There are many reasons why the Shoulder is one of the most delicate and frequently injured joints in the human body. First of all, the shoulder is the 2nd worst lever system in the body, next to the hip joint. Because a person’s arm is so long, and the shoulder is so small, then it’s probably the worst lever in the body, taking everything into consideration. Additionally, the shoulder has an intricate ball and socket joint formation, which allows almost a “free” range of motion that spans up to 180 degrees. Some people that have hyper-mobile joints may actually be able to move their shoulders over the 180 degrees, as well.
There are many delicate ligaments and tendons that connect the shoulder joint together. Among the most delicate are the Rotator Cuff muscles and tendons. The Rotator Cuff consists of 4 muscles and tendons that run continuous, the Supraspinatus, Infraspinatus, Subscapularis, and Teres Minor. The Shoulder capsule itself is part of the joint around the shoulder and contains the Labrum, a cartilage ring for cushioning, and is attached to the biceps tendon for additional stability. Because of all these complicated and intricate structures combined with a poor level system, the shoulder is especially vulnerable to being injured.
Additionally, the shoulder is the only joint in the body that will “freeze” if it’s not being moved and used. Commonly, when an injury occurs to the shoulder, a person will stop moving their arm, because they can’t tolerate the pain level. However, this is the opposite of what they should actually do, because of the shoulder’s strange ability to freeze when “rested” too much. When the shoulder joint freezes, it becomes even more painful than the original injury was. If left untreated, a Frozen Shoulder will continue increasing in pain over time, until it becomes virtually unbearable with deteriorating range of motion and function. Sometimes, patients will seek out doctors or end up in the emergency room and request pain relief, and get shots of cortisone. Although the cortisone shots will help to mask the pain for a period of time, the shoulder will never “unfreeze” until it’s properly treated.
The technical name for a Frozen Shoulder is Adhesive Capsulitis. The reason for this name is because the capsule itself gets inflamed, as adhesions in the form of scar tissue begins developing around the joint. Over time, these adhesions harden and prevent the free range of motion that a normal shoulder has. When the shoulder is “unfrozen,” the scar tissue has broken down and can begin to get back movement. So, the most important thing to start with in Physical Therapy when treating a Frozen Shoulder is doing many different stretches, combining active, active-assistive, and passive exercises. Once most of the motion has returned, the patient will need to add strength throughout all the ranges.
To get functional strength back, PT exercises can consist of pushing, pulling, lifting, carrying, etc. Good specific functional exercises are push-ups, pull-ups, planks, bench press, incline press, decline press, rows, lat pull-downs, inverted rows, TRX pull-ups, etc. After doing some functional strengthening exercises, the patient also will need to strengthen their shoulder with single plane movements. Some good single planes exercises consist of shoulder flexion, scaption, abduction, internal rotation, external rotation, etc. These exercises work great with light dumbbells, therabands, or cables.
Lastly, patients should be able to perform sport-specific, or activity-specific rehab exercises. After completing all of these therapeutic exercises, patients should be able to return to their sport or activity of choice.
