Shoulder Physiotherapy

The gleno-humeral joint, known in lay terms as the shoulder, is a vital part of the links in the upper limb and responsible for our ability to place our hands where we can see them to perform activities. Because flexibility is a prime requirement the shoulder is a less stable joint with moderate muscle power and a large range of motion. It is described as a “soft tissue joint”, implying that the joint’s functional ability is dependent on its soft and not its hard components. Physiotherapists are closely involved in treating and rehabilitating the shoulder, dealing with the muscles, ligaments and tendons.

The gleno-humeral joint is made up of the ball of the humerus and the socket of the shoulder blade which is called the glenoid surface. The top of the arm bone, the humeral head, is large and carries many of the tendon insertions for the stability and movement of the shoulder. The socket or glenoid is a relatively small and shallow socket for the large ball but is deepened slightly by a fibrocartilage rim called the glenoid labrum. Above the shoulder is the acromio-clavicular joint, a joint between the outer end of the collar bone and part of the shoulder blade, a stabilizing strut for arm movement.

The major stability and flexibility joints of the upper limb shoulder girdle are the scapulothoracic and glenohumeral joints and these joints are held steady and moved by large and powerful muscles. The pectoralis major and latissimus dorsi muscles stabilise and perform strong movements, the serratus anterior stabilises the scapula on the thorax, the rotator cuff stabilises the humeral head on the socket and the deltoid and other muscles perform movements. The shoulder blade and thorax need to be kept in a stable relationship for the glenohumeral joint to perform precise and controlled movements.

The rotator cuff is a group of four small muscles which originate from the scapula and insert around the ball of the humeral head, the teres minor, subscapularis, infraspinatus and supraspinatus. The cuff tendons form a sheet around the ball of the arm bone and allow forces to be exerted on the humeral head by the shoulder girdle muscles. If the rotator cuff is not functioning normally the more powerful muscles tend to make the humeral head slide upwards on the socket, interfering with normal function and making a person unable to lift their arm up above their head.

As a person ages, the rotator cuff develops degenerative changes in its tendinous structures, causing small tears in the tendons which can enlarge until there is no continuity between the muscles and their attachments. This leads to loss of normal shoulder movement and can be very painful but is not always so and “Grey hair equals cuff tear” is a common saying. Physios work at rotator cuff strengthening, whilst in massive tears the main shoulder muscles can be progressively strengthened to improve function. Surgery is possible for massive, moderate and small rotator cuff tears and physiotherapists manage the post-operative protocols.

The shoulder joint is not typically affected by OA (osteoarthritis) but when it is physiotherapists treat arthritic shoulders by joint mobilisations, muscle strengthening and ranges of motion. Once physio has nothing else to offer, total shoulder replacement is one of the further options, with various surgical techniques involving replacing the humeral ball and the scapular socket either anatomically or in reverse. The shoulder is often called a “soft-tissue joint” as the soft tissues, their strength and balance, are vital to the function of the joint. Post-operative physio management is essential as the correct protocol must be closely followed to ensure success.

Physiotherapy treatments include the assessment and management of many different shoulder pathologies such as shoulder fractures and dislocations, sub-acromial impingement, tendinitis, abnormal patterning and hypermobility. Physio treatment for fractures and dislocations depends on the severity and type of injury and follows the physiotherapy and surgical protocols. Patient education and muscle stabilising work is used for hypermobility, while biofeedback and correct muscle activity teaching is the treatment for abnormal patterning. Impingement physio is cuff strengthening and joint mobilisation, with joint injections and surgical acromioplasty if physiotherapy is not successful.

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Shoulder Physiotherapy

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