The shoulder, or more strictly the glenohumeral joint, is a major and important joint in the upper limb, responsible mostly for placing the hand in front of the body where the eyes can see it as it performs tasks. To allow this ability the shoulder has a very large range of movement, moderate strength and limited stability. This makes the shoulder a "soft tissue joint", where the stability and satisfactory function depend on the function of the soft tissues, the ligaments, tendons and muscles. For physiotherapists the shoulder is an important joint, with much treatment and pre- and post-operative rehab required.
The gleno-humeral joint is made up of the ball of the humerus and the socket of the shoulder blade which is called the glenoid surface. The top of the arm bone, the humeral head, is large and carries many of the tendon insertions for the stability and movement of the shoulder. The socket or glenoid is a relatively small and shallow socket for the large ball but is deepened slightly by a fibrocartilage rim called the glenoid labrum. Above the shoulder is the acromio-clavicular joint, a joint between the outer end of the collar bone and part of the shoulder blade, a stabilizing strut for arm movement.
The glenohumeral and scapulothoracic joints of the upper limb are acted on by large, strong, prime mover muscles as well as smaller stabilisers. The major back and hip muscles keep the shoulder stable to allow strong movements, the thoracic stabilisers keep the scapula stable so that the rotator cuff can act on a stable humeral head. The deltoid can then perform shoulder movements on the background of a solid base and allow precise placement and control of the arm for hand function to be optimal.
Around the shoulder all the muscles narrow down into flat, fibrous tendons, some larger and stronger, some thinner and weaker. All these tendons are anchoring themselves to the humeral head, allowing their muscles to act on the shoulder. The rotator cuff includes a group of relatively small shoulder muscles, the subscapularis, the supraspinatus, the infraspinatus and the teres minor. The tendons form a wide sheet over the ball, allowing muscle forces to act on it. The rotator cuff, despite its name, acts to hold the humeral head down on the socket and allow the more powerful muscles to perform shoulder movements.
As a person ages, the rotator cuff develops degenerative changes in its tendinous structures, causing small tears in the tendons which can enlarge until there is no continuity between the muscles and their attachments. This leads to loss of normal shoulder movement and can be very painful but is not always so and "Grey hair equals cuff tear" is a common saying. Physios work at rotator cuff strengthening, whilst in massive tears the main shoulder muscles can be progressively strengthened to improve function. Surgery is possible for massive, moderate and small rotator cuff tears and physiotherapists manage the post-operative protocols.
Osteoarthritis (OA) does not commonly affect the shoulder but there is a group of patients who develop severe arthritic problems in the shoulders, whom physiotherapy can help by maintaining joint ranges and muscle power. Once conservative treatments are exhausted then total shoulder replacement (TSR) is possible, either replacing the ball and socket with new components or reversing the combination. Physiotherapy post-operative management is very important as the shoulder is a "soft tissue joint" in the sense that the strength and balance of the shoulder muscles and other tissues is vital for good outcome.
Many other shoulder conditions are managed by physiotherapists, such as hyper-mobility, dislocations and fractures, impingement and tendinitis. Physios manage shoulder hyper-mobility by patient education and stability training and abnormal muscle activity by teaching correct patterns by repetition and biofeedback. Physiotherapy for impingement involves rotator cuff strengthening, sub-acromial injection or surgical management by acromioplasty and tendinitis by local treatment and strengthening. Dislocations and fractures are managed according to the type and severity of injury and according to the trauma surgical and physiotherapy protocols. - 16004
The gleno-humeral joint is made up of the ball of the humerus and the socket of the shoulder blade which is called the glenoid surface. The top of the arm bone, the humeral head, is large and carries many of the tendon insertions for the stability and movement of the shoulder. The socket or glenoid is a relatively small and shallow socket for the large ball but is deepened slightly by a fibrocartilage rim called the glenoid labrum. Above the shoulder is the acromio-clavicular joint, a joint between the outer end of the collar bone and part of the shoulder blade, a stabilizing strut for arm movement.
The glenohumeral and scapulothoracic joints of the upper limb are acted on by large, strong, prime mover muscles as well as smaller stabilisers. The major back and hip muscles keep the shoulder stable to allow strong movements, the thoracic stabilisers keep the scapula stable so that the rotator cuff can act on a stable humeral head. The deltoid can then perform shoulder movements on the background of a solid base and allow precise placement and control of the arm for hand function to be optimal.
Around the shoulder all the muscles narrow down into flat, fibrous tendons, some larger and stronger, some thinner and weaker. All these tendons are anchoring themselves to the humeral head, allowing their muscles to act on the shoulder. The rotator cuff includes a group of relatively small shoulder muscles, the subscapularis, the supraspinatus, the infraspinatus and the teres minor. The tendons form a wide sheet over the ball, allowing muscle forces to act on it. The rotator cuff, despite its name, acts to hold the humeral head down on the socket and allow the more powerful muscles to perform shoulder movements.
As a person ages, the rotator cuff develops degenerative changes in its tendinous structures, causing small tears in the tendons which can enlarge until there is no continuity between the muscles and their attachments. This leads to loss of normal shoulder movement and can be very painful but is not always so and "Grey hair equals cuff tear" is a common saying. Physios work at rotator cuff strengthening, whilst in massive tears the main shoulder muscles can be progressively strengthened to improve function. Surgery is possible for massive, moderate and small rotator cuff tears and physiotherapists manage the post-operative protocols.
Osteoarthritis (OA) does not commonly affect the shoulder but there is a group of patients who develop severe arthritic problems in the shoulders, whom physiotherapy can help by maintaining joint ranges and muscle power. Once conservative treatments are exhausted then total shoulder replacement (TSR) is possible, either replacing the ball and socket with new components or reversing the combination. Physiotherapy post-operative management is very important as the shoulder is a "soft tissue joint" in the sense that the strength and balance of the shoulder muscles and other tissues is vital for good outcome.
Many other shoulder conditions are managed by physiotherapists, such as hyper-mobility, dislocations and fractures, impingement and tendinitis. Physios manage shoulder hyper-mobility by patient education and stability training and abnormal muscle activity by teaching correct patterns by repetition and biofeedback. Physiotherapy for impingement involves rotator cuff strengthening, sub-acromial injection or surgical management by acromioplasty and tendinitis by local treatment and strengthening. Dislocations and fractures are managed according to the type and severity of injury and according to the trauma surgical and physiotherapy protocols. - 16004
About the Author:
Jonathan Blood Smyth is a Superintendent ofPhysiotherapy at an NHS hospital in the South-West of the UK. He specialises in orthopaedic conditions and looking after joint replacements as well as managing chronic pain. Visit the website he edits if you are looking for physiotherapists in Leeds.
