Rotator Cuff Tendonitis/Tear
A rotator cuff injury is an injury to one or more of the four muscles in the shoulder that allow the shoulder to rotate the arm and also to depress the upper arm bone which allows you to lift your arm overhead. Rotator cuff injuries may come on suddenly and be associated with a specific injury such as a fall (acute), or it may be something that gets progressively worse over time with an activity that aggravates the muscle (chronic). Occasionally, even a simple act like rolling over in bed can result in a rotator cuff injury.
The type of injury can range from an inflammation of the muscle without any permanent damage, such as tendinitis. Tendonitis can lead to other complications including impingement syndrome or even a complete or partial tear of the muscle that might require surgery to fix it.
Impingement syndrome is a common condition affecting the shoulder and is often seen in aging adults, closely related to shoulder bursitis and rotator cuff tendinitis. When an injury occurs to the rotator cuff muscles they respond by swelling. However, because the rotator cuff muscles are surrounded by bone, when they swell, the swelling decreases the available joint space which causes then rotator cuff tendons to be pinched or impinged within the joint space.
The typical symptoms of impingement syndrome include difficulty reaching up behind the back, pain with overhead use of the arm and weakness of shoulder muscles. If these muscles are injured for a long period of time, the muscle can actually tear, resulting in a rotator cuff tear. Some people will have rupture of their biceps muscle as part of this continuing impingement process.
Adhesive Capsulitis also known as a "frozen shoulder" is stiffness, pain, and limited range of movement in your shoulder that may follow an injury. The tissues around the joint stiffen, scar tissue forms, and shoulder movements become difficult and painful. Adhesive capsulitis can develop when you stop using the joint normally because of pain, injury, or a chronic health condition, such as diabetes or arthritis. Any shoulder problem can cause adhesive capsulitis if you do not work to maintain full range of motion.
Adhesive capsulitis occurs typically after surgery or injury, most often in people 40 to 70 years of age, more often in women (especially in postmenopausal women) than men, and most often in people with chronic diseases.
The labrum is a band of tough cartilage and connective tissue that lines the rim of the shoulder socket. It cushions the shoulder joint, preventing the bones from directly rubbing against each other. The labrum also helps keep the shoulder bone in place and increases stability of the joint.
The labrum can tear for many reasons. Some people get torn labra from rrepetitive overhead throwing, lifting heavy objects below shoulder height or catching heavy objects and falling onto an outstretched arm. Labral tears can make you feel like your leg is "catching" or "clicking" in the socket as you move it. Over time, labral tears may cause permanent damage to the joint.
Symptoms of a labral tear can include shoulder pain which cannot be localized to a specific point, pain that is made worse by overhead activities or when the arm is held behind the back, weakness and instability in the shoulder, pain on resisted flexion of the biceps (bending the elbow against resistance), and tenderness over the front of the shoulder.
Treatments for these disorders pre-operative and post-operative may include:
Taping techniques to promote correct mechanical alignment, ROM, stretching, and strengthening exercises coupled with pain and anti-inflammatory modalities including ultrasound, soft tissue mobilization, joint mobilization, iontophoresis, cryotherapy, and electrical stimulation pre-operatively. Post-operative rehab includes ROM, stretching, and strengthening exercises coupled with pain and anti-inflammatory modalities after exercises.