Shoulder joint is the most intricate joint of the human body. The achieved freedom of movement in the shoulder in humans is at the expense of sacrifice to stability of the shoulder. Since we are not quadrupetals we are rarely it ever engage our upper extremity into closed kinetic chain activity, therefore proximal stability (neck, scapula, ribcage, spine) is sacrificed to distal mobility (dexterity and prehension) Functionally speaking most shoulder problems unless shoulder is affected by trauma are a result of poor posture, poor body mechanics and overuse.
Shoulder pain is one of the most common musculoskeletal complaints. It can occur in any age group for various reasons. Most frequently the shoulder pain results from trauma and overuse of the shoulder joint and surrounding tissues. Because of the unique anatomy, versatility and overall importance of the shoulder complex the treatment needs to be multilateral. Spanning across various medical disciplines is essential in order to achieve long-lasting positive effects.
The structure and functionality of the shoulder are unique for human species. The anatomy of shoulder joint is in fact the highlight of human evolution. The versatility and mechanics of the motion of the shoulder is far more complex than of any existing precision machine. Human shoulder joint is one anatomical structure that showed marked morphological changes, compared to the corresponding area in closely related animals, even before the beginning of the vertical life of the mankind.
The evolution of the shoulder anatomy is intimately connected with development of human posture and locomotion. The posture and locomotion depend on neuromuscular coordination of shoulder girdle muscles. These develop in parallel, one slightly preceding another, during the postural ontogenesis that takes place in the first months of infants life mirroring the lengthy process of the human evolution. The stability of the scapula-humeral articulation (shoulder joint complex) during this time defines future posture and locomotion. In fact, the child is not able to walk until he can lift his arm above 120 degrees.
It is a scientific fact that anatomical structures and functions, acquired the latest during the evolution, are the most fragile and prone to failures. The human shoulder is a vivid example of that. The enhanced ability to perform complex multilateral movement has developed at the expense of diminished osteo-ligamentous stability, which is so important for all other joints in human body. At the shoulder, strong bone-and-tendon composition of the joint is replaced by an intricate, if delicate, muscular support mechanism known as the rotator cuff.
The rotator cuff is designed to reinforce the otherwise unsupported shoulder joint and hold the ball-shaped head of the shoulder bone (humerus) in the glenoid fossa, the socket of the shoulder blade (scapula). Rotator cuff is made up of four muscles that originate from the scapula surface and are connected to the upper humerus forming a tight elastic blanket of muscle tissue over the shoulder joint holding it together. Without the rotator cuff support, the head of the humerus would freely ride in and out of the shallow glenoid fossa, rendering the joint inoperable.
The function of the rotator cuff
is not limited to the structural support. Besides keeping the joint intact, the rotator cuff assists in some shoulder and arm movements. During the throwing motion, for example, the rotator cuff muscles undergo series of rapid eccentric contractions (they are lengthened under tension) decelerating the arm and softening the impact of the exertion. Diverse functionality of the shoulder joint puts considerable stress on the tendons of the rotator cuffs muscles making them susceptible to overuse injuries. Relatively poor ability of the rotator cuff tissues to withstand excessive forces is frequently exacerbated by inadequate postural support of the shoulder girdle.
The pain due to rotator cuff tear, tendonitis, various arthritic inflictions and overuse is the price we pay for exchanging structural stability of the shoulder for mobility and motor versatility.
The function of shoulder joint depends not only on the integrity of rotator cuff muscles and sinews, but on the stabilization of the scapula. The ideal position of the scapula is achieved when the body is erect. Poor posture impedes scapular stability, generating excessive loads to the rotator cuff muscles.
For example: Try to lift your arm sideways after slumping your thoracic spine or protruding your chin forward and then compare the results to the range of motion of the same movement during the erect spinal position.
Clinical examination allows diagnostic certainty while further radiological investigation by MRI, and/or diagnostic ultrasound allows diagnostic precision.
The combination of physical therapy and rehabilitation exercise constitute scientifically proven and sound method for treatment of shoulder pain. Many shoulder conditions respond well to extracorporeal shock wave therapy, prolotherapy and platelet-rich plasma injections. Whatever the shoulder pain condition is at stake the combination of any of the above described methods and measured exercise brings the best results.
Shoulder surgery is only necessary when the conservative therapy fails or after a destructive traumatic event. It is a responsibility of a conservative care clinician to make a timely referral for the surgery.
At DN Rehabilitation we use combination of physical therapy exercises, DNS exercises and regenerative treatments such as extracorporeal shockwave therapy, prolotherapy and Platelet-rich Plasma injections. Depending on the diagnosis, individualized treatment plans are developed on the individual basis consisting of balanced combination of the above-listed therapies.
Most conventional physical therapy is based primarily on strengthening of the rotator cuff muscles. DNS approach is different in a way that the treatment begins with restoration of the motor control and muscular synergies before strengthening the rotator cuff. Doing this allows reestablishing muscular balance that is imperative for the ideal function of the shoulder. Muscle synergies that are established during the early childhood development serve as foundation of human posture and movement. During early development muscular synergies around shoulder girdle must develop first to ensure the shoulder stability, which is critical for establishment of the first point of support by the child. DNS reenacts these muscular synergies, reestablishing muscle balance, responsible for ideal function of the shoulder prior to strengthening of rotator cuff.
Professional athletes use DNS therapy and exercises to prevent injuries and, should an injury occur, expedite post-traumatic recovery. The general application of DNS extends far beyond sports medicine and is equally effective for all patient groups.
Regenerative treatment is a form of stimulation of bodys own regenerative abilities by different physical or biological agents introduced into the injured area.
ESWT is used for subacromial bursitis, shoulder tendinitis or calcific tendonitis. Please click here to explore our ESWT page…
Platelet-rich Plasma injections are used for moderate rotator cuff tears and frozen shoulders.
Prolotherapy is used for unstable and hyper mobile shoulders, shoulder dislocations and A-C joint suluxation.