The shoulder

The shoulder

1. anatomy

   • bones
   • joints
   • ligaments
   • muscles

2. physiology

   • synovial ball and socket joint
     • multiaxial joint
   • most mobile joint
   • least stable one
   • rotator cuff muscles consist of
     • supraspinatus infraspinatus teres minor subscapularis
   • movements of the shoulder include
     • abduction and adduction flexion and extension internal and external rotation circumduction

3. Lactic acid production

4. Swimmer’s shoulder (shoulder impingement)

   • it is a condition that swimmers gets due to the constant joint rotation in the shoulder that happens when they are swimming
   • shoulder pain develops due to
     • muscle/tendon strain. reduced shoulder stability. ligaments sprains. nerve irritation. rubbing and pressing of shoulder tissues against the Acromion.
   • Symptoms
     • Pain, stiffness, Sudden pain when reaching up, decreased strength
   • treatment
     • applying ice to the place of pain, anti-inflammatory medications, REST, physiotherapy, surgery (in severe cases)
     • certain stretches
       • Pec Major Stretch – Stop Sign
       • . Shoulder External Rotators / Lats Stretch
       • Thoracic Spine Mobility with a wedge roller

5. Physical Examination Of The Shoulder

   • 1. introduction (LOOK)
     • ask about the affected area, observe the position and physical state of the patient, symmetry, general inspection of the patient
   • 2. palpation (FEEL)
     • skin temp (with dorsum of hand), muscle tenderness, joint and bone landmarks, distal pulse (radial)
   • 3. inspection (MOVE)
     • active and passive movements that are in the ROM of the shoulder region
       • special tests
         • apprehension test
         • Apley’s scratch test
         • Impingement Test
           • involves active movement, tests the rotator cuff tendons
           • 2 types : neer and hawkins
   • 4. comment
     • on pain, spasms, limitations in the ROM, crepitus

6. Pain-relieving Medications

   • Non-opioid painkillers
     • Weak inhibitor of the synthesis of prostaglandins
     • over counter drugs
     • eg : paracetamol
   • Opioid painkillers
     • act on opoid receptors of the nervous system
     • need prescription
     • eg: morphine
   • Anti-inflammatory drugs (NSAIDs)
     • inhibit cyclooxygenase (COX)
     • prescription or over counter
     • eg: aspirin, ibuprofen
   • Compound painkillers
     • combination of 2 or more painkillers
     • prescription or over counter
     • Solpadeine : codeine + paracetamol

7. Chronic aspects

   • Shoulder impingement takes about 3-6 months to heal completely
   • Patient can return to normal activities within 4 weeks
   • If relief is not provided, the condition may require surgery
   • If left untreated shoulder impingement can lead to :
     • Rotator cuff tears Adhesive capsulitis Bursitis

8. stages of recovery from a sport injury

9. Psychology of pain

   • when treating the pain of a patient, there aspects should be considered
     • somatic, cognitive and social
     • pain catastrophizing might occur in the patient's case because of pain
       • it is the constant thinking of the pain and its consequences, and living in fear of having this pain forever.

10. Electrotherapeutic modalities

    • machines that physiotherapist use for the purpose to achieve pain relief and healing (eg: Ultrasound, TENS, EMS)
    • the source of energy could be : thermal, electrical, electromagnetic field, light waves
    • benefits
      • increase in blood circulation = increase in healing process
      • pain relief
      • reduce muscle spasms

11. Laser Acupuncture

    • based on the theory that the body has an inner flow of energy
    • When this flow is interrupted, it leads to diseases
    • Laser acupuncture uses low intensity laser beams targeted at the acupoints
    • benefits
      • Cells produce more ATP which brings on changes in the body
      • Change in brain processes

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