shoulder
Rotator Cuff Tears:
Rotator cuff tears are injury or tear of one or more tendons composing the rotator cuff in the shoulder, mainly the supraspinatus, infraspinatus, teres minor, and subscapularis. They serve as tendons connecting the shoulder muscles to the humerus (upper arm bone) and provide stability and movement.
A tear can be partial (where the tendon is frayed or injured) or full-thickness (total detachment from bone). Such injury is usually due to cumulative wear and tear or acute trauma. Individuals with rotator cuff tears usually have shoulder pain, weakness, and trouble with overhead activities like lifting, throwing, or reaching. In advanced cases, it can result in a complete loss of shoulder function and muscle wasting if left untreated.
Causes:
- The most frequent cause are degenerative changes associated with aging, whereby tendons become less elastic and weaker—most commonly occurring in people above the age of 50 years.
- Overuse of tendons due to repetitive overhead movements associated with sports (e.g., tennis, baseball, swimming) or professions (e.g., painting, carpentry) is another contributing factor.
- Rounded shoulders and forward head posture bring about impingement and added stress on the tendons.
- Acute injury, like the sudden lifting of heavy weights or falling onto an outstretched arm, results in sudden tearing of a normally healthy tendon.
- Bone spurs or an anatomically hooked acromion may rub against the rotator cuff tendons, producing friction-induced tearing.
Prevention:
- Perform routine shoulder-strengthening exercises targeting the rotator cuff and stabilizing muscles of the scapula to preserve joint integrity.
- Complete flexibility and mobility exercises to provide maximum tendon elasticity and range of motion for the shoulder.
- Implement ergonomic adaptations in the work environment to minimize repetitive shoulder strain.
- Adopt correct techniques and posture when lifting or engaging in sports involving overhead movement.
- Schedule prompt physiotherapy interventions for any shoulder discomfort to treat incipient inflammation before it becomes severe.
Advantages of Treatment:
- Conservative treatment early with physical therapy, rest, and regenerative injections like PRP or GFC can cure partial tears successfully.
- Regenerative treatments speed up tissue healing, improve collagen remodeling, and lessen inflammation without corticosteroids.
- Arthroscopic rotator cuff repair offers excellent results in full-thickness tears with recovered strength and mobility.
- Long-term prevention of chronic pain and muscle wasting if treated early.
- Enhanced functional independence and quality of life for older patients who otherwise become disabled.
Treatment Option:
- Arthroscopic Rotator Cuff Repair: Minimally invasive surgery to reattach torn tendons to the humerus.
- Suitable for full-thickness tears or failed conservative management.
- Typically performed using suture anchors and small portals to reduce trauma and hasten recovery.
Shoulder Impingement Syndrome:
Shoulder impingement syndrome is a condition wherein the rotator cuff tendons or subacromial bursa are compressed and inflamed as they glide through the small interval under the acromion (subacromial space).
This compression leads to pain, particularly with elevation of the shoulder between 60 to 120 degrees (painful arc), and can result in degeneration of the tendon over a period of time. The condition is prevalent in sportsmen engaged in repetitive overhead activities and in patients with postural dysfunction or anatomical variation in the structure of the shoulder. If left untreated, it can result in tears of the rotator cuff or frozen shoulder.
Causes:
- Chronic bursitis and tendinosis thicken the tendons and bursae, increasing friction upon motion and further decreasing space.
- Scapular dyskinesis (i.e., aberrant scapular control) secondary to lower trapezius or serratus anterior weakness can change mechanics of the shoulder.
- Repetitive overhead motion (e.g., swimming, volleyball, throwing activities) and poor lifting mechanics.
- Poor posture, particularly kyphotic alignment and forward head posture, resulting in chronic impingement stress.
- Structural impingement secondary to hooked acromion, bone spurs, or ligament thickening of the coracoacromial ligament can decrease the subacromial space mechanically.
Prevention:
- Strengthen the posterior rotator cuff and scapular stabilizers to maximize shoulder alignment and movement.
- Incorporate posture-correction exercises like thoracic extensions, chin tucks, and wall angels.
- Utilize modified training protocols in athletes by restricting overhead volume during the season.
- Promote workplace and lifestyle ergonomics, such as proper computer screen position and ergonomic chairs.
- Early diagnosis and treatment of tightness or pain in the shoulder prior to repetitive injury.
Benefits of Treatment:
- Conservative treatment—such as anti-inflammatory drugs, rest, and organized physiotherapy—has an excellent success rate, particularly in the early stages.
- PRP and GFC injections can minimize bursal inflammation and accelerate tendon healing, lessening the use of corticosteroids.
- Arthroscopic subacromial decompression or acromioplasty can remove structural impingement in chronic or refractory cases.
- Appropriate rehabilitation results in pain-free overhead activity, enhanced shoulder strength, and reduced risk of rotator cuff injury.
Treatment Option:
- Subacromial Decompression: Arthroscopic removal of bone spurs or bursa under the acromion.
- Acromioplasty: Reshaping the undersurface of the acromion to create more space.
- Performed in patients with chronic impingement unresponsive to injections and physiotherapy.
AC Joint Injuries:-
Acromioclavicular (AC) joint injuries result when the joint between the clavicle (collarbone) and the acromion (portion of the scapula) is disrupted or injured. These injuries are frequent in athletes after direct impact to the shoulder, for example, a fall on the point of the shoulder or contact sports.AC joint injuries may be a mild sprain or inflammation or full separation, depending on the degree of ligament damage.They may cause deformity, pain with movement at the shoulder, particularly during cross-body exercises, and chronic instability if not adequately treated.
Causes:
- Degenerative disease of the AC joint cartilage and ligament secondary to age or arthritis.
- Weak scapular control and upper back position that places added mechanical load on the AC joint.
- Direct blow to the top of the shoulder, e.g., falling on an outstretched arm or being tackled during sports involving football, rugby, or hockey.
Repetitive stress from weight lifting, particularly with the bench press and shoulder press lifts, can stress the AC joint.
Prevention:
- Wearing shoulder padding and protective gear in contact sports.
- Preserving scapular strength and mobility to evenly distribute loads throughout the shoulder complex.
- Avoidance of overhead heavy weight lifting with suboptimal technique or without proper warm-up.
- Addition of posterior chain strengthening and thoracic mobility exercises to decompress the AC joint.
Benefits of Treatment:
- Mild to moderate sprains usually heal with rest, ice, and physical therapy with complete return to activity in weeks.
- Platelet-rich plasma (PRP) or GFC injections may decrease inflammation and aid in soft tissue healing.
- Severe AC joint separations can necessitate surgical stabilization (e.g., Weaver-Dunn procedure), restoring function and avoiding chronic instability.
- Full range of motion, strength of the shoulder, and minimizing long-term degeneration of the joint can be restored with proper rehabilitation.
Treatment Option:
- AC Joint Reconstruction or Stabilization Surgery: Especially for grade 3+ separations or chronic instability.
- Weaver-Dunn Procedure or Suspensory Fixation Techniques are common options.