Shoulder conditions
Instability, frozen shoulder, tendinopathy: targeted care for each condition
Frozen shoulder
What is frozen shoulder?
Frozen shoulder, also known as adhesive capsulitis, is a condition characterized by chronic inflammation, thickening, and shortening of the soft tissues surrounding the shoulder joint. It leads to a progressive limitation of movement and significant pain, which can greatly impact daily activities.
What are the causes and risk factors?
- Frozen shoulder can be triggered by several factors:
- Prolonged immobilization after a shoulder injury, fracture, or surgery.
- Systemic diseases such as diabetes, thyroid disorders, or autoimmune conditions.
- Idiopathic factors, where the exact cause remains unknown.
How does the condition progress?
- This condition typically follows three distinct phases:
- Phase 1: gradual onset of intense pain, worsened by movement, accompanied by increasing stiffness.
- Phase 2: pain may slightly decrease, but stiffness becomes more pronounced, significantly limiting the range of motion.
- Phase 3: mobility gradually improves and pain decreases, although full recovery may take several months to a few years.
Treatment and personalized follow-up
Conservative (non-surgical) treatment
- Physical therapy: tailored exercises to improve mobility and reduce pain.
- Medications: pain relievers and anti-inflammatory drugs to alleviate discomfort.
- Cortisone injections: recommended for intense and persistent pain.
- Passive mobilization and stretching supervised by a professional to gradually restore range of motion.
Surgical treatment (advanced cases)
- Indicated when conservative treatments are insufficient to restore mobility and relieve pain.
- Possible options: manipulation under anesthesia to loosen the joint capsule or arthroscopy to release contracted tissues.
What is the role of physiotherapists in the recovery of shoulder disorders?
Physiotherapists play a key role in the management of frozen shoulder. A personalized rehabilitation program helps to:
- Gradually maintain and restore shoulder mobility.
- Reduce pain through appropriate techniques.
- Support the patient throughout their recovery process.
A thorough follow-up and an approach tailored to each patient are essential to optimize healing and minimize the risk of recurrence.
Subacromial impingement or Shoulder impingement syndrome
What is subacromial impingement?
Subacromial impingement, or shoulder impingement syndrome, is a condition caused by the compression of the rotator cuff tendons and soft tissues located beneath the acromion (the bony part of the shoulder blade). This compression leads to irritation and inflammation, causing pain and limiting shoulder movement.
What are the causes and risk factors?
- Acromion morphology, which can be more curved and promote compression of the underlying structures.
- Muscle weakness in the rotator cuff and upper back muscles.
- Poor posture, leading to improper shoulder mechanics.
- Repetitive movements requiring overhead actions (e.g., throwing a ball, lifting objects, painting, swimming).
What are the symptoms?
- Pain at the front and side of the shoulder, increasing with arm elevation.
- A pinching sensation during shoulder movements.
- Difficulty reaching objects overhead or placing the arm behind the back.
- Night pain, often worsened when sleeping on the affected side.
What are the treatments?
Conservative (non-surgical) approach
- Rest and activity modification: avoid aggravating movements.
- Physical therapy: strengthening exercises and posture improvement.
- Medications: anti-inflammatory drugs to reduce pain and inflammation.
- Cortisone injections for persistent pain to reduce inflammation.
Surgical approach (as a last resort)
- If conservative treatments are insufficient, surgery may be considered to widen the subacromial space and reduce compression.
What is the role of the expert physiotherapist?
A physiotherapist can help to:
- Identify problematic movements and postures.
- Design an exercise program to strengthen the rotator cuff and improve mobility.
- Work on postural adjustments to prevent symptom worsening.
- Guide rehabilitation after surgical intervention.
Appropriate care helps relieve pain and improve shoulder function, thereby minimizing the risk of long-term complications.
Rotator cuff: tendinopathy and tear
What is the rotator cuff?
The rotator cuff is a group of muscles and tendons located in the shoulder, connecting the humerus (upper arm bone) to the scapula (shoulder blade). This structure plays a vital role in shoulder stability and mobility. It is composed of four muscles, each of which can be affected by injury or tear. When such an injury occurs, it can cause pain and reduced strength, sometimes making it impossible to lift the arm.
What are the causes of a rotator cuff injury?
A rotator cuff injury can occur suddenly due to trauma (fall, blow, or excessive force applied to the arm) or gradually due to wear and tear from repetitive movements. Repeating overhead actions, such as painting, cleaning windows, playing tennis, swimming, or lifting weights incorrectly, promotes this wear. Poor posture, such as slouching or projecting the shoulders forward, reduces the range of motion of the rotator cuff, causing friction that can lead to inflammation and, eventually, a tear.
What are the symptoms of a rotator cuff injury?
- Shoulder pain, especially during overhead movements or rotation
- Weakness when lifting the arm or carrying objects
- Stiffness or loss of mobility
- Nighttime discomfort, especially when lying on the affected shoulder
- Sensation of cracking or grinding during movement
How to treat the rotator cuff?
The treatment of the rotator cuff varies depending on the severity of the injury. It is advisable to consult a doctor for an accurate diagnosis. The initial management often includes rest, pain management with anti-inflammatory medications, and a physical therapy program aimed at restoring mobility and muscle strength. In most cases, proper rehabilitation can prevent the need for surgery.
If surgery is necessary, the shoulder will be immobilized for four to six weeks after the procedure. Recovery then relies on gradual rehabilitation to restore optimal function while preventing complications.
What is the role of the physiotherapist in rehabilitation?
The physiotherapist plays a crucial role in managing rotator cuff injuries, whether the treatment is conservative or surgical. Initially, rehabilitation includes passive movements to restore mobility while minimizing pain. The use of heat or ice can also help relieve discomfort.
Gradually, the physiotherapist introduces exercises aimed at strengthening the shoulder stabilizing muscles and improving posture. They also provide guidance on adapting daily activities and sleep positions to minimize nighttime pain.
Once recovery progresses, the physiotherapist’s support focuses on the safe return to professional, sports, and leisure activities, ensuring optimal functionality and preventing recurrences.
Superior labral tear (SLAP lesion)
What is a superior labral tear?
A superior labral tear, also known as a SLAP (Superior Labrum Anterior to Posterior) lesion, refers to a partial or complete tear of the labrum, a fibrocartilaginous ring surrounding the socket of the shoulder blade where the head of the humerus inserts. This structure stabilizes the shoulder joint and absorbs shock. A SLAP tear affects the upper part of the labrum and can compromise both the stability and mobility of the shoulder.
What are the symptoms of a superior labral tear?
People with a superior labral tear typically experience deep shoulder pain, especially during overhead movements or sports activities involving throwing. A sensation of popping, locking, or instability may also be present. A decrease in strength and muscle fatigue are also common symptoms.
What are the causes of a superior labral tear?
This injury can result from trauma, such as a fall onto an outstretched arm, a sudden movement, or a direct impact on the shoulder. It can also develop gradually due to repeated microtraumas, especially in athletes engaging in activities that heavily stress the shoulder, such as baseball, volleyball, or swimming.
What are the treatments for a superior labral tear?
Treatment depends on the severity of the tear. For moderate cases, a conservative approach including rest, anti-inflammatory medications, and a rehabilitation program may be sufficient. When pain persists and shoulder function is significantly impaired, surgical intervention may be necessary to repair the labrum and restore joint stability.
What is the role of the physiotherapist in recovery?
The physiotherapist plays a key role in rehabilitation after a superior labral tear. They provide specific exercises to improve mobility, strengthen the shoulder stabilizing muscles, and restore movement coordination. The goal is to reduce pain, optimize recovery, and prevent recurrence, especially in individuals engaged in sports or professional activities that place high demands on the shoulder.
Traumatic shoulder dislocation
What is a traumatic shoulder dislocation?
A shoulder dislocation occurs when a shock or forced movement dislodges the humerus from its normal position in the shoulder joint. This injury can damage the surrounding ligaments, muscles, and tendons, and may sometimes result in a fracture of the humerus or the glenoid.
What are the causes and risk factors?
- Falls leading to direct impact on the shoulder
- Sports injuries involving sudden movements or violent impacts
- Repetitive traumas weakening the joint
What are the symptoms?
- Severe and sudden shoulder pain
- Sensation of instability or dislocation of the joint
- Numbness, tingling, or weakness in the arm
- Visible deformity of the shoulder
Management and treatments
Diagnosis and immobilization
- An X-ray is performed to assess the severity of the dislocation and any potential complications.
- The shoulder must be protected with a sling or brace after reduction.
Possible treatments
- Manual reduction: repositioning of the humerus into the joint by a healthcare professional.
- Immobilization: wearing a brace or sling to limit movement and promote healing.
- Rehabilitation: physical therapy to strengthen stabilizing muscles and restore mobility.
- Surgery: in case of recurrent dislocations or associated injuries, surgery may be necessary to stabilize the joint.
What is the role of the hand and upper limb therapist?
A specialized therapist plays a key role in managing traumatic shoulder dislocations. The therapeutic approach is individualized based on the severity of the injury. The goal is to protect the shoulder, reduce pain, and improve mobility through tailored exercises, targeted activities, and advice on returning to daily activities, work, or sports. Close collaboration with the doctor helps optimize recovery and prevent recurrences.
Thoracic outlet syndrome
What is thoracic outlet syndrome?
Thoracic outlet syndrome is a condition resulting from the compression of nerves and blood vessels in the neck and shoulder region. This compression can cause a variety of symptoms affecting the neck, shoulder, arm, and hand.
What are the symptoms of thoracic outlet syndrome?
Symptoms include neck pain, a feeling of heaviness in the arm, tingling or numbness in the hand, muscle weakness, and sometimes a bluish discoloration of the fingers due to poor blood circulation. Fatigue and decreased endurance during daily tasks are also common.
What are the causes of thoracic outlet syndrome?
This syndrome can be caused by several factors, including poor posture, inadequate ergonomic setup, excessive muscle tension, the presence of an extra rib, or pressure from heavy bags or tight clothing. Previous trauma to the neck or shoulder can also contribute to its development.
What are the treatments for thoracic outlet syndrome?
The treatment primarily focuses on correcting aggravating factors, including improving posture and adapting daily activities. Specific exercises may be prescribed to stretch the muscles and improve nerve mobility. In more severe cases, medical management or surgical intervention may be considered.
What is the role of the physiotherapist in recovery?
A physiotherapist assesses postures and muscle tensions that may aggravate symptoms. They provide ergonomic adjustments and a program of exercises to improve nerve mobility and strengthen stabilizing muscles. Patient education on proper practices at work and home is essential to reduce compression and promote recovery.
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