Physical therapy for shoulder injuries. The shoulder injury is one of the most commonly occurring body injuries and according to one survey, the prevalence of shoulder pain and injuries ranges from 26% to 66% worldwide [1]. The shoulder is a ball-and-socket joint, stabilized by several muscles, tendons, and ligaments, and has an incredible freedom to perform a number of movements in several dimensions. However, being a highly mobile and actively used joint of the body, the shoulder has less stability and is more susceptible to injuries, pain, and other abnormalities.

There are many causes of shoulder injury including falls, repetitive movements, overhead motion, direct traumas, fractures, and age, and the incidence rate is higher in women than men with ratio of 2:1 [2]. Nevertheless, everyone is at risk of suffering from shoulder problems while athletes and older people are more prone to it. Fortunately, most shoulder injuries don’t require surgical procedures and are manageable by conservative treatment options including medications, injections, and especially physical therapy.

COMMON SHOULDER INJURIES

The shoulder joint is known as the most mobile and the least stable joint of the body, therefore, it is always at the risk of sustaining injuries.

Some common shoulder injuries include:

Dislocation
In shoulder dislocation, the bone of the upper arm ‘humerus’ get separated from the socket of the shoulder blade, called ‘scapula’ and this dislocation can be partial or complete depending on the injury

Frozen Shoulder (Adhesive capsulitis)
Frozen shoulder is characterized by the formation of scar tissues in the shoulder that thickens over time resulting in stiffness, extreme pain, loss of range of motion, and reduction in joint flexibility.

Rotator Cuff Tear
The rotator cuff comprises a group of muscles, ligaments, and tendons, and forms the most vital part of the shoulder joint. Any injury or damage to the rotator cuff structures is termed a Rotator cuff tear.

Impingement Syndrome
Impingement syndrome occurs when the tendons of the rotator cuff are pressed between the bones of the shoulder joint

Arthritis, bursitis, shoulder strains and sprains, and bone fractures are some other commonly encountered shoulder injuries.

TREATMENT OF SHOULDER INJURIES

There are many treatment options available for shoulder injuries and each intervention is used according to the type, severity, and intensity of injury sustained. Some of the treatment options are:

• Surgery, in case of serious injury
• Medication e.g. NSAIDs
• Immobilization e.g., splints, plaster, rest
• Physical therapy i.e., the treatment of choice for many shoulder injuries

PHYSICAL THERAPY FOR SHOULDER INJURIES

Physical therapy is the best, non-surgical treatment available to cope with shoulder injuries. It provides long-term relief that is permanent and is free from side effects.

Common Shoulder Injuries Treated by Physical Therapy
Injuries and diseases that can be easily manageable by physical therapy include:

• Frozen shoulder
• Rotator cuff tear
• Impingement syndrome
• Osteoarthritis
• Tendinitis/ Bursitis
• Shoulder dislocation
• Bone fractures
• Compromised shoulder mobility
• Reduced flexibility and ranges
• Muscle spasms, trigger points, and
• Other musculoskeletal problems of shoulder joint

Physical Therapy Techniques for Shoulder Injuries
According to the nature and severity of shoulder injury, following physical therapy techniques and methods are often used.

• Manual therapy
  Manual therapy consists of specialized hands-on techniques including soft-tissue mobilization, trigger point therapy, shoulder mobilization and manipulation, traction, muscle energy techniques, and many others, that are applied by a skilled physical therapist to achieve desired results. [3]
• Strengthening
  Strengthening exercises aim at restoring your shoulder strength and subside all sorts of weakness and instabilities caused by shoulder injuries.
• Stretching

Shoulder stretches are specially designed to target the tight muscles to regain normal joint ranges and provide relief from pain and other symptoms caused by shoulder injuries.  

• Ice therapy
  In physical therapy, the application of ice helps to control swelling, and inflammation, decrease muscle spasms, reduce pain, and ultimately provide relief from shoulder pathologies.
• Taping

For shoulder injuries like rotator cuff tear, shoulder impingement syndrome, or to simply support weak shoulder joint, a physical therapist uses a special type of medical taping, commonly known as Kinesiology Taping, to enhance the therapeutic exercises and speed up recovery.

• Electrotherapy

To provide fast relief from shoulder injuries, a physical therapist uses a controlled amount of electric current in form of TENS, EMS, PENS, and IFC to speed up recovery from shoulder injuries. [4]

• Other Modalities

Various other modalities such as therapeutic ultrasound, heat pads, short-wave diathermy, wax, and laser therapy, are also used by a physical therapist to effectively manage shoulder pathologies.

References:

1. Luime, J. J., Koes, B. W., Hendriksen, I. J. M., Burdorf, A., Verhagen, A. P., Miedema, H. S., & Verhaar, J. A. N. (2004). Prevalence and incidence of shoulder pain in the general population; a systematic review. Scandinavian journal of rheumatology, 33(2), 73-81.
   
2. Pribicevic, M. (2012). The epidemiology of shoulder pain: A narrative review of the literature. IntechOpen.

• Southerst, D., Yu, H., Randhawa, K., Côté, P., D’Angelo, K., Shearer, H. M., … & Taylor-Vaisey, A. (2015). The effectiveness of manual therapy for the management of musculoskeletal disorders of the upper and lower extremities: a systematic review by the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration. Chiropractic & manual therapies, 23(1), 1-17.

Hertz, H., Bochdansky, T., & Scharf, W. (1984). Electrotherapy of pain relief using the Tenzcare