Rotator Cuff Syndrome

Rotator Cuff Syndrome

Article by John Miller

Rotator Cuff Syndrome

What is your Rotator Cuff?

Rotator cuff syndrome is a prevalent shoulder injury. Your shoulder joint is a relatively unstable ball and socket joint that is moved and controlled by a small group of four muscles known as the rotator cuff.

As the name suggests, the rotator cuff muscles are responsible for shoulder rotation and form a cuff around the humerus’s head (shoulder ball). The subscapularissupraspinatusinfraspinatus and teres minor are your small rotator cuff muscles. These muscles stabilise and control your shoulder movement on your shoulder blade (scapula).

Rotator Cuff Injury

Your rotator cuff muscles and tendons are vulnerable to rotator cuff tears, tendinopathy, rotator cuff impingement, and related rotator cuff injuries.

Rotator cuff injuries vary from mild tendon inflammation (rotator cuff tendonitis), shoulder bursitis (inflamed bursa) and calcific tendinopathy (bone-forming within the rotator cuff tendon). More significant injuries include partial and full-thickness rotator cuff tears, which may require rotator cuff surgery.

Some shoulder rotator cuff injuries are more common than others.

These include:

Where are your Rotator Cuff Muscles?

Your rotator cuff muscles hold your arm (humerus) onto your shoulder blade (scapula). Most of the rotator cuff tendons hide under the bony point of your shoulder (acromion), which, as well as protecting your rotator cuff, can also impinge on your rotator cuff structures.

What Causes a Rotator Cuff Injury?

Your rotator cuff tendons protect themselves, from simple knocks and bumps, by overlaying bones (mainly the acromion).

In between the rotator cuff tendons and the bony arch is the subacromial bursa (a lubricating sack), which protects the tendons from touching the bone and provides a smooth surface that your tendon glides over.

However, nothing is fool-proof. These structures can be injured – whether they be your bones, muscles, tendons, ligaments or bursas.

Rotator cuff impingement syndrome is when your rotator cuff tendons are intermittently trapped and compressed during shoulder movements. Impingement causes injury to the shoulder tendons and bursa, resulting in painful shoulder movements.

What are the Symptoms of Rotator Cuff Injury?

While each specific rotator cuff injury has its particular symptoms and signs, you can suspect a rotator cuff injury if you have:

  • an arc of shoulder pain or clicking when your arm is at shoulder height or when your arm is overhead.
  • Shoulder pain can extend from the top of your shoulder to your elbow.
  • Shoulder pain when lying on your sore shoulder.
  • Shoulder pain at rest (with more severe rotator cuff injuries).
  • Shoulder muscle weakness or pain when attempting to reach or lift.
  • Shoulder pain when putting your hand behind your back or head.
  • Shoulder pain reaching for a seat belt.

How is a Rotator Cuff Injury Diagnosed?

Your physiotherapist or sports doctor will suspect a rotator cuff injury based on your clinical history and the findings from a series of clinical tests.

A diagnostic ultrasound scan is the most accurate method to diagnose the specific rotator cuff injury pathology. MRIs may show a rotator cuff injury but can miss them. X-rays are of little diagnostic value when a rotator cuff injury is suspected.

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How to Treat a Rotator Cuff Injury?

Once you suspect a rotator cuff injury, it is crucial to confirm its exact type since treatment varies depending on the specific or combination of rotator cuff injuries.

Your rotator cuff is an essential group of control and stability muscles that maintain the “centralisation” of your shoulder joint. In other words, it keeps the shoulder ball centred over the small socket. This centralisation prevents injuries such as impingement, subluxations and dislocations.

We also know that your rotator cuff provides subtle glides and slides off the ball joint on the socket to allow entire shoulder movement. Plus, your shoulder blade (scapula) has a vital role as the main dynamically stable base plate that attaches your arm to your chest wall.

Researchers have concluded that there are mostly seven stages that need to be covered to rehabilitate these injuries and prevent a recurrence effectively.

These are:

  • Early Injury Protection: Pain Relief & Anti-inflammatory Tips
  • Regain Full Range of Motion
  • Restore Scapular Control
  • Restore Normal Neck-Scapulo-Thoracic-Shoulder Function
  • Restore Rotator Cuff Strength
  • Restore High Speed, Power, Proprioception & Agility
  • Return to Sport or Work

For more specific advice about your rotator cuff injury, don’t hesitate to contact your PhysioWorks physiotherapist.

More Information about Rotator Cuff Injury

What is Rotator Cuff Impingement Syndrome?

What is Impingement Zone?

What Causes Rotator Cuff Impingement?

Your PhysioWorks physiotherapist is skilled in assessing and correcting shoulder rotator cuff injuries. Any deficiencies that they detect during your examination will be an essential component of your rehabilitation.

Your physiotherapist will be able to guide you in the appropriate treatment and exercises for your rotator cuff injury after their thorough assessment.

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Common Shoulder Pain & Injury Conditions

Rotator Cuff

Adhesive Capsulitis

Shoulder Bursitis

Shoulder Instability

Acromioclavicular Joint

Bone Injuries

Post-Operative Physiotherapy

Muscle Conditions

Systemic Conditions

Referred Pain

Shoulder Treatment

Researchers have discovered that managing your shoulder injury with physiotherapy is usually successful. Typically, you have two options: a non-operative or a surgical approach. Your condition will dictate which option is best for you at this time. Non-operative care is conservative rehabilitation.

If shoulder surgery is required, then your physiotherapist may undertake:

Pre-operative rehabilitation  - either trial a non-operative/conservative treatment approach or condition and prepare your shoulder and body for a surgical procedure.

Post-operative physiotherapy will safely regain your normal range of movement, strength and function.

PhysioWorks physiotherapists have a particular interest and an excellent working relationship with leading shoulder surgeons. Our physiotherapy team provide you with both conservative and post-operative shoulder rehabilitation options. We aim for you to attain the best possible outcome for your shoulder injury.

For specific information regarding your shoulder, please consult your trusted shoulder physiotherapist.

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Common Shoulder Pain Causes

Shoulder pain can commence after a traumatic injury or present gradually.

Traumatic shoulder injuries include:

The most common cause of traumatic shoulder injuries would be sports injuries or lifting injuries.

Gradual onset shoulder injuries include:

Your shoulder physiotherapist will be able to assist with your diagnosis and treatment plan. Please consult with them regarding your shoulder condition.

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Shoulder Injuries

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Article by John Miller

Shoulder Impingement Syndrome

Your Shoulder Impingement Zone is where your shoulder tendons and bursa are most likely to impinge against the (acromion) top of the shoulder blade during overhead or shoulder height movement. The shoulder impingement zone is the most likely area when injuries to your rotator cuff or shoulder bursa occur due to the narrowing of the sub-acromial (space below the acromion) during this shoulder position.

Postures that significantly narrow the sub-acromial space are:

  • Rounded shoulder postures.
  • Your arm is working at or near shoulder height.
  • Your arm is high overhead.
  • Poor scapulohumeral rhythm.

Injuries that result fall under the Shoulder Impingement Syndrome group of injuries. These include shoulder bursitis and rotator cuff injuries.

Who Suffers Shoulder Impingement Syndrome?

Shoulder Impingement Syndrome is more likely to occur in people who engage in physical activities that require repeated overhead arm movements, such as tennis, golf, swimming, water polo, weight lifting, or throwing a ball. Occupations that require repeated overhead lifting or work at or above shoulder height are also at risk of rotator cuff impingement.

What are the Symptoms of Shoulder Rotator Cuff Impingement?

Commonly rotator cuff impingement has the following symptoms:

  • An arc of shoulder pain occurs approximately when your arm is at shoulder height or when your arm is overhead.
  • Shoulder pain can extend from the top of the shoulder to the elbow.
  • Pain when lying on the sore shoulder.
  • Shoulder pain at rest as your condition deteriorates.
  • Muscle weakness or pain when attempting to reach or lift.
  • Pain when putting your hand behind your back or head.
  • Pain reaching for the seatbelt.

How is Shoulder Impingement Syndrome Diagnosed?

A thorough clinical examination will identify a rotator cuff impingement in most cases. Your physiotherapist will ask about your shoulder pain and its behaviour and examine your shoulder with specific tests that identify impingement signs.

Diagnostic tests may include MRI or diagnostic ultrasound scans to look for rotator cuff tears, shoulder bursitis, or impingement signs.

A problem with your neck joints can commonly cause shoulder pain. Your physiotherapist will examine this area to rule out this cause or include its treatment in your care plan.

For specific shoulder impingement advice, please consult your shoulder physiotherapist.

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Article by John Miller

Rotator Cuff Muscles

Your rotator cuff muscles hold your arm (humerus) onto your shoulder blade (scapula). Most of the rotator cuff tendons hide under the bony point of your shoulder (acromion), which, as well as protecting your rotator cuff, can also impinge on your rotator cuff structures.

The shoulder joint is a relatively unstable ball and socket joint. It is often likened to a golf ball on a tee. Your subscapularissupraspinatusinfraspinatus and teres minor are small muscles that stabilise and control your shoulder movement. Collectively, these four muscles are known as the rotator cuff.

What is your Rotator Cuff?

Rotator cuff syndrome is a prevalent shoulder injury. Your shoulder joint is a relatively unstable ball, and the socket joint is moved and controlled by a small group of four muscles known as the rotator cuff.

As the name suggests, the rotator cuff muscles are responsible for shoulder rotation and form a cuff around the humerus's head (shoulder ball). The subscapularissupraspinatusinfraspinatus and teres minor are your rotator cuff muscles. These muscles stabilise and control your shoulder movement on your shoulder blade (scapula).

Rotator Cuff Injury

Your rotator cuff muscles and tendons are vulnerable to rotator cuff tears, rotator cuff tendonitis, rotator cuff impingement, and related rotator cuff injuries.

Rotator cuff injuries vary. Medium severity injuries include acute or subacute rotator cuff tendon damage (rotator cuff tendinopathy). The lesser end is mild soft tissue pinching and catching (shoulder impingement), an inflamed subacromial bursa (shoulder bursitis). The more significant injury end of the spectrum is more longstanding tendon damage (calcific tendinopathy), a rotator cuff tear, or complete tendon rupture.

Rotator Cuff Treatment

Fortunately, most rotator cuff injuries respond to physiotherapy treatment that addresses how your shoulder moves, e.g. avoid clicking impingement positions. This treatment approach helps with short-term pain and long-term damage such as rotator cuff tears or repeat bursitis.

More significant injuries include partial and full-thickness rotator cuff tears, which may require rotator cuff surgery.

Some shoulder rotator cuff injuries are more common than others.

These include:

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Article by John Ferguson

What is Shoulder Bursitis?

Shoulder bursitis is a common complaint among people of all ages. Shoulder bursitis can occur following acute shoulder trauma, but it is more consistently due to overuse and suboptimal biomechanics. Bursa is a fluid-filled sac-like structure that rests wherever there may be friction between soft tissue and bone. The subacromial bursa, which rests between the humerus and the ceiling of the shoulder joint, can become irritated when tight or weak rotator cuff muscles cause the humerus's head to infringe on it during arm movements. Known as an impingement, this pattern, coupled with repeated overhead arm movement, can cause the subacromial bursa to become inflamed and painful.

Once irritated, shoulder bursitis can result in considerable pain and restriction, which can be felt down the arm and traditionally aggravated by overhead activities.

Positively, despite the pain and disability associated with shoulder bursitis, often it does not coincide with the need for surgical management. Indeed, research suggests that most people respond well to a simple home exercise program and rest from aggravating activities.

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Article by John Miller

What Causes Rotator Cuff Impingement?

Rotator cuff impingement and bursitis causes have primary (structural) and secondary (posture & movement related) causes.

Primary Rotator Cuff Impingement – Structural Narrowing

Some of us are born with a smaller sub-acromial space. Conditions such as osteoarthritis can also cause the growth of sub-acromial bony spurs, which further narrows the space.

Because of this structural narrowing, you are more likely to squash, impinge and irritate the soft tissues in the sub-acromial space, which results in bursitis or rotator cuff tendonitis.

Secondary Rotator Cuff Impingement – Dynamic Instability

Impingement can occur if you have a dynamically unstable shoulder.

Dynamic shoulder instability means excessive joint movement, ligament laxity and muscular weakness around the shoulder joint.

This impingement usually occurs over time due to repetitive overhead activity, trauma, previous injury, poor posture or inactivity.

In an unstable shoulder, the rotator cuff has to work harder, which can cause injury.

An overworking rotator cuff fatigues and eventually becomes inflamed and weakens due to pain inhibition or tendon tears.

Typically, when your rotator cuff fails, it cannot prevent the head of the humerus (upper arm) from riding up into the sub-acromial space, squashing your bursa or rotator cuff tendons.

Failure to properly treat this instability causes the injury to recur. Poor technique or bad training habits such as training too hard is a common cause of overuse injuries, such as bursitis or tendinopathy.

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Article by Zoe Russell

How Can You Tell If You Tore Your Rotator Cuff?

So you have hurt your shoulder - and it is painful. It is interrupting your sleep, and you are lying awake at night, and you wonder - have I torn my rotator cuff?

How Can You Tell?

There are two types of Rotator Cuff Tears.

  • Traumatic Tears
  • Atraumatic Tears

A traumatic tear occurs when you sustain trauma to your shoulder. This trauma could be a fall where you reach out and land on your arm or even a shoulder dislocation. In essence, something specific, memorable and traumatic happens to your shoulder.

You may experience intense pain, it interrupts your sleep, and you may be unable to move your arm, especially with lifting and rotating your arm away from your body.

An atraumatic tear is when your symptoms occur without recollection of a significant force. These atraumatic tears often result from microtraumas. Essentially, the effect of multiple low threshold forces beyond the capacity of your shoulder. A small force, or something that you do every day causes a tear to your shoulder. Often the symptoms of an atraumatic tear are the same as a traumatic tear, where you have pain, and interrupted sleep due to this pain. Commonly, with the inability to lay on your shoulder at night and an inability to move your arm. In these cases, the rotator cuff tendons often display changes to the tendon preceding this trauma.

How we manage these tears is often dictated by the size of the tear, the nature of the precipitating event, and your shoulder's function. If you have any of these symptoms:

  • Constant pain, that interrupts your sleep
  • Inability to move your arm

You may have sustained a tear to your rotator cuff.

Please seek physiotherapy support early, as some tears may require referral to a shoulder specialist. With same-day appointments available - your local PhysioWorks is well equipped with experienced physiotherapists to help you on the path to recovery.

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Article by Matthew Batch

Can You Diagnose A Torn Rotator Cuff Without An MRI?

Yes.  In most cases, a skilled shoulder physiotherapist or doctor will diagnose a rotator cuff tear without an MRI.  In a clinical setting, a doctor or physiotherapist can use the information on how your symptoms developed, the symptoms you are experiencing, and a series of physical tests to determine whether you have experienced an injury to the rotator cuff.  If this is suspected, either high-resolution diagnostic ultrasound or MRI may be considered.  The research evidence identifies ultrasound as the more specific, sensitive and cheaper diagnostic test of the two options.  Your imaging results can help determine whether your condition is more likely to benefit from surgical or non-surgical management.  X-rays do not help decide whether or not you have a rotator cuff tear but can assist in ruling out other possible causes of your symptoms.

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Article by Matthew Batch

Can You Lift Your Arm With A Rotator Cuff Tear?

Whilst it is possible to lift your arm following a rotator cuff tear, several factors can influence how well you can do this. The first key consideration is the severity of the injury. Acute rotator cuff injuries are typically divided into partial or complete thickness tears. In the event of a partial tear, you may experience pain lifting your arm, though the movement remains possible. However, full-thickness tears are associated with more difficulty lifting the arm. The second consideration is the change in your function. Your disability will depend upon which section of the rotator cuff has been affected.

Given that the rotator cuff comprises four different muscles and their tendons and the different movements they are responsible for, the change in your function will be specific to each of them. The final consideration is the amount of pain you are suffering. Unsurprisingly, a high intensity of pain is likely to discourage you from wanting to move and your muscles from making you potentially move in ways that aggravate your condition.

For specific shoulder impingement advice, please consult your shoulder physiotherapist.

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Article by John Miller

How Can You Make Your Rotator Cuff Heal Faster?

Rotator cuff injuries are common. Around 732,000 people seek medical advice for rotator cuff injuries in Australia (Naunton et al., 2020). The majority of these will not need surgery. Does time heal all wounds? Or, is some motion your lotion?

The answer is predictably measured and will involve a little of both. Here are the dot points on how to get your recovery right;

Finding Your Appropriate Load Level

Most rotator cuff injuries are from repetitive overuse. Continuing to load these muscles at the same rate will delay healing. But, complete rest isn't going to work. The damage that has been done requires an appropriate load to stimulate tissue remodelling.

The same can be said of acute rotator cuff injuries, with caveats. A short period of complete rest is usually appropriate before gentle exercise is required to prevent scar tissue buildup.

Providing an appropriate load level at the proper time for your type of cuff injury is tricky. Identifying causative factors and respecting pain are good places to start, but seeking the guidance of a health professional, such as your shoulder physiotherapist, is recommended to ensure you're ticking all the boxes.

Avoid Sleeping On Your Affected Side

Thankfully this one shouldn't require an appointment to get right. Just don't sleep on it.

The reason is that tendons hate compression. And the rotator cuff is very susceptible to compression due to its anatomy.

The cuff muscles originate on the shoulder blade and work to hold the head of the arm bone in place. This naturally leads to them adopting an L shape. When the arm is by the side, the long part of the L is stretched (in the case of the top muscle pictured) and compresses the tendon (the corner of the L) against the arm bone.

Sleeping on the affected side adds another compression element, and now your tendon is being squished from both sides.

Using this new knowledge, you can reason that it is preferable to avoid sleeping on the affected side and with your arm away from your side a slight amount.

It is also best to avoid any rotation, which tensions the other cuff muscles. The most common mistake is sleeping on the unaffected side but letting your hand fall onto your belly.

Changing your sleep position is sometimes difficult. It can be helpful to start thinking about this before you're staring at the ceiling by taking pain relief or icing before it's time for bed.

Ice

Usually, ice is used to reduce inflammation, but in tendon overuse conditions, its function involves preventing the abnormal formation of new blood vessels in the tendon (Khan et al., 2000). Studies have shown that shoulder tendons with neovessels present are 6.5 times more likely to experience shoulder pain than those without (Skazalski et al., 2021). It's a complicated reason for a simple intervention; 20 minutes, multiple times a day, with at least 45 minutes between exposures.

Rotator cuff injuries are common, and most don't need surgery. Minimising compression to the area by adjusting your sleep positioning, icing regularly and loading the right amount at the right time will ensure your rotator cuff heals as fast as possible.

For more specific advice, please seek the guidance of your trusted shoulder physiotherapist or doctor.

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References

Naunton J, Harrison C, Britt H, Haines T, Malliaras P (2020) General practice management of rotator cuff related shoulder pain: A reliance on ultrasound and injection guided care. PLOS ONE 15(1): e0227688. https://doi.org/10.1371/journal.pone.0227688 Skazalski, C, Bahr, R, Whiteley, R. Shoulder complaints more likely in volleyball players with a thickened bursa or supraspinatus tendon neovessels. Scand. J. Med. Sci. Sports. 2021; 31: 480– 488. https://doi.org/10.1111/sms.13831 Khan, K. M., Cook, J. L., Taunton, J. E., & Bonar, F. Overuse Tendinosis, Not Tendinitis. The Physician and Sportsmedicine, 28(5), 38–48. doi:10.3810/psm.2000.05.890

Acute Injury Signs

Acute Injury Management.

Here are some warning signs that you have an injury. While some injuries are immediately evident, others can creep up slowly and progressively get worse. If you don't pay attention to both types of injuries, chronic problems can develop.

For detailed information on specific injuries, check out the injury by body part section.

Don't Ignore these Injury Warning Signs

Joint Pain

Joint pain, particularly in the knee, ankle, elbow, and wrist joints, should never be ignored. Because these joints are not covered by muscle, pain here is rarely of muscular origin. Joint pain that lasts more than 48 hours requires a professional diagnosis.

Tenderness

If you can elicit pain at a specific point in a bone, muscle, or joint, you may have a significant injury by pressing your finger into it. If the same spot on the other side of the body does not produce the same pain, you should probably see your health professional.  

Swelling

Nearly all sports or musculoskeletal injuries cause swelling. Swelling is usually quite obvious and can be seen, but occasionally you may feel as though something is swollen or "full" even though it looks normal. Swelling usually goes along with pain, redness and heat.

Reduced Range of Motion

If the swelling isn't obvious, you can usually find it by checking for a reduced range of motion in a joint. If there is significant swelling within a joint, you will lose range of motion. Compare one side of the body with the other to identify major differences. If there are any, you probably have an injury that needs attention.

Weakness

Compare sides for weakness by performing the same task. One way to tell is to lift the same weight with the right and left sides and look at the result. Or try to place body weight on one leg and then the other. A difference in your ability to support your weight is another suggestion of an injury that requires attention.

Immediate Injury Treatment: Step-by-Step Guidelines

  • Stop the activity immediately.
  • Wrap the injured part in a compression bandage.
  • Apply ice to the injured part (use a bag of crushed ice or a bag of frozen vegetables).
  • Elevate the injured part to reduce swelling.
  • Consult your health practitioner for a proper diagnosis of any serious injury.
  • Rehabilitate your injury under professional guidance.
  • Seek a second opinion if you are not improving.

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Article by Scott Schulte

Will A Cortisone Injection Help A Torn Rotator Cuff?

Your rotator cuff comprises four muscles and tendons surrounding the shoulder joint. They provide strength to lift the arm in all directions and provide stability to the shoulder to firmly hold the ball of the shoulder (head of the humerus) in the socket (glenoid).

Management for Rotator Cuff Tears

Tears of the rotator cuff can occur acutely through several mechanisms or can result from gradual changes over time and, in some cases, can cause shoulder pain and reduced function. Good quality research has suggested that physiotherapy and exercise rehab is effective and should be the first-line treatment for many types of rotator cuff injuries. However, in some particularly stubborn cases, other additional options may need to be considered.

A cortisone injection, also known as an HCLA (hydrocortisone + local anaesthetic) injection, is an injection that can help to reduce inflammation and provide pain relief. With the guidance of your physiotherapist and medical team, a cortisone injection may be considered for people with:

  • Persistent high pain levels despite medication and relative rest.
  • Night pain
  • Where pain has restricted the progression of exercise rehab.

Pros and Cons of Injections

A cortisone injection can effectively reduce pain and inflammation in conditions such as bursitis in the right circumstances. However, injections do also have some potential adverse side effects.

Recent studies show that repeat injections or injections involving large tendon tears can weaken the tendon structure and inhibit the cells that help repair damaged tissue. This is why healthcare professionals, such as your physiotherapist, will try to avoid unnecessary steroid injections and persist with rehab for at least 4-6 weeks before considering them.

Rehab Following Injection

Research shows that people experience significantly greater improvements in shoulder pain and function when completing a specific exercise rehab program following a cortisone injection (Holmgren et al., 2012). Following a successful cortisone injection, your physiotherapist can use this reduced pain “window” to allow the more effective exercise of the muscles in the area. Typically, relative rest is recommended for 1-2 weeks following the injection before commencing exercise rehab.

Consulting with one of our PhysioWorks physiotherapists can ensure that your shoulder injury is accurately diagnosed and treated accordingly. Book an appointment, or feel free to call us, and one of our physiotherapists will be happy to help.

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Article by John Miller

What is Scapulohumeral Rhythm?

Your shoulder-scapula joint motion has a regular functional motion pattern known as scapulohumeral rhythm - to provide you with pain-free and powerful shoulder function. When elevating your shoulder overhead, roughly one-third of your shoulder motion occurs at your scapulothoracic joint. Two-thirds of movement occurs at the glenohumeral joint, or 'true" shoulder joint. However, the timing and coordination of your shoulder muscles and how they control your scapulohumeral rhythm are essential factors.

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Alteration of this regular scapulohumeral movement pattern results in shoulder injuries, pain and impingement.

When your scapulohumeral rhythm becomes abnormal -due to pain, weakness or muscle incoordination - you are more likely to suffer shoulder clicking, pain or rotator cuff injury.

Shoulder Joint Anatomy

Your shoulder motion occurs via a complex group of joints that dynamically controls the movement of three bones (scapula, humerus and clavicle) upon your ribcage. Your shoulder blade (scapula) is the centralised triangular base for your shoulder and arm movements. Your scapular muscles guide your scapula as it articulates around your rib cage. This motion is known as scapulothoracic motion.

Your clavicle or collarbone is the only skeletal attachment of your arm. It attaches to your upper sternum and the lateral edge of your scapula at the acromioclavicular (AC) joint. Your shoulder ball and socket joint is the glenohumeral joint where your upper arm bone (humerus) articulates on the glenoid fossa of your scapula.

What are the Symptoms of Abnormal Scapulohumeral Rhythm?

Poor shoulder blade stability results in abnormal tipping and rotation of your scapular, which causes your acromion (bone) to pinch down into the subacromial structures (e.g. bursa and tendons), causing impingement leading to swelling or tears. Typically signs of abnormal scapulohumeral rhythm include shoulder pain, instability and clicking. Researchers have identified abnormal scapulohumeral rhythm as a major cause of rotator cuff impingement.

Your shoulder physiotherapist is an expert in the assessment of scapulohumeral rhythm. They will observe your shoulder motion and perform strength and control tests to assist their diagnosis. X-rays, MRIs, ultrasound scans and CT scans cannot determine scapulohumeral rhythm dysfunction.

Why is Scapulohumeral Rhythm Important?

Poor scapula stability usually results in tipping and downward rotation of your scapula. The downward posture causes your shoulder (tip of acromion) to pinch down on the subacromial structures.  Rotator cuff impingement, shoulder bursitis or rotator cuff tears result from subacromial impingement.

Normal shoulder blade-shoulder movement - (scapulohumeral rhythm) - is required for a pain-free and powerful shoulder function. Luckily, abnormal scapulohumeral rhythm can be retrained by an experienced shoulder physiotherapist.

Scapulohumeral Rhythm Correction

Your skilled physiotherapist can assess and correct your scapulohumeral rhythm. Any deficiencies will be an essential component of your rehabilitation. Among other treatment options, teaching you how to control your shoulder blade via scapular stabilisation muscles is crucial for a successful recovery.

Your physiotherapist will be able to guide you in the appropriate exercises for your shoulder.

Restore Normal Neck-Scapulo-Thoracic-Shoulder Function

You may find it challenging to comprehend that your neck and upper back (thoracic spine) are essential in treating shoulder pain and injury. Neck or spine dysfunction can not only refer to pain directly to your shoulder but can affect a nerve's electrical energy supply to your muscles, causing weakness.

Plus, painful spinal structures from poor posture or injury don't provide your shoulder, or scapular muscles, with a solid pain-free base. In most cases, especially chronic shoulders, some treatment directed at your neck or upper back may ease your pain, improve your shoulder movement and stop pain or injury from returning.

For more information, please consult your shoulder physiotherapist.

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Kinesiology Tape

Kinesiology tape has a comprehensive array of therapeutic benefits. Because kinesiology taping can usually be left on for several days or up to a week, these therapeutic benefits are available to the injured area 24 hours a day, significantly accelerating the healing process from trauma, injuries and inflammatory conditions.

Benefits of Kinesiology Taping

Pain Relief via Structural Support for Weak or Injured Body Parts

Kinesiology tape is a flexible elastic tape that moves with your body. The supple elasticity provides supports to your body parts without the tape slipping.

By supporting your body part, kinesiology tape can provide you with pain relief and muscular support to help control body parts affected by muscle inhibition.

Muscle Support

Kinesiology tape potentially assists your muscle strength via physical assistance. It also provides tactile feedback through the skin, e.g. proprioception boost. This phenomenon may help both the non-disabled athlete to enhance their performance and hypotonic, e.g. children with low muscle tone.

Swelling Reduction

Kinesiology provides a passive lift to your skin via its elastic properties. This vacuum effect allows your lymphatic and venous drainage systems to drain and swollen or bruised tissue quicker than without the kinesiology tape.

It is also thought that this same principle can assist the removal of exercise byproducts like lactic acid that may contribute to post-exercise soreness, e.g. delayed onset muscle soreness (DOMS).

More info: Strapping & Supportive Taping

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What is Dry Needling?

Dry needling is an effective and efficient technique for the treatment of muscular pain and myofascial dysfunction. Dry needling or intramuscular stimulation (IMS) is a technique that Dr Chan Gunn developed. Dry needling is a beneficial method to relax overactive muscles.

In simple terms, the treatment involves the needling of a muscle's trigger points without injecting any substance. Western anatomical and neurophysiological principles are the basis of dry needling. It should not be confused with the Traditional Chinese Medicine (TCM) technique of acupuncture. However, since both dry needling and acupuncture utilise the same filament needles, the confusion is understandable.

In his IMS approach, Dr Chan Gunn and Dr Fischer, in his segmental approach to Dry Needling, strongly advocate the importance of clearing trigger points in both peripheral and spinal areas.

Dry needling trained health practitioners use dry needling daily for the treatment of muscular pain and dysfunction.

dry needling

What Conditions Could Acupuncture or Dry Needling Help?

Acupuncture or dry needling may be considered by your healthcare professional after their thorough assessment in the following conditions:

Private Health Fund Rebates

Most private health funds offer rebates on acupuncture or dry needling treatments as a component of your physiotherapy or acupuncture consultation.

More Info

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Article by John Miller

Why is Post-Operative Physiotherapy Beneficial?

The success of your surgery doesn't finish the moment you leave the operating theatre. A famous quote: "The only place 'success' comes before 'work' is in the dictionary." Vidal Sassoon.

Your surgeon will have skillfully performed a surgical procedure that is the initial step towards your successful outcome. However, you'll have to do some work in the form of exercises to optimise your results.

Your physiotherapist will provide you with simple exercises to minimise chest infection or DVT complications when in the hospital. They may prescribe some early strengthening or range of motion exercises. Once discharged, you'll usually require re-assessment and checking of your progress.

Post-orthopaedic surgery, you'll almost certainly require exercise progression to regain your strength, flexibility, and function fully. Optimise your prompt return to life by consulting an experienced physiotherapist. Based on their assessment, they'll prescribe the most appropriate exercise for you and discuss your post-operative treatment.

At PhysioWorks, we'll happily assist you in your post-operative care. We are familiar with the treatment protocols prescribed by most Orthopaedic Surgeons. We'll happily liaise with your surgeon to determine any specific requirements based on your surgery.

Common Surgeries Requiring Post-Operative Care

Shoulder

Shoulder Reconstruction, Shoulder Stabilisation, Rotator Cuff Repair, Acromioplasty, Manipulation, Capsulotomy, Fracture

Elbow

Tennis Elbow Release, Golfers Elbow Release, Fracture

Wrist & Hand

Carpal Tunnel Release, Fracture, Tendon Repairs

Hip

Hip Replacements/Resurfacing, Hip labral repairs, Hip Arthroscopy, Fracture

Knee

Knee Replacements, ACL and Ligament Reconstruction, Knee Arthroscopy, Meniscal Repairs, Chondroplasty, Lateral Release, Patella Tendon Transfer, Fracture

Calf

Achilles Tendon Repairs, Fasciotomy

Ankle & Foot

Ankle Reconstruction, Ligament Repairs, Arthroscope, Fracture, Spur Removal, Bunionectomy

Spine (Neck & Back)

Discectomy, Micro-discectomy, Laminectomy, Spinal Fusion/Stabilisation

Individualised Post-Operative Physiotherapy

At PhysioWorks, we'll work with you to develop a tailor-made rehabilitation program to ensure you make the best possible recovery in the quickest time. Whatever your needs, we'll get you back to your work, sport or day to day activities ASAP.

If you have been a surgical patient, it is always beneficial to inform your surgeon that you would like to return for post-operative care at PhysioWorks.

You can make an appointment with PhysioWorks at any stage. Seek their advice if you believe you are not making satisfactory progress in your recovery or if your mobility is compromised.

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When Should You Commence Physiotherapy?

In severe cases, it is best to commence physiotherapy as soon as possible.  However, it does vary from case to case. Your physiotherapist has some nifty tricks to improve your pain straight away.

If you are not sure what to do, please call us for advice. We’ll happily guide you in your time of need. Often a bit of reassurance is all that you will need.

How Much Treatment Will You Need?

After assessing your injury, your physiotherapist will discuss the injury severity with you and estimate the number of treatments needed. No two injuries are ever the same.

Your treatment will include techniques and exercises to regain your:

  • joint, ligament and soft tissue mobility
  • muscle strength, power and speed
  • balance and proprioception
  • prevention tips
  • performance improvement.

What If You Delay Treatment?

Research tells us that symptoms lasting longer than three months become habitual and are much harder to solve. This can lead to nastier conditions.  The sooner you get on top of your symptoms the better your outcome.

All injuries are different and little variations can make a big improvement to your recovery rate.  Stiff joints or muscles may need some range of movement exercises. Other injuries may require massage or very specific strengthening exercises.

Seek professional guidance promptly for your best outcome.

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