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Sunday, January 24, 2016

Physiotherapist and shoulder pain treatment


Bimillahirahmanirahim,
Shoulder pain is one of the common problem in attacking around shoulder region 
and it will affected your activity and also your emotional ,today i would like to share 
the info about of this unique joint 

What is the shoulder  and anatomy around it ?
The shoulder is a complex joint made up of the humerus (upper
arm bone), scapula (shoulder blade) and clavicle (collarbone),
along with tendons, muscles and ligaments. These help us lift,
carry, throw and reach up or backward. The shoulder is the most
mobile – and least stable – joint in the body, because it is not
anchored firmly to the skeleton by surrounding muscle.


Type of injuries of shoulder 
Here i will show a common injuries is always happen around the shoulder and also the mechanism of the type of injuries ,it will give you the idea when you meet the Dr and
this explanation will help you to understand about your condition.

Rotator Cuff Injuries 
The rotator cuff comprises four muscles and cord-like tendons,
tightly enclosed within the shoulder joint. Rotator cuff injuries are
the most common causes of shoulder pain and activity restriction
at all ages.
·         Rotator cuff tendonitis. The mildest rotator cuff injury is tendonitis
(tendon inflammation). Tendonitis can develop with repetitive overhead
activities such as playing tennis, pitching, raking, shoveling or
painting. Tendonitis can also arise from joint degeneration due to
osteoarthritis. It produces pain like a toothache radiating through
the upper arm that can awaken you from sleep. Reaching overhead
or behind your back is painful.

·         Shoulder bursitis. Bursitis, which often accompanies rotator
cuff tendonitis, involves painful inflammation of one or more bursa
(fluid-filled sacs that surround our joints to provide lubrication
and protection).

·         Impingement syndrome. Swelling and inflammation of tendons and/
or bursa can place undue pressure on tendons as they pass
between the upper arm bone and the shoulder tip, called the
scapular acromion. In its cramped space, blood flow to the swollen
tendon is reduced, and it begins to fray. The resulting pain intensifies
when reaching overhead or backward. Ongoing impingement
may produce a torn rotator cuff.

·         Rotator cuff tears. A torn rotator cuff, sometimes called “pitcher’s
shoulder” or “tennis shoulder,” is the most common cause of shoulder
pain. The rotator cuff tendons can split or tear suddenly with
injury, or slowly by rubbing bone spurs. Untreated tears can weaken
the arm, inhibit its overhead elevation and visibly shrink muscles.
Pain occurs during motion and also at night


Other Common injuries at the shoulder

Labral tears
The labrum, a cartilage cuff around the socket that encircles the
head of the upper arm bone to hold it within its shallow bony
socket, can tear with injury to the shoulder. It also becomes more
brittle with age and thus susceptible to fraying. Aching in the shoulder,
“catches” in the shoulder when moved, and pain with some
activities may signal a torn labrum


Instability and dislocation
When one of the shoulder bones moves or is pushed out of place
due to injury, the shoulder becomes unstable and is at risk for
partial or complete dislocation. Recurrent dislocations cause pain
and unsteadiness when raising the arm or moving it away from the
body, and a feeling that the shoulder is “slipping out of place” when
reaching overhead.

Frozen Shoulder
Between ages 40 and 60, the joint capsule surrounding the shoulder
can shrink, making movement painful and stiff. Reluctance to
use the shoulder brings increasing stiffness, restricted motion and a
persistent, dull aching. This condition is most frequently associated
with diabetes, but in more than half the patients has no known
cause. Pain fades after several months, but the shoulder becomes
“frozen” and may take two to three years to “thaw” without treatment.
Treatment is directed at pain relief until the acute phase
passes, followed by therapy and even surgical intervention to regain
motion if it does not return spontaneously.

Fractures
Shoulder fractures are usually caused by trauma: a fall while
skiing, a collision during football, a car accident. A fracture of the
“ball” at the top of the arm bone or its socket, or of the collarbone,
can disable the shoulder. Bruising, pain and swelling, and pain or
a deformed appearance can indicate a shoulder fracture. Most
fractures are effectively treated by immobilizing the arm in a sling
until the bone fragments “knit together,” which takes about six
weeks. All fractures should be assessed; some require surgery

Arthritis
Osteoarthritis is the wearing down of cartilage that allows bones to
glide smoothly within the joints, and can occur with aging, trauma or
overuse injury. The bones in the shoulder begin to rub against each
other, and growths called bone spurs can develop. Stiffness, swelling,
pain and reduced range of motion can occur, along with a “catching”
sensation in the joint.
Rheumatoid arthritis, a disorder of the immune
system, produces chronic, painful inflammation of the joint’s lining,
and eventual joint deterioration. Severe osteoarthritis or rheumatoid
arthritis in the shoulder may necessitate joint replacement.

Other causes
Less common causes of shoulder pain include infection
(osteomyelitis), soft-tissue or bone tumors and nerve problems.
A shoulder specialist can help pinpoint the reason. When
shoulder pain is intense, it’s important to seek help promptly.

What is the necessary action you need to take for managing this shoulder problem ?

Evaluating shoulder pain
Your doctor will thoroughly examine your shoulder, take your health
history and order imaging. X-rays detail bone changes from arthritis
and fractures. Magnetic resonance imaging (MRI) reveals soft-tissue
injuries. Computed tomography shows 3-D images of bony abnormalities
and tendon problems. Advanced centers will offer techniques such
as ultra-fast, high-resolution CT to reveal the source of shoulder pain,
and single-sequence MRI to confirm rotator cuff injuries.

Management and shoulder therapy

Conservative care
Rest, ice and heat are essential. Fortunately, most shoulder problems
do not require surgery, and respond to a directed physical therapy
exercise program and anti-inflammatory medication.

Rest
When your shoulder hurts, it’s important to rest it, and refrain from
reaching upward, carrying heavy objects and using heavy shoulder
bags. Pain and inflammation will not subside if repetitive activities
such as vacuuming, raking or car-washing continue to stress the sore
shoulder. Keeping your elbow below shoulder-level is important. To
prevent frozen shoulder after an injury, however, early movement is
important

Ice and heat
Icing the shoulder with cold packs (or bags of frozen peas or corn)
when pain is severe reduces inflammation and swelling, and the
discomfort they cause. Taking hot showers and doing recommended
stretches first thing in the morning also help

Physical therapy
Orthopaedic specialists prescribe physical therapy to help you
recover from shoulder injury. Physical therapists tailor range-of-motion
exercises to increase flexibility in the shoulder. They will also show
you strengthening exercises that help prevent muscle shrinkage, and
good body mechanics to help you avoid shoulder strain. Ultrasound
or massage may be used for bursitis. In frozen shoulder, anesthesiologists
can perform a nerve block to allow for more aggressive physical
therapy.

Anti-inflammatory medications
Non-steroidal anti-inflammatory (NSAID) medication can be purchased
over the counter to relieve shoulder pain. If aspirin, ibuprofen (Advil®),
naproxen (Aleve®) and acetaminophen (Tylenol®) do not provide adequate
relief, prescription-strength NSAIDs can be prescribed.
    
Injections
When other treatments don’t help severe shoulder pain, cortisone (corticosteroid)
injections may temporarily help to “settle down” inflamed
tissues within the cramped joint, reducing pain. However, cortisone is
a potent drug, and potential side effects should be discussed with your
physician.

Surgical options
When shoulder problems do not respond to any conservative care,
your orthopaedic specialist may recommend surgery. Options range
from minimally invasive arthroscopic surgery to total shoulder replacement.

Arthroscopic Surgery
In arthroscopic surgery, only a few small incisions are required,
making recovery quicker and less painful. A viewing camera is inserted
through one incision, and slender telescopic instruments are inserted
through others. This allows surgeons to inspect and repair labral
tears and rotator cuff tears, and remove spurs and bony growths to
allow inflamed, cramped tendons to move more freely. They can also
remove thickened, inflamed bursa and bone to create space around
the rotator cuff and relieve painful impingement (arthroscopic decompression),
and can cut through tight sections of the joint capsule to
release a frozen shoulder.
Arthroscopic surgery can be combined with standard “open” surgery
when a larger incision is required to properly view and repair a more
complex problem, or with forcible stretching of a tight joint capsule
under anesthesia to free up frozen shoulder.

Rotator cuff surgery
Torn rotator cuffs do not heal by themselves and require surgery when
pain persists. Repairing the torn muscle and tendon, and removing
bone spurs restores comfort and function to the shoulder after several
months of healing.

Surgery for shoulder fractures
Severe osteoarthritis or rheumatoid arthritis can cause painful, debilitating
shoulder deformity. In these cases, or when trauma crushes the
“ball” of the shoulder joint, then shoulder replacement surgery can relieve
pain and improve quality of life. Any damaged cartilage or bone in
the shoulder’s ball and socket are removed, and replaced with a metal
“ball” and a plastic “socket.” This artificial shoulder always relieves
pain and usually improves motion, strength and function.

Recovery from surgery
Physical therapy is essential to regaining your range of motion and
strength, which relieves pain. Your therapist and surgeon will prescribe exercises that
will tailor to your needs. Your therapist will ensure
that you perform your exercises correctly, give you advice on body
mechanics so that you avoid straining your shoulder, and check your
progress wallahuaklam...

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