Shoulder Conditions and Treatments

Shoulder Impingement

What is Shoulder Impingement

The rotator cuff is a group of muscles and tendons that attach to the bones of the shoulder joint, allowing the shoulder to move and keep it stable. The tendons of the rotator cuff pass underneath a bony area on their way to attaching to the top of the humerus. As the tendons become inflamed or irritated, they can become frayed during shoulder movements. This problem is called rotator cuff tendonitis, or impingement syndrome.

Shoulder Impingement Causes:

Sleeping on the same arm at night
Repeated overhead activity
Poor control or coordination of your shoulder and shoulder blade muscles
Poor posture.

Shoulder Impingement Treatment

Treating tendonitis or impingement involves resting the shoulder and avoiding activities that cause pain.

Stage 1 – up to one week

Reduce pain and swelling by applying ice and compression 60 minutes every 2 hours while avoiding overhead and painful activities.

Stage 2 – second week or longer

Use pain as a guide to determine how much activity is enough. Gently increase shoulder range of motion and begin light stretching and postural correction exercises.

Recommended Exercises

Codmans

Shift your body weight in circles to allow your injured arm to swing in circles freely. Your injured arm should be fully relaxed 30 clockwise, 30 counter clockwise

Active Assistive Flexion

In the standing position and holding wand/cane with both arms as shown, raise it up allowing your unaffected arm to push up your affected arm. 10 reps 3 sets

Active Assistive Abduction

While holding a wand/cane palm face up on the injured side and palm face down on the uninjured side, slowly raise up your injured arm to the side. 10 reps 3 sets

Active Assistive ER/IR

In the standing position, hold a wand/cane with both hands keeping your elbows bent. Rock your hands and wand side to side. Your affected arm should be partially relaxed while your unaffected arm does most of the work. 10 reps 3 sets

Sleeper Stretch

Lying with the affected arm on the bottom. Your affected arm should be bent with forearm pointed upwards. Next, use your unaffected arm to gently push forearm towards the table or bed. Hold 10 sec Sets 10

Corner Stretch High

At a corner of a wall, place your arms on the walls with elbows bent as shown. Take one step forward towards the corner. Bend your front knee until a stretch is felt along the front of your chest. Hold 30 sec 3 reps

Corner Stretch Low

At a corner of a wall, place your arms downward as shown. Take one step forward towards the corner. Bend your front knee until a stretch is felt along the front of your chest and/or shoulders. Hold 30 sec 3 reps

Hold Ups

Stand with knees straight while leaning into wall with hands in hold-up position, keep head, shoulder, and lower back flat against the wall. Slide the backs of both hands up the wall toward each other Reps 10 Sets 3

Scapular Retractions

Draw your shoulder blades back and down. Hold 3 sec Reps 10 Sets 3

Elastic Rows

Holding elastic band with both hands, draw back the band as you bend your elbows. Keep your elbows near the side of your body. Reps 10 Sets 3

Prone T’s

Lying on stomach, lift arms and shoulders making the shape of a “T”. Keep chin slightly tucked and squeeze shoulder blades together. Reps 10 Sets 3

Prone Y’s

Lying on stomach, Lift arms and shoulders making the shape of a “Y”. Keep chin slightly tucked and squeeze shoulder blades together. Reps 10 Sets 3

Ball Circles

While standing and holding a ball on a wall, lean into the ball and roll the ball in small circles. Reps 10 Sets 3

Rotator Cuff Tears

Your rotator cuff is a key part of your shoulder, made up of four muscles that help keep your upper arm bone firmly in your shoulder socket. However, the rotator cuff is also prone to tearing that could worsen over time and require orthopaedic treatment.

Causes of a Rotator Cuff Tear

Rotator cuff tears generally fall into two categories: acute and chronic. An acute rotator cuff tear is caused by a quick, jerking motion with explosive force. This is common in contact sports, like football and basketball, as well as other high-intensity activities, such as crossfit and weightlifting.

Chronic rotator cuff tears are much more common and occur when a patient has some degree of impingement syndrome that causes the rotator cuff to weaken over time. This often occurs naturally as part of aging.

Signs of a Rotator Cuff Tear

With an acute rotator cuff tear, the patient will generally hear a tearing or popping sound during an explosive physical movement.

Chronic rotator cuff tears happen gradually over time. The patient may feel weakness when lifting objects over their head or away from their body. Pain in the shoulder may wake them during the night and make a popping sound as they roll over in bed.

Treatment for a Rotator Cuff Tear

We begin our rotator cuff injury treatments are conservatively as possible. Diagnosis of the injury would involve an office visit and a physical evaluation, where we will assess the severity of the injury. An MRI or x-ray may be required to confirm the diagnosis.

If the rotator cuff is sprained, but not torn:

Oral or injection anti-inflammatories will be given to reduce pain and swelling
A physical therapy regimen will be prescribed to restore shoulder mobility

If the rotator cuff is torn:

An arthroscopic repair of the rotator cuff will be necessary
This is a minimally invasive procedure where two small incisions are made and the tendon is bonded back to the bone
In the meantime, oral or injection anti-inflammatories will be given to reduce pain and swelling
During recovery, a physical therapy regimen will be prescribed to restore shoulder mobility

Watch the video below for a detailed look at how Dr. Melander repairs a torn rotator cuff.

Not all rotator cuff tears are created equal. Depending on the location and severity of the tear, recovery times may vary anywhere from three to six months. During that time, the patient will wear a shoulder sling and go through physical therapy.

Rotator Cuff Injury Prevention

Rotator cuff tears are increasingly common as people age, but there are still a number of ways to prevent injury, such as:

Stretching your shoulders before and after any intense physical activity
Practicing good posture
Avoiding sleeping on your shoulder
Refraining from smoking

In addition to the actions listed above, there are several exercises you can do at home to reduce shoulder impingement syndrome and alleviate shoulder pain.

Schedule a Consultation

If you believe you’ve suffered a rotator cuff injury, schedule a consultation with Dr. Melander right away. Our sports medicine experts will evaluate the severity of the injury, provide treatment options and get you back to full strength as quickly as possible.

Shoulder Instability

What is Shoulder Instability

The head of the humerus fits into a shallow socket in your shoulder blade called the glenoid. Strong connective tissue and other ligaments, tendons, and muscles of the shoulder provide stability to the joint. When this system becomes loose or torn the shoulder becomes unstable.

Shoulder Instability Causes:

Shoulder dislocation

Often caused by severe injury or trauma. With a dislocation the ligaments in the front are injured and often leads to continued dislocations.

Repetitive Strain

Shoulder instability can also be resultant of increased laxity due to anatomical reasons or repetitive overhead motion. Looser ligaments make maintaining shoulder instability difficult.

Multidirectional Instability

In a small number of patients the shoulder can become unstable without a history of injury or repetitive strain.

Shoulder Instability Exercises

Perform each exercise 1-2 x’s per day, gradually increasing weight and sets.