What is a Dislocated Shoulder?
A dislocated shoulder occurs when the ball of your upper arm bone (humerus) is forced entirely out of its normal position on the shoulder socket (glenoid labrum). A shoulder dislocation is usually associated with extreme pain and an inability to move your arm until it is relocated back into the socket.
Shoulder subluxation is a partial shoulder dislocation when the shoulder joint comes partway out before relocating.
What Causes a Dislocated Shoulder?
Your shoulder is the most mobile joint in your body. It has a fantastic range of motion. Your shoulder allows you to lift your arms overhead, out to the side, rotate behind your head and back, and reach multiple directions. However, this vast range of motion comes at the cost of its stability.
Shoulder dislocation and subluxation can occur due to sudden trauma or from underlying shoulder joint instability.
Most Common Causes of Dislocated Shoulder
1. Traumatic Shoulder Dislocation
High speed or traumatic shoulder dislocation occurs when your shoulder is in a vulnerable position and is popped out at speed. Commonly this is with your arm out to the side. This injury description is standard when dislocating in a football tackle or during a fall.
2. Repetitive Shoulder Ligament Overstrain
Occasionally, people with looser ligaments in their shoulders can dislocate their shoulders with relative ease. This increased passive shoulder instability is sometimes just your normal anatomy. Sometimes, it is the result of repetitive overstretching of the shoulder joint.
Some sports such as swimming, tennis, throwing sports (cricket, baseball etc.), and volleyball that require repetitive overhead motion can overstretch your shoulder ligaments and joint capsule.
Looser shoulder ligaments make it harder for your shoulder’s rotator cuff muscles to maintain your shoulder stability. If you have an unstable shoulder, the best thing that you can do to prevent or help rehabilitate your shoulder dislocation is to undertake a specific shoulder rotator cuff strengthening program.
Would you please ask your physiotherapist for their professional advice?
3. Multi-Directional Instability
In a small number of patients, your shoulder is unstable in multiple directions due to your genetic disposition. The shoulder may feel loose or repeatedly dislocated in these patients in various directions. This is called multi-directional instability.
These patients have naturally loose ligaments throughout the body and are potentially “double-jointed” or hypermobile.
Due to the genetically elastic collagen fibres in their ligaments, these patients typically do not respond with much success to surgical stabilisation. They are best managed with a thorough shoulder stabilisation strengthening program.
Please ask your physiotherapist for their professional advice.
What are the Symptoms of a Dislocated Shoulder?
The history of a shoulder that is traumatically “popped out” of the joint is the classic sign of shoulder dislocation. Shoulders that do not stay out of joint are more likely to have partially subluxated before self-relocating.
A shoulder that is dislocated will look deformed. The arrow indicates a dislocated shoulder.
Symptoms of Shoulder Instability that can predispose you to dislocation include:
- Shoulder pain
- Repeated instances of the shoulder giving out
- A persistent sensation of the shoulder feeling loose, slipping in and out of the joint, or just “hanging there.”
- Apprehension to put your shoulder in certain positions
- Pins & needles, numbness or arm weakness.
How is a Dislocated Shoulder Diagnosed?
After discussing your shoulder symptoms and injury history, your physiotherapist will examine your shoulder for dislocation or signs of instability. They can typically confirm your diagnosis within the clinic or on the field of play.
Your physiotherapist or doctor may order imaging tests to help confirm your diagnosis and identify any other problems. These may include X-rays. Magnetic Resonance Imaging (MRI). Magnetic Resonance Arthrogram (MRA). Radiological findings may identify fractures, Bankart lesions or labral tears.
If you have any questions about your shoulder please ask your shoulder physiotherapist.
Dislocated Shoulder Treatment Options
A shoulder sling is the initial treatment of choice during the first few weeks post-dislocation.
Kinesiology tape may be helpful to add to the stability of your shoulder in the early stages of your rehabilitation.
A shoulder brace can provide mild to moderate support. Unfortunately, even the best braces will not guarantee 100% protection from a future dislocation.
Dislocated Shoulder Treatment
Both acute and repeated shoulder dislocations usually are treated initially with non-operative rehabilitation guided by your physiotherapist.
Stabilisation surgery may be considered should your exercise-based treatment fail.
PHASE I – Joint Reduction. Check Neurovascular Integrity
The most urgent matter for a recently dislocated shoulder is to ensure that your nerves or blood supply are not compromised.
If your shoulder did not relocate naturally, it is essential to promptly head to the hospital for an emergency X-ray to exclude fractures. You will then have your shoulder reduced to its normal position by the emergency doctors.
PHASE II – Pain Relief. Minimise Swelling & Injury Protection
You are managing your pain. Pain will accompany shoulder movement in the early days. You will usually be prescribed a shoulder sling to support and immobilise your shoulder. Overstretching the injured tissues should be avoided for between two to six weeks.
Manage your inflammation via ice therapy and rest to de-load the inflamed structures.
Your physiotherapist will use various treatment tools to reduce your pain and inflammation. These may include ice, electrotherapy, acupuncture, de-loading taping techniques, soft tissue massage and temporary use of a sling to off-load the injured shoulder ligaments.
PHASE III – Maintain & Restore Muscle Control & Strength
It is essential to maintain the strength of your shoulder’s rotator cuff muscles and scapular (shoulder blade) stabilisers.
Researchers have discovered the importance of your rotator cuff muscles to dynamically stabilise your shoulder joint.
It is also vital to address your shoulder blade stability since your scapular is the stable platform that attaches your arm to your chest wall. It is a substantial base that will allow your shoulder blade to slide into a position that could predispose you to future dislocations if it is not functioning correctly.
Your physiotherapist will assess your muscle recruitment pattern and prescribe the best exercises specific to your needs.
PhysioWorks has developed both a “Rotator Cuff Strengthening” and a “Scapular Stabilisation Program” to assist their patients in regaining standard shoulder muscle control. Please ask your physio for their advice.
PHASE IV – Restoring Normal ROM & Posture
As your pain and inflammation settle and your ligaments start to heal, your physiotherapist will turn their attention to restoring your normal joint range of motion, muscle length, neural tissue mobility and resting muscle tension.
Regaining full shoulder motion in the early phase is not a priority to avoid overstretching the healing shoulder ligaments and capsule.
Treatment may include joint mobilisation and alignment techniques, massage, muscle stretches and neurodynamic exercises, acupuncture, trigger point therapy or dry needling. Your physiotherapist is highly skilled in the methods that will work best for you and avoid predisposing you to a future dislocation.
PHASE V – Restoring Full Function
This stage of your rehabilitation aims to return you to your desired activities. Everyone has different demands on their shoulders that determine what specific treatment goals you need to achieve. For some, it is simply to carry the shopping. Others may wish to throw or pitch a ball, serve or bowl with high speed or return to a labour-intensive activity.
Your physiotherapist will tailor your shoulder rehabilitation to help you achieve your own functional goals.
PHASE VI – Preventing a Recurrent Shoulder Dislocation
Shoulder dislocation and subluxation tend to return in poorly rehabilitated shoulders.
Your physiotherapist will guide you. In addition to your muscle control, your physiotherapist will assess your shoulder biomechanics and start correcting any deficiencies. It may be as simple as providing your will rotator cuff exercises or some scapular or posture exercises to address any biomechanical faults in your upper limb.
Fine-tuning your shoulder stability can be further enhanced by proprioception, co-contraction, speed and agility drills with the ultimate goal of safely returning to your previous sporting or leisure activities!
What Results Can You Expect Post Dislocated Shoulder?
Recurrence is very likely after the first time you dislocate or sublux your shoulder, especially in younger patients. The recurrence rate in patients under 25 years old is about 80%—the recurrence rate decreases as your age advances.
Because of the high recurrence rate, the goal of any treatment is to reduce the possibility of recurrent dislocation. The minimum therapy for the first time dislocation should be immobilisation in a sling for 2 to 3 weeks to take advantage of the off-chance that will reduce the recurrence rate.
Typically, you can take up resumption of athletic activities individually, but 6 to 8 weeks after injury is a minimum, and three months is probably safer to avoid redislocation.
Despite immobilisation treatment, the recurrence range is still relatively high. If your shoulder is not immobilised after a dislocation, the chances of redislocation are incredibly high with unrestricted activity in the first three weeks.
Once your shoulder dislocates a second time, it will almost always continue to re-dislocate with the arm in certain positions and often with less and less trauma on each occasion.
Your best chance to avoid re-dislocation is to immobilise your shoulder in a sling and undertake a physiotherapist prescribed exercise program specific to your shoulder.
What is a Bankart Lesion or Hills-Sach Fracture?
When the head of your shoulder dislocates, the capsular ligaments are overstretched. If the glenoid labrum, which attaches your capsule to the rim of the shoulder socket, is torn, it is known as a Bankart lesion. If a Bankart lesion exists, you are more likely to require surgical stabilisation.
A Hills-Sach Fracture occurs when the humeral head impacts against the rim of the shoulder socket resulting in a depression fracture in the humeral head. The fracture will typically increase your pain but does not normally require surgery as it is stable. It can, however, increase your likelihood of future shoulder dislocation.
These injuries will typically rehabilitate successfully with a supervised shoulder exercise program. A small percentage require surgical stabilisation if there are repeat dislocations.
Surgical Stabilisation Post-Dislocation
Surgical shoulder stabilisation is sometimes necessary to repair torn or overstretched ligaments, Bankart lesions etc., and prevent future shoulder dislocation.
With surgery, the chances of recurrent dislocation for all patients overall are about 5%. Footballers have a slightly higher recurrence, but this is generally 10% or less.
Your physiotherapist will advise you whether this option is suitable for you after discussions between your doctor and physiotherapist have assessed your shoulder and analysed your response to non-operative treatment.
You can feel confident that your PhysioWorks physiotherapist will look after your shoulder dislocation or instability issue. They work with leading shoulder specialists to provide assessment and diagnosis and non-operative and post-operative shoulder rehabilitation programs.
If you have any questions about your shoulder, please ask your physiotherapist.
Common Shoulder Pain & Injury Conditions
- Rotator Cuff Syndrome
- Shoulder Tendinopathy
- Rotator Cuff Calcific Tendinopathy
- Rotator Cuff Tear
- Bicep Tendinopathy
- Shoulder Impingement
- Swimmer's Shoulder
- Subacromial Decompression
- Shoulder Arthroscopy
- Rotator Cuff Repair
- SLAP Repair
- Biceps Tenodesis
- Biceps Tenotomy
- Total Shoulder Replacement
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.
Shoulder Pain FAQs
- When Should You Worry About Shoulder Pain?
- 6 Common Shoulder Injuries?
- What Causes Shoulder Pain?
- What is Your Scapulohumeral Rhythm?
- What is Your Rotator Cuff?
- How Can You Tell If You Have Torn Your Rotator Cuff?
- Can You Diagnose A Torn Rotator Cuff Without An MRI?
- Can You Lift Your Arm With A Rotator Cuff Tear?
- Will Your Shoulder Blade Hurt With A Torn Rotator Cuff?
- Will A Cortisone Injection Help A Torn Rotator Cuff?
- How Can You Make Your Rotator Cuff Heal Faster?
Common Shoulder Pain Causes
Shoulder pain can commence after a traumatic injury or present gradually.
Traumatic shoulder injuries include:
- Shoulder fractures (broken bones),
- Shoulder dislocation (out of position),
- AC joint injury (torn ligaments),
- Shoulder tendinopathy (tendon injuries) or
- Rotator cuff or muscular injuries.
The most common cause of traumatic shoulder injuries would be sports injuries or lifting injuries.
Gradual onset shoulder injuries include:
- Previous injuries that are inadequately treated (e.g. old joint or ligament sprains)
- Shoulder impingement or shoulder bursitis from poor muscular control, soft tissue tightness or joint position issues (biomechanical faults)
- Stiff joints (lack of movement diminishes joint nutrition), e.g. frozen shoulder
- Joints laxity (excessive sloppiness causes joint or tendon damage through poor control)
- Shoulder Arthritis
Your shoulder physiotherapist will be able to assist with your diagnosis and treatment plan. Please consult with them regarding your shoulder condition.
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.
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.
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.
More info: Shoulder Injuries
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 subscapularis, supraspinatus, infraspinatus 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 subscapularis, supraspinatus, infraspinatus 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.
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.
More info: Shoulder Bursitis
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.
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.
More info: Rotator Cuff Tears
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.
More info: Shoulder Injuries
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.
More info: Shoulder Injuries
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.
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.
More info: Shoulder Injuries
ReferencesNaunton 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, 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.
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.
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.
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.
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.
More info: Rotator Cuff Syndrome
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.
View it on Youtube here: http://www.youtube.com/watch?v=_Ia0VvT81xc
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.
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.
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.
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
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.
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.
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
Wrist & Hand
Carpal Tunnel Release, Fracture, Tendon Repairs
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.
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.