Shoulder and Upper Limb Conditions or Pathology

You should always seek a professional healthcare provider if you are unsure of your pain for assessment and management.

You may have been diagnosed with one or more of these however they may not tell the whole story about your pain. Often the pain is from something else. The findings on your scans may be incidental.

If you have shoulder or upper limb pain for more than 7 days which is not getting better and there are other symptoms you should seek a healthcare practitioner immediately. 

The shoulder is made up of the blade (scapula), collar bone (clavicle) & the ball and socket (glenohumeral) joint. In its nature the shoulder is very flexible and requires control, balance and strength in many directions. 

It is a complicated and elegant collection of joints. There are literally many moving parts and is complex. The good news is that shoulder pain responds very well to physiotherapy.

The elbow, wrists and hands work in unison and help us manipulate objects in space. The joints are many and the conditions are also. The following list are just some of the common presentations of conditions/injuries that Physiotherapy can help with. 

 An umbrella term for pain that is coming from irritation/damage to tendon, muscle, bursa (cushion) or approximation (increasing contact) of the joints in the shoulder.

The rotator cuff muscles comprise of 4 groups of muscles. The subscapularis, supraspinatus, infraspinatus and teres minor muscles. All of these muscle start from around the shoulder blade and then turn into tendon to blend into the capsule (sleeve) around the glenohumeral joint (ball and socket) to create control around the ball and socket joint. There is also a bursa which is a lubricated cushion to allow the tendons glide more freely.

The shoulder muscles are like an orchestra where the rotator cuff muscles work in concert with the big moving muscles around the shoulder. Different parts have to work more depending on the movement.

The area under the collarbone is called the acromion. It is the roof above the shoulder tendons and the bursa. These can be irritated by approximation/compression of the ball of the shoulder into the roof.

It is not fully understood why the ball and socket joint stiffens significantly. We know that this affects people who are female and in their 50's to 70's. 

This loss of movement can lead to a loss of function and will affect the activities of daily living. It can be a very painful and disruptive condition. Commonly people find it difficult to wash their face, brush their hair, pull on a t-shirt, tuck their shirt in etc. Some experience night pains and find it difficult to sleep. If you are getting shoulder pain at night and have difficultly sleeping you should be assessed by a health professional urgently.

Often there are unhelpful adaptations of your movement which can overload other parts of your upper limb that will cause secondary pains. Each person may present with different symptoms, it may be neck or wrist pains due to the limitations of your shoulder joint.

In some cases surgery is done to help with the range of movement. Whether the rehabilitation is conservative or surgical Physiotherapy can help with managing the pain and loss of function.

See Bursa in RCRSP. This lubricated cushion can be irritated through trauma and what it is thought to be repetitive strain though repeated overhead movements. A contributing factor is thought to be the shape of the roof (acromion)

The most common type of dislocation/subluxation is at the front front of the ball and socket (glenohumeral) joint. Rarely is the tissue at the back (posterior capsule) injured. Following is the mechanism of the most common dislocation.

The tissue at the front that is stressed is called the anterior capsule. This gives stability of the joint when the arm is drawn back with overhead movements. The tissues can normally handle the stretch to allow the movement. In some cases where there is trauma the anterior capsule becomes looser and can possibly lead to re-dislocation.

The male population under 25 years old are more prone to these injuries than other demographics. Their risk of re-dislocation is higher than other demographics.

 
A pop or feeling that the shoulder is out of place is often described when the shoulder is dislocated. There are conservative and surgical options of managing a dislocated shoulder that would be discussed with your orthopaedic consultant. 

If the anterior capsule is more loose there are ways to control and strengthen the shoulder. Post operatively or post injury you would require physiotherapy to rehabilitate step by step to return to your chosen sport.

This is often a repetitive strain injury of the tendons that attach to the elbow. The muscles that grip and manipulate the wrist turn into tendon and lead to the inside of the elbow or the outside. If your pain is on the outside of the elbow it is called Tennis elbow (lateral epicondylitis) and if its on the inside it is called Golfer's elbow.

This is a complex between the wrist and palm on the pink side. It is made up of tough tissue and can be injured. Normally it is left to heal with bracing and rest. This leads to weakening of muscles (atrophy) and will require rehabilitation of the different types of grips and muscles of the wrist and hand. 

This is where the nerve at the front of your wrist (Median nerve) is irritated from being in a tight space with the neighbouring tendons. There is often pain at the wrist and possibly tingling and numbness of the middle three fingers.

This is an overuse injury where the tendon of the thumb is strained from holding up a new born's neck. The pain is normally at the base of the thumb and is painful on giving the thumbs up. 

This is where the fingers can get 'stuck' and painful as the tendons can get sticky or stuck under a band that normally guides the tendon in the right direction. Physiotherapy can help with conservative management