If a shoulder has been sore and you continue to use it, a tendon may tear. A tear may result from a fall, lifting, pulling, pushing, or throwing; however, it is the repetitive nature of all activities that causes most shoulder injuries. The tissues are simply being worn away. It is impossible for muscles or tendons that have scars or tears to function normally.
The shoulder is a ball and socket joint with a large range of movement. Such a mobile joint tends to be more susceptible to injury. Shoulder pain can stem from one or more of the following causes: strains from overexertion; tendonitis from overuse of the shoulder joint, causing instability; dislocation of the collar bone; or upper arm bone fractures; frozen shoulder; and pinched nerves (also called radiculopathy).
® Soreness, pain and achiness in the arm or shoulder
® Pain in the deltoid area of the shoulder (the sleeve area of a short sleeve shirt)
® Trouble lifting the arm over the head
® Trouble bringing the arm behind the back or across to the other shoulder
® Tenderness and swelling of the shoulder
® Pain radiating to the neck and forearm
® Decrease in range of motion and strength
An understanding of how shoulders work is the first step in understanding your shoulder joint pain. The shoulder joint consists of the ends of two (2) or more bones that are connected by thick bands of tissue called ligaments.
® The shoulder blade (scapula)
® The upper arm bone (humerus)
Symptoms of a Rotator Cuff Tear May Include:
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Arm or shoulder soreness
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Trouble lifting the arm over the head
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Shoulder tenderness and swelling
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Pain radiating to the neck and forearm
- Diagnose the injury with a thorough ART® physical exam
- Plan your treatment depending upon severity of the injury
- Recommend that your shoulder be immobilized, but only for a short period of time
- Advise rest and specific exercises for minor tears that may heal on their own
- Advise surgery for serious tears
- Physical or occupational therapy to improve strength and flexibility
- Complete healing may take several months
- Contact your ART doctor if you or a family member have symptoms of a rotator cuff tear
- Contact your ART doctor if there is no improvement or if symptoms worsen despite treatment
- Contact your ART doctor if pain prevents restful sleep.
Adhesive Capsulitis, also known as Frozen Shoulder, is the result of the shrinking and scarring of a previously normal joint. The shoulder joint capsule is a loose bag of tissue that completely surrounds the shoulder joint. This joint capsule is made up of tough ligaments that form a water tight bag. A ligament is a soft tissue connective structure that attaches bones to bones. Inside the bag is a small amount of joint fluid that lubricates the joint surfaces. The joint capsule bag has a considerable amount of slack, loose tissue that allows for unrestricted shoulder movement. The most common locations for Adhesive Capsulitis are the shoulder or hip joints.
Adhesive Capsulitis results in:
® Significant or complete loss of movement
® Pain that can last from months to years
® Altered biomechanics or posture of the entire body
Frozen shoulder can be caused by many situations which include: acute shoulder injury, cumulative trauma to the shoulder, diabetes, thyroid problems, heart. or lung conditions.
One theory is that the condition may be due to an autoimmune reaction in which the body's defense system (which normally protects the body from infection) mistakenly begins to attack parts of the body. The immune system thinks that the tissue it is attacking is foreign material when, in actuality, it is attacking itself. This causes an intense inflammatory reaction in the tissue that is under attack, and it causes the shoulder to "freeze up."
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Diagnose the injury with a thorough physical examination including an Active Release Techniques® (ART®) exam
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Take x-rays and/or for the possiblity of a bone spur
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Order an MRI with contrast to see the integrity of the tissues and to confirm the exact location and extent of a possible tear
What You Can Do:
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Have the injury looked at by someone who knows the shoulder anatomy, understands your injury, and knows how to properly diagnosis it
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Pay close attention to the exact activities or movements that cause pain so you can explain your pain in great detail to the doctor
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Ice the injured area after activity to keep inflammation down
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Drink lots of water and maintain proper nutrition as these are very important to the healing process
Once the tissues are free from scars, get proper physical or occupational therapy in order to improve strength and flexibility
Active Release Techniques® (ART®) has been shown to be very effective in the treatment of Frozen Shoulder. Rather than addressing just one area, ART® restores unimpeded motion and function to all soft tissues in the shoulder's kinetic chain. The treatment plan for frozen shoulder is extensive, often taking a few months, depending upon the severity. With the integration of ART® and proper rehabilitation, the success rate of treatment for frozen shoulder is well over 90%. Every ART® session is actually a combination of examination and treatment. The ART® provider uses his or her hands to evaluate the texture, tension, movement and function of muscles, fascia, tendons, ligaments and nerves. Abnormal tissues are treated by combining precisely directed tension with very specific movements.
- Osteoarthritis (OA) -- Osteoarthritis is sometimes called degenerative arthritis because it is a "wearing out" condition involving the breakdown of cartilage in the joints. When cartilage wears away, the bones rub against each other, causing pain and stiffness. OA usually occurs in people aged 50 years and older and frequently in individuals with a family history of Osteoarthritis.
- Rheumatoid Arthritis (RA) -- Rheumatoid Arthritis produces chemical changes in the joint space that cause the tissue to become thickened and inflamed and the joint fluid (synovial fluid) to destroy the cartilage within the joint. This results in pain and stiffness. RA affects women about 3 times more often than men, and RA may affect multiple organs within the body.
- Post-traumatic Arthritis -- Post-traumatic Arthritis may develop after an injury to the joint if bone and cartilage do not heal properly. Irregularities in the bone and cartilage after injury may lead to wear on the joint surfaces.
Other causes of joint pain include avascular necrosis which can result when bone is deprived of its normal blood supply (for example, after organ transplantation or long-term cortisone treatment). Joint pain may also occur due to deformity or direct injury to the joint. In some cases, joint pain worsens when a person avoids using a painful joint and consequently weakens the muscles and makes the joint even more difficult to move.
LVPRC utilizes ART® protocols, joint manipulation, active therapies, and passive modalities during all phases of healing. Minor tears may heal on their own with rest and specific exercises; however, without proper care (ART®), the injured sight will be permanently weakened and will never function at 100%. Shoulder immobilization may be recommended but only for a very short period of time. Restoring cellular healing and growth as soon as possible is vital to a complete and full recovery. The sooner active ART®care is administered, the better the outcome. However, some serious tears may need surgery.
LVPRC methodology is ART® protocols prior to surgery, if surgery is indeed needed, and immediately after surgery to alleviate the opportunity for frozen shoulder to occur. Once the tissues are free from the fibrous dense scars that have developed over time, the tissues will begin to utilize oxygen better which, in turn, causes the tissues to heal faster. The sooner the tissues can be restored to proper biomechanical function, the better the outcome. Once the tissues are free of scars, then the tissues can be properly rehabilitated. Very structured rehabilitation protocols are given during the appropriate phase of care. Finally, a home training program should be followed, and ART® maintenance visits are recommended to protect the injured area and prevent re-injury.
Complete healing and biomechanical restoration may take several months; however, most treatment plans are eight to ten (8-10) weeks of active therapy.
