Shoulder

Ryan LaCorte Treatments

The shoulder complex is comprised of three bony articulations; the sternoclavicular joint, the acromioclavicular joint and the glenohumeral joint.  The complexity of the shoulder lies in its lack of attachment to the rest of the body.  The only point at which the shoulder complex attaches to the body is the sternoclavicular joint (where the clavicle or collar bone attaches to the sternum of chest.)  The acromioclavicular joint connects the clavicle to the scapula (shoulder blade.)  This joint makes up the roof of the shoulder complex and connects the shoulder blade to the collar bone.  Finally, the glenohumeral joint (the attachment of the humerus to the scapula) is a ball and socket joint where the majority of shoulder motion occurs.  All of these joints have stabilizing ligaments as well as joint capsules and cartilage. The muscles supporting and controlling the shoulder complex serve as the primary stabilizer.  The shoulder complex’s lack of attachments to the trunk allows for a great amount of joint motion.  The coordinated contraction of multiple shoulder muscles increases the versatility, control, and range of active movements available to the upper extremity. Due to the complex nature of this functional relationship among the shoulder muscles, paralysis, weakness, or tightness of any single muscle can disrupt the entire shoulder complex and lead to injury.  Listed below are several common injuries involving the shoulder complex.

Rotator Cuff Impingement or Tear

The Rotator cuff consists of four muscles that originate from the scapula (shoulder blade) and insert onto the proximal humerus (arm.)  These muscles control all shoulder motion.  Impingement occurs as the arm is raised to the front or side, at or above shoulder level, and the tendons of the rotator cuff are pinched between the head of the humerus and acromion.  In most cases, rotator cuff injury is secondary to repetitive overhead motion.  As the rotator cuff becomes irritated, the muscles will no longer contract.  This drastically effects the coordinated movements of the shoulder and leads to further impingement and injury.  In many cases, the impingement occurs due to arthritic changes or bone spurs that can occur along the underside of the acromioclavicular joint thus narrowing the space for the rotator cuff tendons to pass. Over time, repetitive injury to rotator cuff tendons can lead to a partial or full thickness tear.  Fortunately, many rotator cuff injuries can be treated conservatively.  If caught early, the goal is to simply control the inflammatory response and restore the coordinated motion of the shoulder.  Frequently anti-inflammatory medications are employed or steroidal injections along with physical therapy to reduce symptoms and restore strength and range of motion.   In more complex cases involving partial or full thickness tears, the goal is to teach the body to utilize the remaining rotator cuff muscles to compensate for the injured muscle.  As stated previously, the rotator cuff consists of four muscles.  If one is torn, the body can frequently learn to function with the remaining 3 muscles.  Your physical therapist will perform a thorough evaluation to assess your condition and devise a treatment plan to best address your symptoms.   All of our facilities are equipped with state of the art modalities and equipment to meet your needs.   Please visit our Toms River, Whiting, Manchester, Brick, Forked River, Freehold, Jackson, or Barnegat facilities and allow us to “give you your life back.”

*** For more information please see our article on Shoulder Impingement by Diane Sinnott and “Rotator Cuff Injuries Aren’t Just For Athletes” written by Frank Ranuro in our publications.

Subacromial Bursitis

While there are multiple structures in the shoulder complex that are frequently injured, the subacromial bursa is one of the easiest to irritate.  The subacromial bursa separates the rotator cuff and biceps long head tendon from the acromion process of the scapula.  In many cases involving the rotator cuff tendons, the bursa will also become inflamed.  In most cases, rotator cuff tendonitis and subacromial bursitis go hand in hand.  As one structure is irritated, the other will also become inflamed.  Treatment of subacromial bursitis is very similar to that of rotator cuff tendonitis.  The goal is to reduce the inflammation of subacromial bursa while also taking away the mechanism if the irritation.   Your physical therapist will perform a thorough evaluation to assess your condition and devise a treatment plan to best address your symptoms.  Depending upon the condition, modalities and different manual techniques are employed along with range of motion and strengthening exercises.  All of our facilities are equipped with state of the art modalities and equipment to meet your needs.   Please visit our Toms River, Whiting, Manchester, Brick, Forked River, Freehold, Jackson, or Barnegat facilities and allow us to “give you your life back.”

*** For more information please see our article on bursitis written by Lori Heuberger in our publications.

Glenohumeral Dislocation/ Shoulder Instability

The glenohumeral joint is commonly compared to a golf ball on a tee.  This relationship allows for a wide range of motion however creates limited joint stability.  The glenohumeral joint has many stabilizing and supportive structures including countless muscles and ligaments as well as a cartilage ring known as the labrum.  At times the stress placed on the shoulder in specific positions can lead to a dislocation of the glenohumeral joint.  Most commonly, dislocation of the shoulder will occur as the head of the humerus moves anterior (forward) on the glenoid fossa.  This frequently occurs as the arm is abducted (moved to the side) to 90 degrees or higher while the elbow is pushed posteriorly (backwards.)  Unfortunately, reoccurrence following an initial dislocation is very common and therefore medical attention is highly recommended.  In some cases, we are able to strengthen the muscles surrounding the shoulder to improve shoulder stability and prevent future dislocations.  In cases involving 2 or more dislocations, surgery is often recommended to tighten the joint capsule and increase stability.  Your physical therapist will perform a thorough evaluation to assess your condition and devise a treatment plan to best address your symptoms.   All of our facilities are equipped with state of the art modalities and equipment to meet your needs.   Please visit our Toms River, Whiting, Manchester, Brick, Forked River, Freehold, Jackson, or Barnegat facilities and allow us to “give you your life back.”

Adhesive Capsulitis or “Frozen Shoulder”

Adhesive Capsulitis or Frozen shoulder is an inflammatory condition involving the joint capsule surrounding the glenohumeral joint.  When the arm is at the side, the joint capsule will overlap on itself.  It is believed with adhesive capsulitis, the joint capsule with adhere to itself and limit shoulder motion.  There are a number of contributing factors that can lead to adhesive capsulitis including rotator cuff injury, fractures involving the proximal humerus, and Diabetes Melitis.  Once adhesive capsulitis is detected, it is essential to work to prevent progression and regain joint motion.  This can be challenging task and take weeks or months to restore.  Fortunately, most cases of adhesive capsulitis can be treated conservatively through physical therapy.  Your physical therapist will perform a thorough evaluation to assess your condition and devise a treatment plan to best address your symptoms.   All of our facilities are equipped with state of the art modalities and equipment to meet your needs.   Please visit our Toms River, Whiting, Manchester, Brick, Forked River, Freehold, Jackson, or Barnegat facilities and allow us to “give you your life back.”

Proximal Humerus Fracture (Broken Shoulder)

A Proximal Humerus Fracture is the result of a direct trauma to the shoulder.  Frequently, this is a result of a fall landing directly on the shoulder.  Depending on the location of the fracture, some injuries will require surgical intervention, while others are able to heal conservatively (without surgery.)  It is essential to get immediate medical attention to determine the appropriate intervention.  Following a Proximal Humerus Fracture, physical therapy will be a crucial intervention in order to regain shoulder range of motion, strength and functional use.  Your physician and physical therapist will work together to decide when physical therapy is appropriate for you.  In many cases it will be within the first week following the injury.  Early mobilization will play a key role in restoring function. Your physical therapist will perform a thorough evaluation to assess your condition and devise a treatment plan to best address your symptoms. All of our facilities are equipped with state of the art modalities and equipment to meet your needs. Please visit our Toms River, Whiting, Manchester, Brick, Forked River, Freehold, Jackson, or Barnegat facilities and allow us to “give you your life back.”

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