Shoulder Injuries

The shoulder joint is a highly mobile ball-and-socket joint that connects the upper arm bone (humerus) to the shoulder blade (scapula), enabling a wide range of motion for the arm

The shoulder joint is biomechanically very complex, combining movements in three planes.

Four joints are involved in the movement of the shoulder: the connection between the humerus and the scapula, the connection between the scapula and the clavicle, the connection between the clavicle and the sternum, and the connection between the scapula and the ribcage.

Around the joint that connects the humerus and the scapula, there are four muscles that form a kind of dome above the humerus. These are called the Rotator Cuff muscles. The role of these muscles is to center the head of the humerus and stabilize the joint.

One common cause of shoulder pain is instability. The shoulder joint is the most mobile joint in the body, making it the least stable.

When pain arises in the shoulder, we perform certain physiological tests to help us pinpoint the source of the pain.

I've chosen to focus on some common shoulder injuries:

1. Tendinitis/Tendon Rupture: The most common injury is to the tendon of the supraspinatus due to its location. Tendinitis can progress to a tendon rupture. When a tear occurs in the tendon, the tear itself does not heal but rather forms scar tissue. Our goal is to ensure that the scar tissue does not interfere with the muscle's contraction. Simultaneously, we aim to create new fibers to restore the muscle's strength and function. To prevent aggravating the tear, all activity should be performed without pain, and strengthening should be done gradually with support to avoid exacerbating the rupture.
   

2. Frozen Shoulder: This condition occurs when the tissue surrounding the joint becomes inflamed. The inflammation causes the tissue to become stiffer and narrower around the joint, resulting in pain and significant limitations in range of motion. This condition is more common in women around the age of fifty, and while there may be a hormonal connection, the exact cause of the inflammation is not definitively known. Frozen shoulder is a very frustrating condition, as the restriction in movement is significant and affects the quality of daily activities. In treatment, we focus on learning breathing techniques that allow the body to relax in specific positions, facilitating healing. I employ tissue release through massage and mobility exercises, primarily focusing on static stretching positions that enable the tissue to change its length. The complete healing process can last up to a year, but pain relief can be felt after a few individual treatments.
   

3. Recurrent Shoulder Dislocations: As previously mentioned, the shoulder joint is highly mobile, making it the joint with the largest range of motion in the body. However, this mobility comes at the expense of stability. Stability in the joint is maintained by the surrounding ligaments and muscles. In the case of a shoulder dislocation, the head of the humerus shifts from its place, causing a significant stretching of the ligaments. This stretching alters the elasticity of the ligaments. The body has the ability to heal itself; after the first dislocation, the ligaments can return to their original stiffness and restore joint stability, a process that takes approximately 6 weeks. However, if another dislocation occurs, the ligaments lengthen and lose their stiffness, potentially resulting in irreversible damage. In such cases, we aim to rely on the muscles surrounding the joint to provide stability. The initial focus is on strengthening the muscles around the joint with restrictions to prevent further dislocation. Gradually, the strengthening will be directed towards the direction of dislocation to ensure the muscles prevent further occurrences.