Shoulder Injuries and Disorders

  • Frozen Shoulder [Adhesive Capsulitis]
  • Rotator Cuff Syndrome & Impingement,
  • Shoulder Dislocation / Separation
  • CRPS – Complex Regional Pain Syndrome [formerly known as RSD; Reflex Sympathetic Dystrophy]
  • Tennis Elbow; Carpal Tunnel Syndrome
  • DeQuervain’s; Trigger Finger

Frozen Shoulder

Frozen shoulder, also known as adhesive capsulitis, is a condition characterized by stiffness and pain in your shoulder joint. Signs and symptoms typically begin gradually, become persistent and worsen over time. Though these symptoms can resolve on their own, usually within two to three years, physical therapy is usually a standard method of care, in order to reduce pain and increase functional mobility of the affected shoulder within a more reasonable period of time.

Your risk of developing frozen shoulder increases if you’re recovering from a medical condition or procedure that affects the mobility of your arm – such as a stroke or a mastectomy.

Treatment for frozen shoulder involves stretching exercises and, sometimes, the injection of corticosteroids and numbing medications into the joint capsule. In a small percentage of cases, surgery may be needed to loosen the joint capsule so that it can move more freely.

Rotator Cuff Injury

Rotator cuff tear

Your rotator cuff is made up of the muscles and tendons in your shoulder. These muscles and tendons connect your upper arm bone with your shoulder blade. They also help hold the ball of your upper arm bone firmly in your shoulder socket. The combination results in the greatest range of motion of any joint in your body.

A rotator cuff injury includes any type of irritation or damage to your rotator cuff muscles or tendons. Causes of a rotator cuff injury may include falling, lifting and repetitive arm activities – especially those done overhead, such as throwing a baseball or placing items on overhead shelves. There are various degrees and stages of rotator cuff disorders, ranging from tendonitis to partial or complete tear. These disorders also offer a variable degree of pain and disability. Effective physical therapy treatment is dependent on an accurate medical diagnosis from your physician and a comprehensive physical assessment and plan by your physical therapist. Those cases requiring surgical repair must undergo careful and focused physical therapy management for optimal short term and long term outcomes.

Dislocated Shoulder

Anterior shoulder dislocationA dislocated shoulder is an injury in which your upper arm bone pops out of the cup-shaped socket that’s part of your shoulder blade. A dislocated shoulder is a more extensive injury than a separated shoulder, which involves damage to ligaments of the joint where the top of your shoulder blade meets the end of your collarbone.

A period of sling immobilization is usually required for a few weeks after experiencing a dislocated shoulder. Physical therapy will be prescribed after sling removal in order to correct any joint stiffness and restriction of motion, while restoring optimum muscular strength around the shoulder; necessary prevent instability and predisposition to repeat dislocations.

Separated Shoulder

Shoulder separation

Shoulder separation

A separated shoulder is an injury to a part of one of your body’s most mobile joints – the joint formed where the top of your shoulder blade meets the end of your collarbone. A separated shoulder is a stretch or tear of one or more of the ligaments supporting this joint.

A separated shoulder doesn’t usually require surgery. Conservative treatment, such as rest, ice, pain relievers and physical therapy are often enough to relieve the pain and restore function of a separated shoulder. Most people regain full shoulder function within several weeks after experiencing a separated shoulder.


Wrist and Hand Pain

Wrist and hand pain is a common complaint. Many types of wrist pain are caused by sudden injuries that result in sprains or fractures. But wrist pain also can be caused by more long-term problems – such as repetitive stress, arthritis and carpal tunnel syndrome.

Because so many factors can lead to wrist pain, diagnosing the exact cause of long-standing wrist pain sometimes can be difficult. An accurate diagnosis is crucial, however, because proper treatment depends on the cause and severity of your wrist pain.

Volar carpal tunnelCarpal Tunnel Syndrome

In the wrist, nerves and tendons pass through a space called the carpal tunnel.

Because the carpal tunnel is somewhat narrow, a major nerve called the median nerve that passes through this tight space can become irritated or compressed. Carpal tunnel syndrome is a combination of numbness, tingling, pain and weakness in the hand caused by compression of the median nerve in the carpal tunnel. Symptoms tend to show up most in the thumb, index finger, middle finger and half of the ring finger because the median nerve provides sensation to those areas.

Because the carpal tunnel already is narrow, the nerve can become irritated if it narrows even a little more. Injury to the nerve also can cause carpal tunnel syndrome. There are several common causes, including:

  • Arthritis or fracture near the wrist
  • Pregnancy
  • Diabetes
  • Overuse (as in typists, cashiers or certain athletes)
  • Thyroid disease, particularly an underactive thyroid

Often, carpal tunnel syndrome occurs without a clear reason. The condition affects women more often than men, perhaps because women normally have smaller carpal tunnels. It can occur in one or both hands.

Treatment for carpal tunnel usually consists or wrist bracing, modified activity and physical therapy in the form of anti-inflammatory treatment to the affected median nerve and manual therapeutic techniques to increase wrist joint mobility and corrective mechanics.

De Quervain’s Tenosynovitis

DeQuervains TenosynovitisDe Quervain’s tenosynovitis (dih-kwer-VAINS ten-oh-sine-oh-VIE-tis) is a painful condition affecting the tendons on the thumb side of your wrist. If you have De Quervain’s tenosynovitis, it will probably hurt every time you turn your wrist, raise your thumb, grasp anything or make a fist.

Although the exact cause of de Quervain’s tenosynovitis isn’t known, any activity that relies on repetitive hand or wrist movement – such as working in the garden, playing golf or racket sports or lifting your baby – can make it worse. Physical therapy is usually required to reduce local inflammation and manual therapeutics to improve the flexibility and tendon gliding mechanism; severe or resistant cases may require steroid injection by your physician; resistant cases may be referred for surgical release.

Ganglion Cysts

Ganglion cyst

Ganglion cysts are noncancerous lumps that most commonly develop along the tendons or joints of your wrists or hands. They also may occur in the ankles and feet. Ganglion cysts are typically round or oval and are filled with a jelly-like fluid. Small ganglion cysts can be pea-sized, while larger ones can be around an inch (2.5 cm) in diameter. Ganglion cysts can be painful if they press on a nearby nerve. Their location can sometimes interfere with joint movement.  They frequently come and go according to physical demands and stresses placed on the affected joint.

If your ganglion cyst is causing you problems, your doctor may suggest physical therapy to reduce the size and increase functional mobility of the wrist, or recommend draining the cyst with a needle. Removing the cyst surgically is also an option, though not common, unless it severely impairs function. But if you have no symptoms, no treatment is necessary. In many cases, the cysts go away on their own.