BY IPL


It is no wonder we encounter so many shoulder issues! The shoulder joint, the most mobile, versatile and yet unstable joint in our body, is responsible for so much movement. Because your shoulder is a ball-and-socket joint, it has the ability to move in all directions. Just think how many ways you can move your arm.

The hip, knee and shoulder joints are generally considered to be our most important joints and they are all designed to balance stability with mobility. The American Medical Association tells us that a normal shoulder accounts for 60 percent of upper extremity function. With all this available range of motion, it is easy to see why the shoulder and its close neighbor, the rotator cuff, are vulnerable to injuries.

"Approximately a little over half of my patients coming to me for treatment from shoulder injury, is a result of rotator cuff injuries."
At least in my (IPL"S) practice thats the percentage I see.

To remain in a stable condition, the shoulder depends on the muscles, ligaments and tendons to hold it in place. Your shoulder joints consist of three bones: the humerus (upper arm), the scapula (shoulder blades) and the clavicle (collar bone). Of the nine major muscles that act upon the shoulder, the two largest are the pectoralis major (chest muscle) in the front of the shoulder and the latissimus dorsi, the largest muscle in the back.

The strongest muscle of the shoulder, the deltoid muscle, sits like a cap on top of the shoulder and consists of three muscle heads:

Anterior deltoid, the front part of your deltoid, which when contracted allows you to move your arm away from your side toward the front.

Medial deltoid, located on the side of your delts, which when contracted enables you to lift your arm straight out to the sides.

Posterior deltoid is in the back, providing movement of the arm toward the back.

Four small but very important muscles surrounding the shoulder joint are the rotator cuff muscles. Together they rotate the shoulder joint and help maintain shoulder stability by preventing the arm from sliding out of its socket. During movement, they are the main stabilizers of the shoulder. Strengthening the rotator cuff will help prevent injuries such as tendonitis, rotator cuff tears and shoulder impingements.


The two most common rotator cuff injuries are a result of overuse or acute injuries such as a fall, heavy lifting or pulling with too forceful a movement.
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A bit More On the MOST common Shoulder injuries~

Shoulder injuries are frequently caused by athletic activities that involve excessive, repetitive, overhead motion, such as swimming, tennis, pitching, and weightlifting. Injuries can also occur during everyday activities such washing walls, hanging curtains, and gardening.

Warning Signs of a Shoulder Injury
If you are experiencing pain in your shoulder, ask yourself these questions:
Is your shoulder stiff? Can you rotate your arm in all the normal positions?
Does it feel like your shoulder could pop out or slide out of the socket?
Do you lack the strength in your shoulder to carry out your daily activities?
If you answered "yes" to any one of these questions, you should consult an orthopaedic surgeon for help in determining the severity of the problem.

Most problems in the shoulder involve the muscles, ligaments, and tendons, rather than the bones. Athletes are especially susceptible to shoulder problems. In athletes, shoulder problems can develop slowly through repetitive, intensive training routines.

Some people will have a tendency to ignore the pain and "play through" a shoulder injury, which only aggravates the condition, and may possibly cause more problems. People also may underestimate the extent of their injury because steady pain, weakness in the arm, or limitation of joint motion will become almost second nature to them.

Orthopaedic surgeons group shoulder problems into the following categories.

Instability
Sometimes, one of the shoulder joints moves or is forced out of its normal position. This condition is called instability, and can result in a dislocation of one of the joints in the shoulder. Individuals suffering from an instability problem will experience pain when raising their arm. They also may feel as if their shoulder is slipping out of place.

Impingement
Impingement is caused by excessive rubbing of the shoulder muscles against the top part of the shoulder blade, called the acromion.

Impingement problems can occur during activities that require excessive overhead arm motion. Medical care should be sought immediately for inflammation in the shoulder because it could eventually lead to a more serious injury.

Rotator Cuff Injuries
The rotator cuff is one of the most important components of the shoulder. It is comprised of a group of muscles and tendons that hold the bones of the shoulder joint together. The rotator cuff muscles provide individuals with the ability to lift their arm and reach overhead. When the rotator cuff is injured, people sometimes do not recover the full shoulder function needed to properly participate in an athletic activity.

Treatment of Shoulder Injuries
Early detection is the key to preventing serious shoulder injuries.

Shoulder Exercises
Often, an orthopaedic surgeon will prescribe a series of exercises aimed at strengthening the shoulder muscles.

Here are some easy shoulder exercises that you can do to strengthen your shoulder muscles and prevent injuries.

Basic shoulder strengthening
Attach elastic tubing to a doorknob at home. Gently pull the elastic tubing toward your body. Hold for a count of five. Repeat five times with each arm. Perform twice a day.

Wall push-ups
Stand facing a wall with your hands on the wall and your feet shoulder-width apart. Slowly perform a push-up. Repeat five times. Hold for a count of five. Perform twice a day.

Shoulder press-ups
Sit upright in a chair with armrest, with your feet touching the floor. Use your arms to slowly rise off the chair. Hold for a count of five. Repeat five times. Perform twice a day.

Other Treatment
Anti-inflammatory medication also may be prescribed to reduce pain and swelling.
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Chronic Shoulder Instability
Anatomy
Description
Cause
Symptoms
Doctor Examination
Treatment
The shoulder is the most moveable joint in your body. It helps you lift your arm, rotate it, and reach up over your head. It is able to turn in many directions. This greater range of motion, however, results in less stability.

Shoulder instability occurs when the head of the upper arm bone is forced out of the shoulder socket. This can happen as a result of a sudden injury or from overuse.

Once a shoulder has dislocated, it is vulnerable to repeat episodes. When the shoulder is loose and slips out of place repeatedly, it is called chronic shoulder instability.

Anatomy

Normal shoulder anatomy
Your shoulder is made up of three bones: your upper arm bone (humerus), your shoulder blade (scapula), and your collarbone (clavicle).

The head, or ball, of your upper arm bone fits into a shallow socket in your shoulder blade. This socket is called the glenoid. Strong connective tissue, called the shoulder capsule, is the ligament system of the shoulder and keeps the head of the upper arm bone centered in the glenoid socket. This tissue covers the shoulder joint and attaches the upper end of the arm bone to the shoulder blade.

Your shoulder also relies on strong tendons and muscles to keep your shoulder stable.


Shoulder dislocations can be partial, with the ball of the upper arm coming just partially out of the socket. This is called a subluxation. A complete dislocation means the ball comes all the way out of the socket.
Once the ligaments, tendons, and muscles around the shoulder become loose or torn, dislocations can occur repeatedly. Chronic shoulder instability is the persistent inability of these tissues to keep the arm centered in the shoulder socket.

There are three common ways that a shoulder can become unstable:

Shoulder Dislocation
Severe injury, or trauma, is often the cause of an initial shoulder dislocation. When the head of the humerus dislocates, the socket bone (glenoid) and the ligaments in the front of the shoulder are often injured. The torn ligament in the front of the shoulder is commonly called a Bankart lesion. A severe first dislocation can lead to continued dislocations, giving out, or a feeling of instability.

Repetitive Strain
Some people with shoulder instability have never had a dislocation. Most of these patients have looser ligaments in their shoulders. This increased looseness is sometimes just their normal anatomy. Sometimes, it is the result of repetitive overhead motion.

Swimming, tennis, and volleyball are some sports examples of repetitive overhead motion that can stretch out the shoulder ligaments. Many jobs also require repetitive overhead work.

Looser ligaments can make it hard to maintain shoulder stability. Repetitive or stressful activities can challenge a weakened shoulder. This can result in a painful, unstable shoulder.

Multidirectional Instability
In a small minority of patients, the shoulder can become unstable without a history of injury or repetitive strain. In such patients, the shoulder may feel loose or dislocate in multiple directions, meaning the ball may dislocate out the front, out the back, or out the bottom of the shoulder. This is called multidirectional instability. These patients have naturally loose ligaments throughout the body and may be "double-jointed."

Symptoms
Common symptoms of chronic shoulder instability include:

Pain caused by shoulder injury
Repeated shoulder dislocations
Repeated instances of the shoulder giving out
A persistent sensation of the shoulder feeling loose, slipping in and out of the joint, or just "hanging there"Doctor Examination
Physical Examination and Patient History
After discussing your symptoms and medical history, your doctor will examine your shoulder. Specific tests help your doctor assess instability in your shoulder. Your doctor may also test for general looseness in your ligaments. For example, you may be asked to try to touch your thumb to the underside of your forearm.

Imaging Tests
Your doctor may order imaging tests to help confirm your diagnosis and identify any other problems.

X-rays. These pictures will show any injuries to the bones that make up your shoulder joint.

Magnetic resonance imaging (MRI). This imaging study creates better images of soft tissues. It may help your doctor identify injuries to the ligaments and tendons surrounding your shoulder joint.

Treatment
Chronic shoulder instability is often first treated with nonsurgical options. If these options do not relieve the pain and instability, surgery may be needed.

Nonsurgical Treatment
Your doctor will develop a treatment plan to relieve your symptoms. It often takes several months of nonsurgical treatment before you can tell how well it is working. Nonsurgical treatment typically includes:

Activity modification. You must make some changes in your lifestyle and avoid activities that aggravate your symptoms.

Non-steroidal anti-inflammatory medication. Drugs like aspirin and ibuprofen reduce pain and swelling.

Physical therapy. Strengthening shoulder muscles and working on shoulder control can increase stability. Your therapist will design a home exercise program for your shoulder.

Surgical Treatment
Surgery is often necessary to repair torn or stretched ligaments so that they are better able to hold the shoulder joint in place.

Arthroscopy. Soft tissues in the shoulder can be repaired using tiny instruments and small incisions. This is a same-day or outpatient procedure. Arthroscopy is minimally invasive surgery. Your surgeon will look inside the shoulder with a tiny camera and perform the surgery with special pencil-thin instruments.

Open Surgery. Some patients may need an open surgical procedure. This involves making a larger incision over the shoulder and performing the repair under direct visualization.

Rehabilitation. After surgery, your shoulder may be immobilized temporarily with a sling.

When the sling is removed, exercises to rehabilitate the ligaments will be started. These will improve the range of motion in your shoulder and prevent scarring as the ligaments heal. Exercises to strengthen your shoulder will gradually be added to your rehabilitation plan.

Be sure to follow your doctor's treatment plan. Although it is a slow process, your commitment to physical therapy is the most important factor in returning to all the activities you enjoy.


Stay Strong~~!!!
IPL