Shoulder Problems

The most common cause of acromioclavicular joint arthritis is wear and tear through over use. For this reason it is most common in people who are aged 50 or older and in athletes who place a lot of stress on the joint.

Bicep Problems

The most common shoulder conditions affecting the biceps are injuries to the cartilage and tendons that attach the biceps muscle to the shoulder bones. These include SLAP lesions, tendonitis, and tendon rupture.

Calcific Tendonitis

Calcific tendonitis is a build-up of calcium deposits within one or more of the four tendons that meet at the top of the shoulder joint. Together these four tendons are known as the rotator cuff.

Frozen Shoulder

Frozen shoulder is a condition where the ball and socket joint of the shoulder appears to "freeze". This causes loss of motion with stiffness in all directions. Typically the shoulder joint is stiff and initially painful.

Shoulder Arthritis

Glenohumeral arthritis is also known as shoulder arthritis. It is a progressive type of arthritis that is normally caused by damage to the cartilage surfaces of the shoulder's glenohumeral (ball and socket) joint.

Shoulder Instability

This is when the ball of your shoulder slips in certain position or completely comes out of joint (dislocates). There are a number of types of instability and it can get worse with time.

Rotator Cuff Injuries

The rotator cuff is the group of four tendons that surround the shoulder joint and control its movement. The tendons can become inflamed, degenerate or tear and can lead to pain and weakness, particularly with sudden movements.

Snapping Scapula

Snapping scapula is a general term applied to a range of disorders that can result in a painful clicking or snapping sensation in the shoulder blade (scapula).

Subacromial Impingement

Subacromial impingement is a condition that causes pain in the shoulder and upper arm. It happens when the tendons of the shoulder joint are strained or injured.

Winging Scapula

Winging scapula is the description for a condition where the shoulder blade protrudes from your back, giving the impression of a wing. In most cases, only one shoulder blade is affected.

Anterior stabilisation

Anterior Stabilisation (open or arthroscopic +/- Bankart repair)

On Ward

Sling 4-6 weeks. Washing techniques and sling advice/management.

Day 1 on ward – scapula setting in neutral elbow, wrist and hand exercises.

Follow operation post-op instructions – usually to commence active-assisted elevation in neutral to 90° - external rotation to neutral only.

NB. No isometric medial rotation and anterior deltoid for 2 weeks. Can start external rotation in neutral 30 % Maximal Voluntary Contraction.

Can commence active external rotation from day 1 post-op if pain and muscle control allows to neutral for 2/52. No passive mobilisation into E.R. until 6/52.

Review by clinical specialist at 2/52 post-op in clinical specialist shoulder clinic at RSH, to be booked before discharged by ward staff.

2-6 weeks

2/52 can commence static/isometric rotator cuff strengthening in neutral. Progress to isometrics thro range.

Commence 0-90° active assisted elevation and active lateral rotation beyond neutral as pain and active control allow.

3/52 – 6/52. Progress active assisted to active elevation >90° as pain and control allow.

NB. Concentrate on quality of movement.

6 weeks

Can progress to active-assisted in all directions from 6/52.Please discuss with Catherine Howard / Debbie Prince if want to progress sooner.

Shoulder clinic review at 6/52, 3/12, 6/12 and 1 year.

Resisted light rotator cuff through range >4/52 onwards, if good control. Ensure good scapula upward rotation is maintained throughout movement. Use free weights ~I kilo and light bands

Progress to active controlled movement > 6/52 in all ranges, esp. abduction.

Can start weight bearing with good technique – avoid pec major over dominance. 4 pt kneeling, push up on gym ball on wall, push up plus if able

Use of kinetic chain to facilitate scapula control and normal movement.

Proprioceptive exercises 6/52 onwards

Return to work: Sedentary 4-6 weeks (as pain allows). Physical 3-6 months (as control and strength allows).

Driving: 6 weeks (as pain and range allows) patient confirms they are able to drive safely.

Sport: Non contact 4-6 months. Contact 9-12 months

Swimming: Gentle with modified stroke 6-8 weeks. Freestyle 12 weeks

Andrew Cole6 November 2018

Anterior stabilisation

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Southampton Shoulder Clinic

Southampton Shoulder Clinic

Mr Cole’s Shoulder Clinic