Shoulder Impingement Syndrome (Bursitis/Rotator Cuff)
Shoulder impingement syndrome typically describes the repetitive compression on the rotator cuff tendons that causes a general impingement and injury to these tendons or associated bursa producing pain and limitations in motion of the shoulder. The compression may occur over time (overuse) as seen in repetitive overhead motions of the shoulder such as throwing, reaching or lifting movements, or following an acute trauma such as a fall onto the shoulder. Other causes include bony abnormalities, damage to the joint and the soft tissue structures in the region, muscle damage and arthritic changes. This result is either rotator cuff tendinitis whereby the tendons are damaged or inﬂamed, or bursitis whereby the bursa (ﬂuid-ﬁlled cushion-like sac) between the acromion (bone at the top of your shoulder) and the rotator cuff tendon becomes inﬂamed. Symptoms include painful and restricted shoulder movements and associated weakness. The pain is exacerbated by throwing, lifting and reaching movements and may radiate down the arm. This injury can present long term symptoms and it is therefore important to see an experienced practitioner for an accurate diagnosis and treatment plan to reduce the risk of recurrence and accelerate healing, as well as differentiating between a soft tissue injury and any joint abnormalities that may cause ongoing problems.
Acromioclavicular (AC) Joint Injury
The AC joint forms part of the shoulder and can be felt at the bony bump at the top of the shoulder (acromion process) where it meets the collarbone (clavicle). The joint is supported by ligaments (acromioclavicular and coracoclavicular ligaments) and it is these ligaments that are typically affected in an AC joint injury. Injury commonly occurs in active young adults from impact to the AC joint that pushes it beneath the clavicle causing a sprain or joint separation, and in severe cases, complete ligament tears. It often occurs in high impact contact sports and throwing sports as well as in trauma such as falls onto the shoulder, bicycle and car accidents. Following impact, swelling, pain and tenderness is felt at the collar bone that can radiate throughout the shoulder, the shoulder may stiffen, pain is exacerbated by moving the shoulder in most directions, especially when trying to raise the arm. A lump at the injury site may also be present. Because there are numerous structures that can be affected in shoulder injuries, it is important to have your shoulder thoroughly checked by your health professional to ensure you get the best treatment and care advice to get you back to full function.
Shoulder instability describes the condition whereby the humerus (upper arm bone) is displaced out of the shoulder socket. While the shoulder is a ball-and-socket joint with a strong joint capsule and supporting ligament system, injury or repetitive strain can disrupt the joint and cause painful subluxation (the ball of the humerus partially comes out of the joint) or dislocation (the ball of the humerus comes completely out of the socket). Repetitive injury and dislocation can lead to chronic instability whereby the tissues of the shoulder joint are weakened and stretched and are therefore unable to control and prevent further dislocations. Alongside a history of injury and overuse to the shoulder, some connective tissue disorders can also result in loose and unstable shoulder joints.
Frozen Shoulder (Adhesive Capsulitis)
Frozen shoulder describes the swelling and stiffening of the shoulder joint capsule and the surrounding ligaments. While the exact cause is not completely understood, there’s a tendency for occurrence following injury and thereby immobility. Frozen shoulder has a higher prevalence in females over 40 years old and in endocrine conditions such as diabetes and thyroid disturbances. Typically a frozen shoulder will present with stiffness in all directions and pain on movement that can worsen at night. With tissue stiffening, scar tissue forms which can also greatly reduce the movement available at the shoulder joint, a process that occurs slowly over time. This condition can last anywhere between 1-3 years so it is important to seek treatment from a health professional in order to optimise your overall rehabilitation time.