Common Shoulder Conditions (Page still being created)
After having experienced through many clients, the frustration of long term recovery from various shoulder surgeries and how so many could have been avoided through knowledge and remedial exercises, it was high time to share this article in the hope that it prevents suffering. Having said this, people often take self care seriously after itadversly affects their functional ability and/or pain. So please help yourself avoid unnecessary pain and suffering by being assessed and treated by an experienced massage therapist or Physiotherapist to keep your shoulders functional and pain free.
Rotator cuff tears, bursitis and tendinitis of supraspinatus or biceps long head are three common conditions I often treat which can all be caused by similar muscular imbalances resulting in the shoulder not moving correctly and so aggravating these structures, leading to pain and long term damage, if not dealt with.
In short it boils down to the shoulder rolling forward, the scapular not moving correctly or the sub-acromial space (between the outer top edge of the shoulder blade and the head of the humerus or upper arm bone) lessening which leads to tendons or bursa being impinged (squished) and subsequently damaged. A complex joint the shoulder is but there are some causes which are often common to all three conditions.
- Scapular Dyskinesis
- Centering of forces on the Glenohumeral joint.
- Structural changes such as arthritis, ligament lengthening, bony growths.
Scapular Dyskinesis
Shoulder movement comes from 4 joints, one of which is not technically a joint but acts as much (Scapulothoracic joint). These are the:
Glenohumeral (GH) joint (ball and socket joint between the humerus- upper arm - bone and the glenoid fossa
and
the Scapulothoracic (ST) joint which is the movement between the scapular (shoulder blade) and the thoracic ribs
Acromioclavicular & Sternoclavicular Joints, where the Clavicle (collar bone) joins the sternum at one end and the acromion (outer tip of shoulder blade) at the other.
So if you abduct your arm out to the side and continue above your head both the ST & GH need to move in sync in order for this complete range of motion to occur. If the scapula is restricted in range, the humerus (upper arm bone) will reach full range (~90˚ on its own) and press against the acromion (bone above humerus). This can lead to structures being aggravated and lead to pain, damage & inflammation.
Muscles which restrict this free rotation of the scapular, you may well be aware of as painful and tight when massaged. The common 3 are the Rhomboids (between the shoulder blades), Levator scapular, upper trapezius and Pectoralis minor.
The other 2 aspects of shoulder movement once shortened muscles are lengthened are strength and correct movement control. Identifying weak muscles or ones which do not activate well to make a well coordinated movement is essential in completing the rehabilitation of shoulder movement. Exercises can be given to address any dysfunction found.
Centering
Muscular relationships of length and strength which keep the ball and socket (GH Joint) aligned. This is especially important when laxity or damage has occured to the ligaments and or the Rotator cuff tendons. The rotator cuff is 4 tendons (joining muscle to bone) which surround the shoulder joint.
Structural changes
Bursa (fluid filled sacks to cushion moving parts) may become inflamed with increased pain sensitivity and increased space, leaving less space (subacromial) for the other structures to function in.
Bony growths can be another cause of impingement.
Arthritis can be caused by previous injury or chronic misalignment of the joint space, leading to pain and further dysfunction.
Tendon sheaths can become inflamed, causing pain & dysfunction.
Assessment
Both muscular and structural anomalies can be tested to allow a treatment plan to address each part.
Hands on treatment to loosen tight structures or decrease pain to allow for improved movement and function. Exercises to address strength length and correct movement control can then be prescribed to address underlying causes.
I hope through writing this people may have a niggling pain addressed whilst it is a small problem to treat before it slips into a more serious condition, to avoid requiring surgery and lengthy recovery time.