Shoulder

Conditions We Treat:

Bankart Lesion-Labral Tear (Slap Lesion)
Biceps Tendon Rupture
Bursitis
Erb’s Palsy (Brachial Plexus Birth Palsy)
Fractures
Frozen Shoulder/Capsuliti
Impingement Syndrome
Instability
Pain
Post-Operative
Rotator Cuff Tear/Rupture

Bankart Lesion-Labral Tear (Slap Lesion)

The Bankart lesion is a tear on the labrum in the lower part of the shoulder joint. It can involve part of the glenoid bone where it can be broken off. A SLAP (superior labrum anterior to posterior) lesion involves the labrum and the ligament on the top part of the shoulder joint.

Causes:

The tear often occurs due to overuse or trauma to the shoulder joint. It is commonly seen in athletes that engage in overhead activities, such as volleyball, tennis, and handball.

Management

The first step in treatment varies depending on how the issue is presented. The main goal is to lessen pain and inflammation initially. This involves adjusting activities to avoid pain triggers, especially those involving throwing. As your symptoms improve, you'll gradually increase the intensity of your exercise to aid your recovery. However, the recovery can be slow, and in certain instances, surgery may be necessary.

Fractures

A fracture is a break in a bone. There are different types of fractures based on whether the bone is partially or completely broken, whether the bone breaks through the skin, the direction or shape of the break, the cause of the break, and the location of the break.

Causes:

Fractures commonly happen because of car accidents, falls, or sports injuries. Overuse and repetitive motions can also cause fractures. Low bone density and osteoporosis are conditions which cause weakening of your bones. Having one of these conditions makes you much more likely to break a bone.

Management:

Cast or splint: Wearing a cast or a splint will keep your bone from moving while it heals. How long you need to wear it will depend on the type of fracture and which bone is affected.
Recovering from fractures (Bone Health and Osteoporosis Foundation)

Frozen Shoulder/Capsuliti

Frozen shoulder is a condition in which the shoulder is painful and loses motion because of inflammation.

Causes: The capsule of the shoulder joint has ligaments that hold the shoulder bones to each other. When the capsule becomes inflamed, the shoulder bones are unable to move freely in the joint. Most of the time, there is no cause for frozen shoulder. Women 40 to 70 years old are most affected, however, men can also get the condition.

Management:

Follow any exercises instructed by your physical therapist.
Move your shoulder but avoid strenuous exercises on the shoulder. Keeping the shoulder still will make the pain worse.
Apply heat packs on the shoulder.

Biceps Tendon Rupture

The biceps tendons attach the biceps muscle to bones in the shoulder and elbow. The rupture can occur either on the distal or proximal end of the biceps. Most people need only simple treatments to relieve symptoms and can still function at a high level with a biceps tendon tear around the shoulder. This is because there are two attachments of the biceps tendon in the shoulder and typically, a tear only involves one.

Causes:

Biceps tendon rupture is mainly caused by injury or overuse. You can tear your biceps tendon when you fall hard on an outstretched arm or lift something too heavy. Meanwhile, many biceps tendon ruptures are the result of wearing down and fraying of the tendon that occurs slowly over time.

Management:

Apply cold packs for 20 minutes at a time, several times a day to keep down swelling. Do not apply ice directly to the skin.
To relieve pain and limit swelling, avoid heavy lifting and overhead activities. Your doctor may recommend using a sling for a brief time.
Follow the exercises prescribed by your physical therapist. Flexibility and strengthening exercises will restore movement and strengthen your shoulder.

Bursitis

A bursa is a small, fluid-filled sac that acts as a cushion between a bone and other moving parts, such as muscles, tendons, or skin. Bursitis occurs when a bursa becomes inflamed.

Causes:

People get bursitis by overusing a joint. It can also be caused by an injury. It usually occurs at the knee or elbow. Kneeling or leaning your elbows on a hard surface for a long time can make bursitis start. Doing the same kinds of movements every day or putting stress on joints increases your risk.

Management:

Taking a break from activities that put pressure on that part of your body will give it time to heal and prevent further injury
Apply a cold compress or ice packs wrapped in a thin towel to the area for 15 minutes at a time, a few times a day.
Apply heat (like a heating pad or a hot water bottle wrapped in a towel). Your provider might suggest alternating ice and heat.
Wear a splint, sling or brace to keep the injured area supported.
Elevate the injured area.

Impingement Syndrome

When you lift your arm, the rotator cuff tendon passes through a narrow space at the top of your shoulder, known as the subacromial space. Shoulder impingement happens when the tendon rubs or catches on the bone at the top of this space, called the acromion.

Causes:

Shoulder impingement often occurs as a result of an injury, overuse of the shoulder (such as swimming or tennis), or wear-and-tear with age. In some cases, it is caused by the acromion being curved or hooked instead of flat, which is what some people are born with. Boney growth/spurs on the acromion that some people develop over time can cause impingement syndrome as well.

Management:

Shoulder exercises. Your physical therapist may instruct you to perform simple shoulder exercises.
Avoid activities that involve repeatedly lifting your arm above your head (such as swimming or playing tennis) for a few days or weeks.
Do not stop moving your arm completely – try to carry on with your normal daily activities as much as possible so your shoulder does not become weak or stiff. It's usually best to avoid using a sling.
Gently hold an ice pack (or bag of frozen peas) wrapped in a towel on your shoulder for 15 to 20 minutes a few times a day.

Instability

The shoulder is the most moveable joint in your body. It helps you to lift your arm, to rotate it, and to reach up over your head. It is able to turn in many directions. This greater range of motion, however, can cause instability. Shoulder instability occurs when the head of the upper arm bone is forced out of the shoulder socket.

Causes:

This condition typically happens as a result of a sudden injury, such as a fall or accident. 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.

Some people with shoulder instability have never had a dislocation. Most of these patients have looser ligaments in their shoulders. Sometimes, the looseness is the result of repetitive overhead motion. Swimming, tennis, and volleyball are among the sports requiring 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.

Management:

Strengthening shoulder muscles and working on shoulder control can increase stability. Your physical therapist will often design an additional home exercise program for your shoulder.
Make some changes in your lifestyle and avoid activities that aggravate your symptoms.

Rotator Cuff Tear/Rupture

When one or more of the rotator cuff tendons is torn, the tendon becomes partially or completely detached from the head of the humerus. Most tears occur in the supraspinatus tendon, but other parts of the rotator cuff may also be involved. In many cases, torn tendons begin by fraying. As the damage progresses, the tendon can completely tear, sometimes with lifting a heavy object. A torn rotator cuff may weaken your shoulder. This means that many daily activities, like combing your hair or getting dressed, may become painful and difficult to do.

Causes:

Rotator cuff tears may occur in two ways:

A sudden acute tear may happen when you fall on your arm while it is stretched out. Or, it can occur after a sudden, jerking motion when you try to lift something heavy.
A chronic tear of the rotator cuff tendon occurs slowly over time. It is more likely when you have chronic tendinitis or impingement syndrome. At some point, the tendon wears down and tears.

Management:

It is best to rest and limit overhead activities. You should also avoid any activities that cause shoulder pain.
Specific exercises will restore movement and strengthen your shoulder. The exercise program prescribed by your physical therapist will include stretches to improve flexibility and range of motion. Strengthening the muscles that support your shoulder can relieve pain and prevent further injury.