The function of the human arm is to allow placement of the hand in useful positions so the hands can perform activities where the eyes can see them. Because of the huge range of positions required the shoulder is very flexible with a large motion range, but this is at the expense of some reduced strength and greatly reduced stability. A "soft tissue joint" is often a description of the shoulder, indicating it is the tendons, muscles and ligaments which are important to the joint's function. Shoulder treatment and rehabilitation is a core physiotherapy skill.
The humeral head and the glenoid of the scapula make up the glenohumeral joint, with the glenoid being small and flat and the humeral ball being large and partly spherical. The main ligaments and shoulder tendons insert on the humeral head, giving the movement and support the joint requires. The socket is made deeper by the glenoid labrum, a rim made of cartilage, which aids joint stability. Above the shoulder lies a joint between the outer end of the clavicle and the acromion, part of the scapula. This is a stability joint for arm movement and called the acromio-clavicular joint.
The major stability and flexibility joints of the upper limb shoulder girdle are the scapulothoracic and glenohumeral joints and these joints are held steady and moved by large and powerful muscles. The pectoralis major and latissimus dorsi muscles stabilise and perform strong movements, the serratus anterior stabilises the scapula on the thorax, the rotator cuff stabilises the humeral head on the socket and the deltoid and other muscles perform movements. The shoulder blade and thorax need to be kept in a stable relationship for the glenohumeral joint to perform precise and controlled movements.
The shoulder muscle tendons become flatter and thinner as they approach and then insert themselves onto the head of the humerus. By this way the rotator cuff, a group of four muscles including the supraspinatus, infraspinatus, teres minor and subscapularis, is able to exert its forces on the humeral head. The tendons coalesce as they surround and insert onto the ball of the humerus, forming a cuff around the ball, centering the ball on the socket to counter the tendency to slide upwards under muscle activity. Keeping the ball centred on the socket means the larger and more powerful muscles can perform functional shoulder and arm movements.
With age, small degenerative tears occur in the tendons of the cuff, in some cases painful and in others not, causing loss of movement and strength. As tears progress they can become massive, cutting off the cuff muscle power from the humeral head and severely reducing function. Rotator cuff strengthening work is performed by physiotherapists and if the tears are severe they concentrate on anterior deltoid strength to improve functional ability in the absence of cuff power. Shoulder surgeons can repair many rotator cuff tears and physiotherapists rehabilitate patients following the shoulder protocols.
The shoulder joint is not typically affected by OA (osteoarthritis) but when it is physiotherapists treat arthritic shoulders by joint mobilisations, muscle strengthening and ranges of motion. Once physio has nothing else to offer, total shoulder replacement is one of the further options, with various surgical techniques involving replacing the humeral ball and the scapular socket either anatomically or in reverse. The shoulder is often called a "soft-tissue joint" as the soft tissues, their strength and balance, are vital to the function of the joint. Post-operative physio management is essential as the correct protocol must be closely followed to ensure success.
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. - 16650
The humeral head and the glenoid of the scapula make up the glenohumeral joint, with the glenoid being small and flat and the humeral ball being large and partly spherical. The main ligaments and shoulder tendons insert on the humeral head, giving the movement and support the joint requires. The socket is made deeper by the glenoid labrum, a rim made of cartilage, which aids joint stability. Above the shoulder lies a joint between the outer end of the clavicle and the acromion, part of the scapula. This is a stability joint for arm movement and called the acromio-clavicular joint.
The major stability and flexibility joints of the upper limb shoulder girdle are the scapulothoracic and glenohumeral joints and these joints are held steady and moved by large and powerful muscles. The pectoralis major and latissimus dorsi muscles stabilise and perform strong movements, the serratus anterior stabilises the scapula on the thorax, the rotator cuff stabilises the humeral head on the socket and the deltoid and other muscles perform movements. The shoulder blade and thorax need to be kept in a stable relationship for the glenohumeral joint to perform precise and controlled movements.
The shoulder muscle tendons become flatter and thinner as they approach and then insert themselves onto the head of the humerus. By this way the rotator cuff, a group of four muscles including the supraspinatus, infraspinatus, teres minor and subscapularis, is able to exert its forces on the humeral head. The tendons coalesce as they surround and insert onto the ball of the humerus, forming a cuff around the ball, centering the ball on the socket to counter the tendency to slide upwards under muscle activity. Keeping the ball centred on the socket means the larger and more powerful muscles can perform functional shoulder and arm movements.
With age, small degenerative tears occur in the tendons of the cuff, in some cases painful and in others not, causing loss of movement and strength. As tears progress they can become massive, cutting off the cuff muscle power from the humeral head and severely reducing function. Rotator cuff strengthening work is performed by physiotherapists and if the tears are severe they concentrate on anterior deltoid strength to improve functional ability in the absence of cuff power. Shoulder surgeons can repair many rotator cuff tears and physiotherapists rehabilitate patients following the shoulder protocols.
The shoulder joint is not typically affected by OA (osteoarthritis) but when it is physiotherapists treat arthritic shoulders by joint mobilisations, muscle strengthening and ranges of motion. Once physio has nothing else to offer, total shoulder replacement is one of the further options, with various surgical techniques involving replacing the humeral ball and the scapular socket either anatomically or in reverse. The shoulder is often called a "soft-tissue joint" as the soft tissues, their strength and balance, are vital to the function of the joint. Post-operative physio management is essential as the correct protocol must be closely followed to ensure success.
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. - 16650
About the Author:
Jonathan Blood Smyth is a Superintendent Physiotherapist 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 Manchester.
