Category Archives: Shoulder Pain

Injuries Around Shoulder Joint

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3d render of a male figure with close up of shoulder joint Free Photo

Physical Therapy for Shoulder injury

The mechanism of injury can be interpreted by asking about the mode of injury such as fall by asking about the mode of injury ,such as fall from height, road traffic accident, position of the limb or body at the time of injury, any rotational force acting on the body and the type of activity done by the time of  injury.

The mechanism of injury, site of injury, pain and disabilities should be interpreted from the history.

Examination

Inspection: The patient should be examined in sitting position with his upper torso and upper limbs exposed upto the waist.

Attitude: The position of the limb on inspection should be noted. In fractures of clavicle and anterior dislocation of shoulder, the patient often supports the injured limbs with the other hand. The arm segment may appear short or long depending on in fracture neck of scapula, there will be lengthing of the arm.

Swelling or deformity: In anterior dislocation of shoulder, the anterior axillary fold may be abnormally prominent due to the presence of head of humerus. A swelling along the line of clavicle, diffuse swelling surrounding the proximal humerus may be seen in fractures of the underlying bones. The lateral end of clavicle may appear to be prominent in acromioclavicular joint injuries. The medial end of clavicle may be seen prominently in sternoclavicular injuries.

Shoulder contour: Normally, the shoulder has a round contour due to prominence of the greater tuberosity beneath the deltoid muscle. The greater tuberosity projects beyond the edge of acromion process giving the normal contour. In dislocation of the shoulder joint, due to loss of projection of greater tuberosity, the normal contour will be lost. This is a valuable sign of dislocation. In deltoid paralysis due to axillary nerve injuries, there may be wasting of the muscle causing apparent loss of contour of the shoulder. The shoulder contour may be masked by diffuse swelling associated with fractures of the proximal humerus.

Bony arch: The bony arch is formed by the clavicle, acromion process and spine of scapula. Any deformity in the bony arch should be noted for.

Palpation

The bony points to be palpated are: clavicle, proximal humerus, acromion process, spine and borders of scapula for signs of fracture.

Clavicle: By standing behind the sitting patient, the examiner places both his hands on the medial end of clavicle and runs his fingers along the shaft of both the clavicles. Any irregularity, gap or crepitus should be looked for. In acromioclavicular joint dislocation, the lateral end of clavicle may be displaced upward. On pressing the lateral end of clavicle, it depresses and bounces back like a piano key.

Proximal humerus: By standing on the side of the patient, the elbow is flexed and the proximal humerus is palpated bimanually by keeping one hand and the medial surface of arm and other on the outer surface of the arm. By standing behind the patient, the examiner slides his fingers down from the acromion process to the arm to palpate the greater tuberosity and proximal humerus. If the head of humerus is in normal position, then there will be a bony resistance to palpation. In dislocations, there will be an empty feeling in the shoulder region. The head may be palpable in either of axillary folds. Diffuse tenderness may be present in fractures of proximal humerus. In an intact humerus, the medial epicondyle will be in the same direction as that of the head of humerus.

Scapula: The acromion process and spine of scapula are palpated for irregularity, bony tenderness and crepitus. The axillary and vertebral borders are palpated for signs of fracture. The coracoids process is situated half an inch below the clavicle at its junction with medial two third and lateral one third. Fracture neck of scapula is diagnosed by axial pressure applied through the arm with the elbow flexed.

Movements

Both active and passive movements of the shoulder should be tested. In anterior dislocation of the shoulder, the patient will not be able to touch the opposite shoulder with his hand of affected extremity. This is called Dugas test.

Tests for detecting anterior dislocation of shoulder:

Hamilton ruler’s test: In normal persons, a straight ruler cannot be placed between the acromion process and lateral epicondyle because of the presence of greater tuberosity in its normal position. In dislocation of the shoulder, a ruler can be placed.

Callaway’s test: The vertical circumference of the axillary is increased in dislocation of shoulder due to the presence of head in the anterior axillary fold.

Measurements

The length of the arm is measured from the angle of acromion process to the lateral epicondyle.

Neurological examination: In fracture of the clavicle, brachial plexus may be injured. In fractures and dislocations of humorous, axillary nerve may get damaged. Axillary nerve damage may manifest as paralysis of deltoid muscle and anesthesia in skin over the lower part of deltoid muscle.

Active physical Therapy providing state-of-the-art physical therapy throughout the state of Maryland having multiple locations located in (Aspen Hill/ Layhill Road, Clinton, Clinton WHC, College Park/ Berwyn Heights, Columbia/ Elkridge, Columbia Aquatic, Gaithersburg/ Germantown, Hyattsville/ Langley Park, Landover, Laurel, Oxon Hill/ Temple Hills, Rockville), Washington, D.C (Washington D.C. N.W./ Near GWU , Washington D.C. N.E./ Brookland CUA, Washington D.C. S.E./ Capitol Hill), Western Maryland (Frederick, Hagerstown), Southern Maryland (California/ Lexington Park, Fort Washington La Plata, Prince Frederick, Waldorf), and Baltimore Metro area (Baltimore/ Mt. Vernon, Dundalk, Glen Burnie, Rosedale/ Near Franklin Sq. Med. Ctr.). We specialize in evaluation and treatment of acute and chronic conditions of the Upper Extremity. Experienced, Qualified and Skilled Certified therapists and our dynamic clinical staff focus on providing personalized attention, individual care, and a positive friendly environment during your treatment session. You can also make your appointment online to start your treatment within 24 to 48 hours at Active Physical Therapy, For more information just visit our Website:-http://active-physicaltherapy.com/

HOW TO GET BACK TO RUNNING AFTER BACK PAIN?

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Running is arguably the most basic form of exercise. Runners face many challenges in their life, they get hurt,stay busy and tired. Back pain is very common nowadays not only for runners or athletes, 70% of the population has been facing the same issue. They go to the doctor’s clinic and miss their official and routine work. Sports injuries are also another concept to consider the back pain from muscle aching to a shooting, burning or stabbing sensation. Most back pains gradually improve with home treatment and self care. Repeated heavy lifting or sudden awkward movement cause muscle or ligament strain and spasms. Osteoarthritis can affect lower back pain. Pain can be acute, sub acute or chronic under the categories of muscles, bones, lower back, buttocks and specific sensation is sharp, electric, burning type pain that can originate from any part of the body. When an injury at some point extended break at your movements due to pain but there is good news your muscles have a memory of those past activities. A few things are common if you want to run after acute or chronic back pain. Start with your own unique challenges and requirements to help your body. To get back to running after a long interval follow some important steps:-

Understand The Cause

Whenever a long interval enters in any kind of activity it is difficult to start from the point you left and there must be a cause that why a person left that from schedule. In the case of a runner Runner spine’s vertebrae and discs experience extra pressure, lower back pain due to bending or lifting in high frequency. At the same time, to get back to your recovery track, you should go to the doctor to diagnose why you have back pain. You don’t need any scans if you are going through a short term of pain but if you have a sudden injury you should take your extra care for diagnosing the reason. After this process the doctor will arrange a PT for you, to skip the doctor you can go to the Physical Therapy, A skilled Physical Therapist will be able to access you and provide you with diagnosis and treatment plan. Developing muscle strength and aerobic capacity at rehab will help to reschedule your elapsed exertion.

 Don’t let your Injury keep you Down

When you are suffering from an acute back injury, take a rest for a couple of days after bending, twisting or straining. Don’t rest too much time after injury because the more time you take to get comfortable, the more it will feel hard to come back. At the prior times of injury more chances are there to function properly within a week or 2 weeks. In fact unused muscles switch themselves off. For that reason, start walking by the wall as your pain decreases, begin normal and slow movements such as walking around the house, and start slow and regular exercise. Listen to your body if you are feeling any tenderness, communicate with your Physical Therapist who can alleviate pain and regain function. They must focus on the exercises and stretches designed for you in PT sessions.

 Celebrate Each Step

Start counting your progress day by day, try warming up under your Healthcare’s treatment plan. A Physical Therapist will also identify your weak points so that he/she can analyse where to give stress and rest so you can handle the pain with comfort. If you have any impact on joints, PT will schedule not only running but runs with biking, swimming which will make cardiovascular endurance without stressing your joints. Sometimes the runners get frustrated as one who was running 40- 50 miles per week is not able to walk around. Be positive, your positive emotions reinforce you to get back in action. Commit yourself to join body strength training sessions in the Rehab Center. Measure day by day progress and praise yourself. Self care works more than healthcare. Your encouragement to yourself will help to design your new road map of success.

 Have Patience

Casual Runners or Professional Athletes always want to run as soon as possible. No one is happy by sitting during an injury. Don’t be scared and do not increase your weekly mileage by more than 10% in order to help your body. Keep in mind and be aware to stress the muscles. Your Pt would design a plan for you to improve your blood flow to your muscles. Don’t increase your running speed before your PT’s recommendations. You can continue if pain does not return. PT always designs a healing and training process from walk to run progression, for each new activity take your time as your body is in healing process and if you are going to exert pressure as you were before strain or injury it will cause more stress and take a long time to heal. Let your body adapt. For a couple of months run on the alternative days to allow for recovery and time for the body. Everyone’s recovery time can be different, as the injury caused can take more or less time to recover as compared to other patients with the same injury.  PT will help you from walk to run with some additional elliptical, cycling, swimming to mix it up during the week. Chances of reinjury are the biggest risk during or after a painful injury. Start under the guidance of your PT to lessen the risk, that will enhance the progression of running in which PT will include to give strength to previous injured tissue.

 Use your Physical Therapy Knowledge

After Rehabilitation when you come back at your home, higher chances of skipping your PT schedule and it hinders the linear progress. Always stay in contact with your Physical Therapy Center and use the plan given by your trainer. Post Rehab, keep in mind your PT is there for you even after you are discharged. Physical Therapy is important to help you get to running as soon as you can. Physical therapists by their equipment analyse the deficiencies in your running style. Therapy team will overdo for your quick recovery with specific therapy techniques. They will educate you on some key concepts for do’s and don’ts. Once or twice a weekly rehab day allows you to keep working at the cause of injury.

Live Smart

Add good habits, avoid lying on one side, get into a neutral position. Don’t look down for a long time without a break. Physical exercises are the dental floss of the running world. Stick to your prescribed physical plan. Runners already know the importance of strong glutes to control your hip rotation and prevent injury pain. Show more attention to your calves, soleus strength.

 To Get Back to Running Consider Rules- 

  • All running to be completed at liberal rate.

  • No speed work until you completely return to the Running phase.

  • Don’t run in a row of days, choose alternative days to give your body time to recover.

  •  Focus on the duration you are adding day by day.

  • Stop the discomfort and judge your each run.

  • Consider 6-8 Rehabilitation Center meetings to your PT in a month.

  • Practice Patience, Get Strong.

Contact Active Physical Therapy 

Biceps Tendinitis

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Biceps Tendinitis is a common shoulder pathology which usually develops in younger athletic population due to repetitive overhead injuries. The patients suffering from this condition usually have to suffer pain, lesser range of motion & strength and impaired functional mobility. This pathology develops over the time with pain located at the front of the shoulder.

What do we mean by Biceps Tendinitis?

There are two parts of biceps muscles: the long head and the short head. The long head is usually affected with tendinitis. Biceps tendinitis is known as the inflammation of the tendon around the long head of biceps muscles. The most commonly irritated tendon is the one that attaches the top of the biceps muscles to the shoulder. Biceps tendinitis results due to the repetitive stress which in turn results into irritated, swollen and painful tendon.

What causes Biceps Tendinitis?

Excessive and abnormal forces applied across the tendon results into biceps tendinitis. Apart from this, several other conditions also contribute towards developing the condition including:

  • Tension and pulling of a tendon or muscle
  • Compression i.e. pushing, pinching or shearing
  • Weak rotator cuff and upper back muscles
  • Tight shoulder joints or muscles
  • Poor body mechanics
  • Overuse from certain types of work or sports
  • Gradual wear and tear
  • Continuous or repetitive shoulder actions
  • Abrupt increase in exercise routine
  • Age- relate bodily changes
  • Degeneration in a tendon
  • A direct injury to the shoulder.

What are the potential signs and symptoms of Biceps Tendinitis?

Biceps tendinitis is common amongst the athletes involved in swimming, throwing, gymnastics and other contact sports. Workers who are involved in overhead shoulder work or heavy lifting are at greater risk. The sufferers commonly report symptoms including:

  • Sharp pain in the front of shoulder
  • Tenderness in the front of the shoulder
  • Pain radiating towards neck down the arm
  • Feeling pain after every activity
  • Weakness around the shoulder joint
  • Catching or clicking sensation near top of the biceps
  • Pain aggravating with flexion, forearm supination or elbow flexion.

What are the Physical Treatments to treat Biceps Tendinitis?

Once you are diagnosed with Biceps Tendinitis your physical therapy will develop a customized treatment program while keeping your specific goals and condition in mind.  Your physical therapy may suggest:

  • Initially RICE; rest, ice, compression and evaluation may be suggested. He may also advice to avoid the activity aggravating the condition
  • Soft-tissue therapy, electrical stimulation or ultrasound therapy may be suggested
  • Series of stretching or strengthening exercises may be suggested to regain lost range of motion
  • Postural corrections may be suggested to correct the sitting and standing posture.
  • Physical therapists may also employ hands-on therapy to gently move or mobilize your shoulder
  • Functional training would be provided to prevent future injuries. He would point out and correct your faulty movement.

Contact Active Physical Therapy for the state-of-art treatment of any of your musculoskeletal disease. Our treatment modules are planned and coordinated according to the needs, requirements and urgencies of our patients. The treatment modules co-ordinated by us will not only cure your current ailment but also pose a check on the further ones.