightness_hover=”100″ filter_contrast_hover=”100″ filter_invert_hover=”0″ filter_sepia_hover=”0″ filter_opacity_hover=”100″ filter_blur_hover=”0″ first=”false” last=”true” padding_bottom=”0px” margin_bottom=”0px” padding_left=”0px” element_content=”” align_content=”center” border_sizes_top=”0px” border_sizes_bottom=”0px” border_sizes_left=”0px” border_sizes_right=”0px” padding_top=”46px”][fusion_imageframe image_id=”5466|full” max_width=”” style_type=”” blur=”” stylecolor=”” hover_type=”none” bordersize=”” bordercolor=”” borderradius=”” align=”center” lightbox=”no” gallery_id=”” lightbox_image=”” lightbox_image_id=”” alt=”” link=”” linktarget=”_self” animation_type=”” animation_direction=”left” animation_speed=”0.3″ animation_offset=”” hide_on_mobile=”small-visibility,medium-visibility,large-visibility” class=”” id=”” filter_hue=”0″ filter_saturation=”100″ filter_brightness=”100″ filter_contrast=”100″ filter_invert=”0″ filter_sepia=”0″ filter_opacity=”100″ filter_blur=”0″ filter_hue_hover=”0″ filter_saturation_hover=”100″ filter_brightness_hover=”100″ filter_contrast_hover=”100″ filter_invert_hover=”0″ filter_sepia_hover=”0″ filter_opacity_hover=”100″ filter_blur_hover=”0″]https://store.livewellhealth.co.uk/wp-content/uploads/2021/05/compr_a00071f02-normal-capsule-frozen-shoulder-kh-3.jpg[/fusion_imageframe][/fusion_builder_column][fusion_builder_column type=”1_1″ type=”1_1″ layout=”1_1″ spacing=”” center_content=”no” link=”” target=”_self” min_height=”” hide_on_mobile=”small-visibility,medium-visibility,large-visibility” class=”” id=”” hover_type=”none” border_color=”” border_style=”solid” border_position=”all” box_shadow=”no” box_shadow_blur=”0″ box_shadow_spread=”0″ box_shadow_color=”” box_shadow_style=”” background_type=”single” gradient_start_position=”0″ gradient_end_position=”100″ gradient_type=”linear” radial_direction=”center center” linear_angle=”180″ background_color=”” background_image=”” background_image_id=”” background_position=”left top” background_repeat=”no-repeat” background_blend_mode=”none” animation_type=”” animation_direction=”left” animation_speed=”0.3″ animation_offset=”” filter_type=”regular” filter_hue=”0″ filter_saturation=”100″ filter_brightness=”100″ filter_contrast=”100″ filter_invert=”0″ filter_sepia=”0″ filter_opacity=”100″ filter_blur=”0″ filter_hue_hover=”0″ filter_saturation_hover=”100″ filter_brightness_hover=”100″ filter_contrast_hover=”100″ filter_invert_hover=”0″ filter_sepia_hover=”0″ filter_opacity_hover=”100″ filter_blur_hover=”0″ first=”true” last=”true” element_content=”” padding_top=”1%” padding_right=”2″ padding_bottom=”” padding_left=”” border_sizes_top=”0px” border_sizes_bottom=”0px” border_sizes_left=”0px” border_sizes_right=”0px”][fusion_text columns=”” column_min_width=”” column_spacing=”” rule_style=”default” rule_size=”” rule_color=”” animation_type=”” animation_direction=”left” animation_speed=”0.3″ animation_offset=”” hide_on_mobile=”small-visibility,medium-visibility,large-visibility” class=”” id=””]

Symptoms

There are 4 recognised clinical stages of the condition:

  1. Painful stage- moderate pain and reduction of movement lasting less than 3 months
  2. Freezing stage- severe pain and reduction of movement lasting 3-9 months 
  3. Frozen stage- pain may be present but stiffness predominates lasting 10-14 months 
  4. Thawing stage- minimal pain and gradual improvement in movement lasting 14-24 months

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Causes

The cause of frozen shoulder is still unclear. Historically researchers into the aetiology of the condition have shown that it is characterised by a thickened, tight capsule with chronic inflammatory cells and fibroblasts found in the joint capsule. It can occur as a primary idiopathic condition or secondary to medical conditions or trauma.

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Diagnosis

Frozen shoulder is diagnosed by testing positive to three characteristics:

  1. Insidious onset of severe pain over a period of months, night time pain is a common feature 
  2. Shoulder stiffness with markedly reduced external rotation 
  3. Negative radiographic findings

Some patients describe the pain as a deep ache, poorly localised and non specific without any point of tenderness. In others it presents as a pain which refers to the deltoid origin and radiates down to the bicep area. Manual testing will often return normal rotator cuff strength but a greatly reduced passive and active range of motion. 

In some cases laboratory tests may be carried out to identify or rule out underlying conditions. Radiographs of the shoulder will also return normal with a patient suffering from frozen shoulder, but may be carried out to exclude conditions such as shoulder dislocation, GH arthritis or calcific tendinopathy.

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Treatment

There is no universally accepted intervention which is viewed as the most effective treatment for restoring motion and reducing pain. 

Non-surgical or conservative management is preferred with most patients improving in 6-18 months. This includes analgesics, oral steroids, physical therapies and supra-scapula nerve block. Physical therapy, from a sports massage and remedial therapist or physiotherapist, has traditionally been the first choice of treatment for frozen shoulder. The therapist can work to reduce pain, mobilise the joint and provide the patient with a supervised  stretching and strength maintenance programme.

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Exercises

Exercises should be carried out under the direction of a qualified therapist and vary according to the stage of the condition. 

  1. Early freezing stage: gentle and short duration stretches e.g. pendulum exercises, passive external rotation and supine passive forward elevation
  2. Later frozen stage: strengthening exercises e.g. isometric external shoulder rotation and posterior capsular stretching 
  3. Thawing stage: combined strength in and stretching exercises with increased frequency 

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Prevention

As the aetiology of the condition is still unknown advising on how to prevent an incidence of the condition is difficult. Research has suggested that prolonged immobilisation or limited use of the shoulder joint may contribute to the likelihood of developing frozen shoulder. With this in mind regular balanced exercise and stretching can help to maintain the structural support and mobility of the GH joint.

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Rotator Cuff Strain

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Overview

In the rotator cuff region there are four muscles, tendons and ligaments, surrounding the shoulder which provide added stability to the shoulder joint. This structure helps to keep the bone securely placed into the socket. Injury to the rotator cuffs can cause an ache like pain in the shoulder. This may lead to a feeling of muscle weakness and inability to lift the shoulder above the head. 

Rotator cuff injuries are most commonly presented in people regularly exposed to overhead movements, such as painters, carpenters and builders. Individuals who suffer from this injury can usually manage their symptoms, through sports massage and specific exercises focusing on the rotator cuff muscle region. However, if not treated correctly, further injury to the area may occur such as a complete tear, which may result in surgery.

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Anatomy

The rotator cuffs are made up by four muscles, these are the supraspinatus, infraspinatus, teres minor and subscapularis. These muscles aid in keeping the upper arm and shoulder into the socket with stability. They also each allow specific movements at the shoulder joint. The group of four muscles all originate within the shoulder blade, but all insert into different portions of the upper arm bone. 

Supraspinatus: This muscle originates at the supraspinous fossa; the muscle belly passes laterally over the acromion process and inserts into the greater tubercle of the humerus bone. This muscle allows the first 15 degree’s movement of abduction, after this the deltoid and trapezius muscles will then allow further motion. 

Infraspinatus: The origin of the infraspinatus is the infraspinatus fossa, and the insertion is also the greater tubercle of the humerus. The motion created by this muscle is lateral rotation of the shoulder, moving the arm away from the centreline of the body. 

Teres Minor: A small narrow muscle on the back of the shoulder blade which sits underneath the infraspinatus. The origin is the lateral boarder of the scapula. This muscle contributes to external rotation of the arm of the body. 

Subscapularis: This rotator cuff is the strongest and largest out of the three listed above. This muscle originates at the subscapularis fossa and inserts into the lesser tubercle of the humerus. The subscapularis allows greater motion at the shoulder and mainly aids in allowing medial rotation of the arm. 

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Symptoms

Common symptoms of possible rotator cuff strain include:

  • Dull ache 
  • Difficulty lifting arm over head 
  • Weakness around the shoulder
  • Disturbed sleep
  • The constant need to use self-myofascial techniques 

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Causes

There are a few common risk factors of why rotator strain may occur:

  1. Family History: There may be family history of rotator cuff injuries which may make certain family members more prone to having the injury than others. 
  2. The type of job you do: Individuals who work in construction or manual labour who have repetitive overhead movement of the shoulder could damage the rotator cuff overtime. 
  3. Age: As you get older joints and muscles become weaker, meaning you may be more prone to injury overtime. 

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Diagnosis

To diagnose a rotator cuff strain a physical examination will be carried out by a doctor or a physiotherapist. Firstly, they may ask about your day-to-day activities which may determine the seriousness of the injury. The doctor will test the range of movement at the shoulder by getting you to perform movements such as flexion, extension, abduction, adduction and medial and lateral rotation. This will allow the doctor to determine if it is actually rotator cuff strain or whether it may be other conditions such as impingement or tendinitis. 

Imaging scans such as X-Ray’s may also be used to see if there is any abnormal bone growth within the joint, which may be causing the pain. 

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Treatment

Treatments for rotator cuff injuries can be non-surgical or surgical. Tendinitis may occur over time from the repetitive strain placed around the joint, so it is important to treat the affected area. 

  • Apply a cold compress/ ice to the effected area to reduce swelling
  • Heat packs can be used to reduce swelling 
  • Resting the affected area 
  • Inflammatory medication such as ibuprofen and naproxen 
  • Reduce the amount of repetitive movement to the joint
  • Don’t lift the arm overhead

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Exercises

  • Doorway Stretch 
  • External rotation with weight
  • High to low rows with resistance band 
  • Reverse fly’s 
  • Lawn mower pull with resistance band 
  • Isometric internal rotation 
  • Isometric external rotation

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