Rotator cuff tears are one of the most common causes for shoulder surgery. Rotator cuff tears can happen in all ages. Younger people can have a tear resulting from trauma such as a fall. Middle-aged people sustain a tear resulting from degeneration of the rotator cuff tendons. People with a rotator cuff tear can experience pain in the shoulder radiating down into the middle of the arm especially with movement, as well as weakness and sometimes the complete inability to raise the arm. An MRI is the most common diagnostic test to determine a rotator cuff tear. Conservative treatments such as activity modification, cortisone injections, and physical therapy can be prescribed for minor tears. Moderate and significant tears usually require arthroscopic surgery with physical therapy afterwards.
Shoulder impingement is usually the result of inflammation of the rotator cuff tendons which could occur from overuse, trauma, etc. Signs of inflammation are redness, warmth, and tenderness over the area as well as loss of function. Impingement occurs when the arm is raised overhead repeatedly, raised overhead with a heavy load, or from sleeping on the shoulder. Treatment will usually involve rest, anti-inflammatories, and physical therapy to rehabilitate the irritated tendon.
Adhesive capsulitis, or frozen shoulder, occurs when the capsule surrounding the shoulder joint become tightened, affecting range of motion. There are many possible causes of frozen shoulder, such as minor trauma, hyperthyroidism, diabetes, post-surgical patients, and prolonged immobilization of shoulder. This condition is characterized by three phases – freezing, frozen, and thawing stages. Frozen shoulder can go away on its own but can take up to two years to do so. Physical therapy in beneficial in helping restore range of motion and strength to help patients progress through the stages appropriately.
An AC separation, also known as a shoulder separation, commonly occurs from a fall on the end of the shoulder. There is a hallmark deformity of the collarbone “sticking up.” Treatment for a separated shoulder includes rest, ice, bracing, pain/anti-inflammatory medication, and physical therapy to restore appropriate range of motion.
Shoulder instability occurs when the shoulder dislocates out of its socket and must be “re-located” by a medical professional. Shoulder instability can also occur when the shoulder slips out of joint and then will spontaneously move back into place, also called a subluxation. The shoulder can dislocate in a forward direction (anterior), a backward direction (posterior), or a downward direction (multidirectional instability). The shoulder is most at risk for a dislocation in the forward direction when the arm is abducted and externally rotated, such as falling on an outstretched arm or when tackling a player in football. A sudden dislocation is a medical emergency and the person should be evaluated to make sure no damage is sustained to the blood vessels and nerves in the arm. Physical therapy is typically started about 2-3 weeks after a dislocation to strengthen the muscles around the shoulder joint to make it more stable.