Shoulder pain rehabilitation

Shoulder pain rehabilitation

Our shoulder pain rehabilitation pathways are well established and evidenced based. We are able to offer physiotherapy expertise and for more complex cases further pain management and orthopaedic assessments if invasive intervention is being considered. Our services monitor our treatments and their progress with the use of regular follow ups and evidenced based markers such as the DASH outcome questionnaire.

Although the majority of shoulder pain seen by our experts at Circle Health is insidious in onset our orthopaedic shoulder consultants and physiotherapists regularly manage acute injuries. Common injuries in this category may include shoulder joint or AC joint dislocation, fractures to the upper humerus and clavicle as well as significant tears to the rotator cuff tendons.

Prior to more aggressive rehabilitation commencing, these injuries must be managed according to well established guidelines in the acute phase. Our experts will provide appropriate advice and education concerning pain and anti-inflammatory medication following injury.

These acute shoulder injuries may often be managed effectively without the need for surgical intervention if immobilised immediately following injury. Depending on the exact nature of the injury, our experts may allow certain movements to commence after a few days. During this time our shoulder physiotherapists will provide effective pain relief and strategies to keep your upper spine, elbow and hand functioning as best as possible, thereby, allowing active rehabilitation to commence as quickly as possible.

Although a range of different types of shoulder surgery exist many of the problems post operatively may be similar. Inflammation and pain post surgery lead to stiffness to the shoulder range of motion. Early stage shoulder pain rehabilitation will involve gentle exercises with the arm supported to relieve some of the stiffness. In most cases these exercises may commence while still wearing the sling or brace between sets.

Depending on the exact surgical protocol and once acute shoulder pain and inflammation has settled, range of motion exercises will continue in a more aggressive manner and strengthening exercises will commence. Following certain types of fracture fixation and rotator cuff repairs this phase may be delayed but physiotherapists may advise initial strengthening exercises which involve static muscle contractions. This type of exercise allows the muscles to be gently recruited without moving the joints excessively leading to less post exercise pain.

Following early rehabilitation exercises and following an in depth review and clearance with the orthopaedic consultant exercises will generally be prescribed according to an assessment of the factors outlined in the next section.

Movements of the shoulder are complex and involve the correct positioning, appropriate flexibility, strength and co-ordination at several joints. The middle spine (thorax) must have the flexibility to extend (straighten) it’s posture. This allows the shoulder blade (scapular) to be able to rotate upwards and tilt. In turn these scapular movements place the shoulder socket in a more stable position (facing further upwards and backwards) when lifting the arm and carrying and lifting load. This positioning allows the shoulder joint to avoid common problems such as impingement and rotator cuff tendon pain and tears. A large degree of shoulder pain rehabilitation is focused upon optimising these biomechanical factors as well as addressing any flexibility, strength or co-ordination problems with the shoulder joint itself (glenohumeral joint).

When patient’s go through a course of physiotherapy exercises to rehabilitate a painful shoulder they may hear the term neuromuscular control or movement control. This form of exercise is used by our expert physiotherapist at Circle Health and involves low load movements and postures to retrain rather than strengthen the muscles of the thorax, scapular and shoulder joint. These early stage movements are synonymous with our evidenced based approach to shoulder rehabilitation which involves in depth education of our patients as to the underlying causes and long term solutions. A number of higher load strengthening and co-ordination activities will follow once appropriate awareness and co-ordination of the scapular movements has been established.

The evidence base also supports a graded approach to strengthening the muscles and tendons of the rotator cuff. The benefits of this include increased control and stability to the shoulder socket on movement as well as stimulation of the tendon cells (tenocytes) to optimise healing of unhealthy or torn tendon tissue.

Shock wave therapy is a novel treatment which uses powerful pulses of energy delivered through a probe to affected areas of the rotator cuff tendons. It aims to stimulate a new, more effective healing response in the tendon and early evidence has demonstrated that shock wave therapy may deliver similar benefits to a steroid injection with less risk to the tissue. This treatment may specifically be used when imaging has demonstrated a calcified deposit within the body of the tendon.

Circle Health we are able to offer shock wave therapy as a consultant led course of treatment or under the direction of our expert musculoskeletal physiotherapists.

For more in depth information on shock wave therapy please visit our treatment page.

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Circle Health, 32 Welbeck St, Marylebone, London W1G 8EU