The shoulder joint is one of the most flexible joints in the body. It relies on muscles to give it flexibility and stability. The deep layer of muscle surrounding the shoulder joint are known as the ” rotator cuff”. For a healthy shoulder these muscles must be strong and flexible.
In the younger age group shoulder tendonitis can develop from overuse and impingement. In the older age group it is often chronic muscle imbalances and degeneration that cause the problem.
A bursa is a small sack of fluid that acts as a cushioning shock absorber . The sub acromial bursa , which lies under the outer part of the collar bone, is probably the most problematic one in the shoulder area. There are several other burae in the area which can also become troublesome.
Causes of Shoulder bursitis/tendonitis;
If tendons or bursase are put under repeated stress from poor bio-mechanics they can become inflamed , swollen and painful. Faulty posture and poor sporting techniques – such as serving incorrectly in tennis-can lead to these types of problems.
Physiotherapy Assessment for shoulder bursitis /tendonitis
Although the tendons and bursae are very different structures the cause of problems with them are the same . Physiotherapy assessment will determine which stucture is responsible for the pain.
Firstly the chartered physiotherapist will take a full history of the problem then check the patients posture. The alignment of the head , neck and shoulder blades will be noted.
Next the range of motion in the joint will be measured. Any stiffness will be noted. Then strength of the shoulder muscles will be tested.
Based on assessment we will be able to determine the cause of the bursitis. In many cases a combination of poor posture,muscle imbalance and faulty movement patterns are the root of the problem.
At Swords Physiotherapy we aim to address the cause of the problem . In this way we can treat it effectively and minimize the chance of recurrence.
Physiotherapy treatment for shoulder bursitis and tendonitis
If faulty posture is contributing to the problem we will correct this. We teach the patient how to use visual and auditory cues to check their posture. Mirror exercises are very helpful. Sometimes we will tape the shoulders into a good postural position to reinforce postural awareness. Correct posture will off load the inflamed area at rest.
In acute bursitis the patient will be shown positions of ease. Ice can be helpful in easing symptoms. Electrotherapeutic modalities such as T.E.N.S.can also be used to treat pain.
Muscle imbalances can develop over years. They are often secondary to poor posture or poor movement patterns. Muscles that are tight will need to be stretched out and this is often part of physiotherapy treatment. The patient will be shown how to self stretch the muscles at home. Weakened muscles will need to strengthened. The patient will be prescribed specific exercises to work on at home or in the gym.
At swords physio we will always work closely with sports coaches if we think the faulty movement pattern is related to a sporting technique . Video analysis is now easy to do and a trained eye can determine faults.
Rotator Cuff Tears
The deep layer of muscles surrounding the shoulder joint are known as the rotator cuff. In the older part of the population tears are common results of injury to the shoulder. Falls and lifting/throwing awkwardly overhead are common injury mechanisms.
Rotator cuff Strains are classified as 1st, 2nd and 3rd degree:
- 1st Degree: Mild muscle sprain with minor pain, swelling and only very temporary dysfunction. Usually do not require medical or physiotherapy intervention to resolve fully.
- 2nd Degree: Moderate muscle Sprain- pain, swelling and dysfunction . The joint will be painful to move and it may be difficult to move the arm.
This type of sprain will recover quicker and better with physiotherapy.
- 3rd Degree: Major muscle sprain- pain, swelling and major dysfunction (e.g. unable to lift the arm). This type of sprain needs medical intervention for surgical repair.Surgical repairs are more successful in patients under 60. At swords physio if we suspect a full thickness rotator cuff tear we will refer the patient for a MRI scan. A MRI scan is the best type of investigation for this type of problem. X-rays show only bones not the soft tissue so are not helpful in diagnosis of this type of problem.
Post Surgical Shoulder physiotherapy
With modern surgical techniques many shoulder problems can be improved. However the long term success is very dependent on correct rehabilatation afterwards. Common shoulder surgical procedures such as hydro dilitation, manipulation under anaesthetic, decompression/acromioplasty , rotator cuff repair and joint replacement are seen by our chartered physiotherapists.
At swords physiotherapy we follow post -op protocol set my the orthopaedic surgeon. We aim to restore joint mobility and strength to the affected shoulder. The patient will be given specific exercises at each phase of rehabilitation. We use printed exercise sheets with diagrams of the relevant exercises to help our patients remember the correct techniques at home.