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.

Rotator Cuff Repair

Mini-open / Arthroscopic + arthroscopic sub-acromial decompression

On Ward

Sling for 4-6/52.

Day 1 on the ward. Physiotherapist to start passive and gentle active-assisted (dependant on post-op instructions) ) external rotation to neutral, elevation in neutral with weight of arm supported avoiding pain. Hand squeeze can reduce pain, use of ball to slide along lap or table surface to support weight of arm. Ensure good posture and scapula set before each movement.Patient will only be able to achieve up to 40 degrees in first few weeks.

Maintenance elbow, wrist, hand and neck exercises (this may be taught to relative as appropriate).

Posture and scapula setting.

Washing techniques and sling advice/management. Patient may need a donjoy ER brace with extra instruction to take on and off.

2-6 weeks

Gradual increase in assisted ROM in scaption and flexion with weight of arm assisted. Usually aim to achieve 60 degrees actively by week 4 with humeral head centred. If humeral head upwardly or anteriorly migrating – exercises level is too difficult. Continue with ball rolling on table – can progress to ball up wall in flexion/scaption if pain and control allows.

Early neutral isometric cuff work can be activated in pain free effort levels. Start with post/ant deltoid with elbow flexed at 90 degrees – progress to med rotation then lat rotation. Progress isometric to 30 and 60 elevation – keeping humeral head centred.

Short lever AROM scaption, flexion and lat rotation to pain free range.

Outpatient physiotherapy may increase joint range with gentle passive and active-assisted techniques after 4/52. If the joint is becoming tight, accessory mobilisations and soft tissue techniques can be applied to post joint capsule.

Milestone at 6 weeks: Active assisted ROM to 90 degrees pain free.

6 weeks +

> 6/52 progress to full AROM actively if pain allows – don’t underestimate the weight of the arm. Start and finish with short lever.

6-12/52. Active/light activation cuff retraining through range, start with light Thera band in neutral and progress as pain allows. Do not use theraband if still has night pain. Avoid movement into pain.

>12/52. Full activation of cuff through range and functional rehabilitation to include proprioceptive training. Ensure good quality scapulo: humeral movement patterns through range.

Patient has follow-up appointments in shoulder clinic at 6/52, 3/12 and 9/12.

NB ½-1 kilo weight usually sufficient for cuff activation with weight of arm against gravity. If patient has a large degenerative RC repair or margin convergence – NO resistance for 12 weeks.

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

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

Sport: Non contact 6 months. Contact: 9 months to 1 year

Swimming: Gentle with modified stroke 8-10 weeks. Freestyle 16 weeks plus

Andrew Cole6 November 2018

Rotator Cuff Repair

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Southampton Shoulder Clinic

Southampton Shoulder Clinic

Mr Cole’s Shoulder Clinic