Do you have difficulty reaching the top shelf of the cabinet or fastening your bra? Are you waking up at night if you roll over onto your side or have you noticed that pouring milk into coffee is a burden? Your Physician advised you it was an issue with your shoulder but you didn’t quite understand what he or she said. Are they telling you that the problem is in your shoulder but you are feeling it in other areas? The shoulder articulation is a complex structure composed of the sternoclavicular joint, acromioclavicular joint, glenohumeral joint, and scapulothoracic joint. The shoulder also consists of a joint capsule, muscles, ligaments, and tendons. Action in the shoulder requires a certain amount of movement in the mid-back and cervical spine. Shoulder pain can refer down your arm and shoulder blade which works with your mid-back. Among so many moving pieces it is no wonder shoulder issues are some of the most common problems Physical Therapists encounter in clinics. As a P.T. I ordinarily see patients who have been diagnosed with either a rotator cuff pathology, bursitis, or impingement. Before we go any further I feel like I must implore you to not get too caught up in a diagnosis because like with most issues in the body if provided the right care you will get better. Also don’t let a diagnosis freak you out and have you make drastic life choices before you are ready.
Many patient’s come in with a diagnosis of Rotator cuff lesion. The rotator cuff is a group of four muscles that help to stabilize the shoulder and assist with rotation and abduction of the shoulder. The muscles in the rotator cuff include the Supraspinatus which helps move the arm away from the body, the Infraspinatus and Teres Minor which help to perform motions such as brushing your hair or the overhead motion to throw a baseball or volleyball and the Subscapularis which helps with motions such as scratching your back and wiping your bottom. These rotator cuff muscles are like support beams of the shoulder helping to provide some stability during movement. Like support beams they are generally strong especially if proper care and maintenance have been given to them. Of these stabilizing structures the supraspinatus is most often involved with issues such as a rotator cuff tear or tendonitis. It is generally the most diminutive of the four and gets a lot of work. Innumerable patients have come in fearing the worst when informed that their shoulder presents with some type of rotator cuff pathology. Physical Therapy will customarily include some type of strengthening and mobility program focusing on these muscles. A superior program will consist of exercises in each plane that the shoulder moves in and in multiple positions focusing on activities pertinent to the patient being seen. Also the patient should be properly assessed in other regions of the body to make sure there are no underlying factors that could be contributing to the shoulder pain/limitations and if found these issues should be addressed. Modalities such as ice, heat, or even electronic stimulation should be used sparingly and definitely should not take up the majority of the treatment session.
Another diagnosis of the shoulder commonly seen in clinics is Shoulder Bursitis. A bursa is a fluid-filled sac that serves to reduce the friction of one surface gliding on another. A bursa is supposed to allow for a smoother ride. Bursitis is the inflammation or irritation of one of these bursae. Research shows that there are at least 6-8 bursae in the shoulder. Signs of bursitis include a “hot spot” that is quite sensitive to touch, decreased mobility, and pain with movement and with pain with an activity such as lying on the shoulder. Bursae generally just don’t switch to an irritated state on their own and are usually due to some type of trauma or compensatory pattern. Conservative interventions generally achieve resolution when managing bursitis. Focus initially is placed on reducing pain to tolerable levels, then working to improve either a lack of coordination, mobility, and strength but usually all three.
As a therapist, I’ve endured a cascade of scripts calling for treatment of Shoulder Impingement Syndrome. Impingement is noted to be inflammation of a tendon in a very narrow space. For instance follow your collarbone from your sternum down to the close to your shoulder. There is a bump there called the Acromion. Walk your fingers just below that bump and you have your Subacromial Space. Many individuals are tender in that area and have been diagnosed with impingement. The subacromial space is similar to a modest studio apartment with multiple roommates. As long as everyone minds their business it can work even though there may be some occasional aches in pains in the living arrangement. It’s when one roommate starts taking up too much space is there a problem. As with the other two pathologies most of these people do well without surgical interventions.
It is important to remember that “You are not your diagnosis”. Most of these issues are part of the normal aging process and can usually be improved to at least a satisfactory level if one is willing to put the work in and make any necessary changes. There will be some pain at times a lot of pain but remember pain is required to grow. The gardener has to prune the vine to get the good fruit to grow. Don’t let the pain and decreased motion wreck your life by limiting what you do. Fear, uncontrolled stress and depression slows down the healing process and aren’t conducive to your health. Find a good Physical Therapist that empowers you to be an active, driving force in your treatment and who doesn’t just treat you as a diagnosis.