Musculoskeletal Monday: The Shoulder

There has been an increase in rotator cuff surgical procedures performed after surgical consultation in patients presenting with shoulder pain. This has resulted in a 238% increase in the number of rotator cuff repairs in the last decade! Although large tears have been shown to benefit positively from surgery, it is important to note that there is evidence that physical therapy can have equal outcomes after 5 years.    shoulderAnatomy Doesn’t Lie 

Lewis (2009) in his article investigating RC tendoinopathy reported the supraspinatus, infraspinatus, teres minor and subscapularis tendons “interdigitate and fuse together before inserting into the humeral tuberosities”. He highlights that this will assist efficiency in the distribution of forces and reduce intratendinous stress with extremes of movement. He also notes that the RC is comprised of “six to nine structurally independent parallel fascicles”. His research concludes that the supraspinatus is not the only muscle to fire prior to movement of the shoulder, but the rotator cuff muscles contract in a “direction specific” pattern.

The Body Heals in a Predictable Manner 

When considering tendon repair it is important to understand its response to loading. With inappropriate loading, (Benjamin et al., 2006) demonstrated delayed maturation of the supraspinatus enthesis during postnatal development in mice. Also, mice with reduced muscle loading demonstrated less mineral deposition, impaired fibrochondrocyte and matrix organization, and inferior mechanical properties at later time points (Thomopoulos et al., 2010). These studies continue to stress the importance of appropriate tendon loading in the rehabilitation process. (refer to the work of Jill Cook)

Pain Is In the Brain

According to Lewis presence of a tear/tissue damage does not correlate with pain. In fact, there is a better correlation with age and tissue damage then whether you have pain or not in your shoulder. (Lewis et al. 2015)

We Are Prone Clinical Reasoning Errors During a Busy Clinic Day

Mohamadi A, et al. (2017) questions the use of corticosteroid injections for rotator cuff tendonopathy. They discovered it only provided transient pain relief compared to a placebo group. Injections are expensive, can accelerate degeneration and a change in intervention is necessary. Let’s consider the routine PT interventions we routinely utilize as PT and always question what we do.

Treat the Person and You Win Every Time

picmonkey_image

Video of the Week

#PTbeyond140

Immediate Effects of Mobilization With Movement vs Sham Technique on Range of Motion, Strength, and Function in Patients With Shoulder Impingement Syndrome: Randomized Clinical Trial

Upcoming…

Take your Upper Extremity skills to the next level with one of these 2018 courses:


Enjoy your week!

terry_pratt175-Terry

Terry Pratt, MS, PT, COMT, FAAOMPT

One thought on “Musculoskeletal Monday: The Shoulder

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Google+ photo

You are commenting using your Google+ account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s