Our Burlington Physiotherapy and Chiropractic clinic treats lots of different conditions and injuries affecting any joint, muscle, tendon or ligament in the body (more or less). Shoulder pain and shoulder injuries are among the most common conditions. For the next few weeks, we’re going to focus our blogs on shoulder pain, its causes, treatment options and exercises. For this week, we’re going to start from scratch and walk you through some of the basic anatomy of the shoulder, relevant to most of our Burlington readers…

To keep it simple, the humerus is the bone in your arm that forms a joint with the scapula (or shoulder blade as many call it). Of note in the picture is the clavicle (commonly known as the collar bone). The clavicle (visible from the front) has a joint with the scapula (on your back). This joint is called the acromioclavicular joint, which is the joint we injure with a separated shoulder.

This picture illustrates the more superficial muscles. The deltoid has three parts; the front, middle and back. From this view, we can see the middle and rear deltoid. In the next picture we can see the front or “anterior” deltoid. Underneath the deltoid are the rotator cuff muscles.

This is a picture of the front of the shoulder. You can see the bicep muscle / tendon tucks underneath the deltoid. Also under the deltoid are the rotator cuff muscles seen in the next picture

The rotator cuff muscles have attachments on the scapula (shoulder blade) and the humerus. Among other things, they are very important muscles for stabilizing the humerus so that it moves in the right “spot” on the scapula. Rotator cuff muscles are often injured. We regularly see diagnostic ultrasound reports that indicate tendinosis, tendinopathy or tear of these muscles, most frequently the supraspinatus.

Obviously, this is a very basic outline of the shoulder. We plan on tackling various concepts related to the shoulder in the coming weeks so this will serve as a starting point and reference point for weeks to come.

Many patients visit our Burlington physiotherapy and chiropractic clinic for assistance with pain in the front of the shoulder. There are various causes to pain in this area, but perhaps one of the leading suspects would be the bicep tendon.

Pain in the front of the shoulder

As the name implies, the bicep tendon has two heads. In the shoulder area, there are two tendons that insert in different areas. The specific anatomy is beyond the scope of this blog but the take home point is that there are two areas of insertion in the area of the shoulder. The muscle extends down the front of the arm to just past the elbow. The reason it crosses the elbow joint is so that it can function to bend the elbow. The bicep in the shoulder area functions to raise the arm out in front, as you would do when reaching for something out of a kitchen cupboard (for example).

 Symptoms of bicep tendon injury include local pain (in the front of the shoulder) and pain with movements that use the bicep. There are various conditions that can affect the bicep. These include (but are not limited to) tendinosis, tendonopathy, tendinitis, tear of the bicep tendon or rupture of the bicep tendon. The most common presentation we see in our Burlington clinic is a simple irritation or degeneration of the tendon as it occurs in bicep tendinopathy. This is usually a fairly simple condition for a knowledgeable practitioner to diagnose.

X-rays are not usually helpful in diagnosing bicep tendinopathy. Your family doctor may refer you for diagnostic ultrasound to confirm the diagnosis or rule out other causes, but is not always necessary. Interestingly, ultrasound reports often mention fluid around on the head of the bicep tendon. Although this may be less common with other tendon disorders, it is part of the reason our practitioners avoid aggressive manual treatment in this area of the shoulder. Conservative options like laser therapy or acupuncture can be more useful in resolving this area of shoulder pain. Of course, this is a generalization and there are many variables. We recommend that you consult with a knowledgeable practitioner who can diagnose your condition and suggest an appropriate management strategy.

 The “take-home” point? Many tendon disorders can benefit from manual treatment like active release and graston. Yet in the case of bicep tendinopathy, you may be best off icing the front of the shoulder and not using aggressive manual therapy. This can perhaps aggravate the area and lead to more inflammation. Perhaps for this area of pain a more “delicate” approach can get you better faster!

If you’re experiencing pain in the front of your shoulder, you may have an injury to your bicep tendon. The bicep tendon is a relatively common source of shoulder pain. There are variable patient presentations and different treatment options depending on the specific dysfunction. Let’s start with the basics…

Anatomy of the Bicep Tendon

The bicep muscle is the one in your arm that you flex when you’re at the beach. The muscular portion turns into a tendon as it inserts onto the skeleton. There are actually two divisions to the muscle (where the name “bi”-cep comes from). The long head of the biceps is usually the one that is injured. It continues upward into the shoulder and anchors in two places; on a piece of cartilage and on a piece of bone.

Follow the bicep muscle to the shoulder, where the bicep tendon is!

Function of the Bicep

As mentioned above the bicep muscle is well known for its ability to bend the elbow. Its role in shoulder motion and stability is an area of controversy in the world of muculoskeletal medicine, but we do know for certain that the tendon of the bicep (located in the front of the shoulder) has the ability to generate pain.

Pain in the front of the Shoulder

Pain in the bicep tendon is usually located in the front of the shoulder. An easy way to landmark this tendon is to flex your bicep muscle and follow it right up into the top of your shoulder. The top few inches of that line is the vicinity of the bicep tendon. Pain in this area suggests injury to the bicep tendon. According to the literature, there are various causes of bicep tendon injury.

Acute injury

Acute injury to the bicep tendon usually involves a tear. This can occur in the tendon or muscle itself, or more often in the area of the insertion. As mentioned above, the bicep tendon has an insertion on a piece of cartilage called the labrum. For all you baseball fans out there, you’d understand that labrum injuries can be frustrating and stubborn for throwing athletes!

Instability of the Bicep Tendon

Another dysfunction that can affect the bicep tendon is instability. This also commonly affects throwing athletes. Instability of the bicep tendon is when the tendon doesn’t sit in the little groove that it’s supposed to. When the shoulder is moved into certain positions the tendon can “slip out”. This causes pain and irritation.

Bicep Tendinitis / Bicipital Tendinitis / Bicep Tendinopathy

This type of bicep tendon injury is probably the most common type that we see at our clinic. A patient with this type of pain usually has pain in the front of the shoulder and complains of pain with pressure over the area. One explanation for this type of dysfunction is general “wear and tear” on the tendon.

Imaging findings

Quite often patients come to our clinic with a diagnostic ultrasound report showing inflammation in the bicep tendon. As mentioned above, wear and tear can be associated with inflammation in the area of the bicep tendon. Conservative treatment can be helpful in this situation. In the situation of acute injuries where the cartilage is thought to be damaged (such as labral tears) an MRI is more useful than diagnostic ultrasound.

Treatment of Bicep Tendon Injuries

Our clinic treats bicep tendon injuries quite often. The treatment approach used often depends on the various factors present in each case. For example, a recent traumatic cartilage injury would likely require referral to an orthopedic surgeon. In the case of the more common degenerative tendinopathy or when your doctor has diagnosed you with bicipital tendinitis, physiotherapy or chiropractic can be helpful. Physiotherapy or chiropractic at our clinic usually involves the use of modalities like laser therapy, interferential current, acupuncture, active release technique, graston technique, other manual therapies and/or rehabilitative exercise.

Unsure what to do? Give us a call or email us, we can help you. info@burlingtonsportstherapy.com

References
Barber A, Field L, Ryu R. Biceps tendon and superior labrum injuries: decision making. The Journal of Bone and Joint Surgery 2007; 89(8): 1843-1855.
Gill HS et al. Physical examination for partial tears of the biceps tendon. American Journal of Sports Medicine 2007; 35(8): 1334-1340.
Krupp RJ, Kevern MA, Gaines MD, Kotara S, Singleton SB. Long head of the biceps tendon pain: differential diagnosis and treatment. Journal of Orthopaedic & Sports Physical Therapy 2009; 39(2): 55-70.

It seems that over the last decade more and more research is being published on the role of the scapula (shoulder blade) in athletic shoulder injuries.  Perhaps it is safe to say that in the past, most of the research was focused on the more obvious, common structures that get damaged in the shoulder as opposed to looking at subtle dysfunctions which may predispose someone to injury.

Scapular Dyskinesis

The scapula is the technical term for our shoulder blade.  Scapular dyskinesis is a relatively new concept that refers to aberrant movements of the shoulder blade.  For example, many baseball players have different movement patterns around their shoulder blades.  This is because repeatedly throwing changes the balance of muscle use around the shoulder and scapula, changing the way the entire area functions.  As practitioners, we can now use the scapula and the clinical movement of the scapula as a way to decipher the cause of someones shoulder pain.

SICK Scapula

The “sick scapula” is a slang term used by some practitioners describing various changes in the shoulder (or shoulder blade to be more precise). In this situation, the athlete’s shoulder blade will appear in the wrong position at rest (for example the bottom end of it may protrude too much), the front of the shoulder near your chest muscle might be painful with pressure and the shoulder blade (scapula) might move differently when compared to the other shoulder blade.

Imaging

These shoulder injuries usually have normal imaging findings. That is, x-rays don’t show any bony injury and soft tissue imaging (like ultrasound or MRI) fail to show any soft tissue damage. In other words, there isn’t anything torn or broken, but rather certain muscles have shortened and changed the way the entire shoulder functions. Other muscles may have become weak as a result.

Treatment for the Throwing Shoulder

Treatment for altered shoulder movement and function (attributed to something like throwing) often involves a “re-balancing” of the muscles. Muscles that are too tight need to be stretched. If they are overused, active release or graston might be helpful in removing scar tissue. Strengthening is always an important part of the rehabilitative process to help “undo” some of the changes and prevent them from recurring.

Have a painful shoulder due to lots of throwing? We can help you! info@burlingtonsportstherapy.com

References
Burkhart SS, Morgan CD, Kibler WB. The disabled throwing shoulder: spectrum of pathology part III: the sick scapula, scapular dyskinesis, the kinetic chain and rehabilitation. The Journal of Arthroscopic and Related Surgery 2003; 19(6): 641-661.

A “trigger point” is a slang term used to describe an irritable, localised area of dysfunction in a muscle. What makes a trigger point unique is that it refers pain in a characteristic pattern. That is, it sends a pain signal to a different location and this location is often predictable (depending on the dysfunctional muscle).

Does your neck get sore when you sit at a computer for too long?

What causes a trigger point?

Trigger points are the result of overuse. They can occur in muscles that are subjected to obvious use, like the legs of a marathon runner. Perhaps less obvious but quite common, are the trigger points that form in postural muscles. These areas of dysfunction occur because of the constant low level demand placed on them, such as the muscles in the shoulder and neck after slouching at a computer desk.

What happens to the muscle?

A trigger point makes a muscle short and weak.  Sometimes they can affect a person’s movement.

Types of Trigger Points

There are two major types of trigger points; latent and active. Latent trigger points are not usually painful unless someone pushes on the area or unless you move in a way that stimulates the muscle. An active trigger point is painful even without touching it or moving it.

How do you diagnose a trigger point?

There really aren’t any diagnostic tests for a trigger point (that are usually necessary at least). Trigger points are usually palpable by the practitioner. As previously mentioned, a trigger point (by definition) refers pain in a characteristic pattern and increases pain locally with pressure.

Treatment for Trigger Points

There are various treatment approaches for muscular trigger points. Massage therapy, acupuncture, active release technique and graston technique are all common methods for treatment. In most cases, rehabilitative exercises are important to not only reverse the muscular aggravation, but to change the function of an area so that the muscle does not become overused in the future. In the same line of thinking, activity modification may be helpful in avoiding overuse of an area.

Think you may have a muscular trigger point? Give us a call, we can help! info@burlingtonsportstherapy.com

References

Hyde TF, Gengenbach MS.  Conservative Management of Sports Injuries 2nd Ed.  Jones & Bartlett Learning 2007.

Put your hand on your clavicle (or collar bone as many people call it) and follow it outwards as far as you can toward your shoulder; that big bump at the end on the top of your shoulder is called your acromioclavicular joint or “AC joint”. Traumatic injuries to this joint are common accounting for 9% of injuries to the shoulder. Sprain of the AC joint is often referred to as a separated shoulder.

Physiotherapy in Burlington for a Separated Shoulder

Separated Shoulder vs. Dislocated Shoulder

A dislocated shoulder is when the large bone in your arm actually comes out of the shoulder “socket”. An AC joint sprain or shoulder “separation” is when the lateral portion of your collar bone pulls away from the shoulder joint after trauma. Quite often these injuries involve a “step defect”, where the ligament damage has left the shoulder with a visible deformity since they can no longer hold the collar bone in place.

Who gets Separated Shoulders?

AC joint sprains are more common in younger adults, probably because they are more likely to be out taking chances and playing more aggressive sports.  Statistically, these injuries are far more common in men than women. Usually the trauma would involve impact on the shoulder (like falling) with the arm either across the body or outstretched.

Types of Shoulder Separations

There are generally six types of AC joint sprains. The first being a mild sprain with no visible dislocation of the collar bone, all the way to the sixth type, which involves a rather significant dislocation of the joint. Types one and two can usually be managed conservatively with physiotherapy or chiropractic. Type three is border-line, but anything above (type four to six) warrant a consultation with an orthopedic surgeon.

Symptoms of Shoulder Separation

Usually there is pain locally in the joint (on the top pointy part of your shoulder) but you can also get some pain in the neck and throughout the shoulder joint. Newer injuries are usually painful with pressure and aggravated with bringing your arm up to shoulder level and across your body.

Treatment for AC Joint Sprains (Shoulder Separation)

As mentioned above, the milder types of AC joint injuries are the ones that we normally treat. Chiropractic and / or physiotherapy at our clinic can involve the use of various treatment modalities depending on the presentation of the patient. Some of these modalities include laser, interferential current (IFC), graston, active release technique, acupuncture and rehabilitative exercise. Consulting with a chiropractor in this case is helpful so that diagnostic x-rays can be ordered and the degree of separation can be determined. 

Unsure what to do?  We can help you! Call or email us at info@burlingtonsportstherapy.com

References
Mazzocca AD, Arciero RA, Bicos J. Evaluation and treatment of acromioclavicular joint injuries. American Journal of Sports Medicine 2007; 35(2): 316-329.

Many people don’t realize that our shoulder muscles (in particular the rotator cuff muscles) can wear down with time. The concept of rotator cuff degeneration is now a well established explanation for shoulder pain for many patients over the age of 40.

Rotator Cuff Injury is Progressive

There are different theories as to how the aging rotator cuff gets injured. Sure, there can be a spectacular event which initiates all the pain, but there doesn’t have to be. For many people, an “event” of injury is what they relate the symptoms to, but there was years of tendon degeneration already occurring which perhaps made the injury inevitable.  Tendon degeneration can be considered progressive.  Over time it gets worse and worse, where at the far end of progression is a complete tear of a rotator cuff tendon.

Causes of Rotator Cuff Degeneration

The factors that cause rotator cuff degeneration can be divided into two main categories; intrinsic factors and extrinsic factors.  An example of an extrinsic factor would be a surrounding structure compressing a rotator cuff tendon, whereas an intrinsic factor would be that the tendon is degenerating because of the inherent characteristics of that tendon itself.  This may be a little too technical for our average reader, so we’ll just review some of the basic reasons our shoulder muscles (namely the rotator cuff muscles) degenerate. This may assist you in learning how to keep your shoulders healthy!

Tendon Compression

Rotator cuff tendons are susceptible to degeneration when they are repeatedly subjected to compression.  This can occur for various reasons.   Some of us have a unique shape to the bones in our shoulder which can lead to tendon compression.  For others, degenerative arthritis (and the bone spurs related to arthritis) are the real problem.  These bone spurs have the ability to compress muscles and tendons leading to advanced tendon degeneration.  Muscle tightness can also cause problems.  For various reasons, some of us get tight in certain areas of the shoulder.  This can lead to the development of altered movement patterns in the joint and can eventually cause tendons to get compressed. In each of these scenarios, the tendon gets compressed and is subjected to wearing down or degeneration.

Age Related Shoulder Pain

For many of us, the activities we choose place an enormous demand on our shoulder muscles. This demand can often outweigh the ability of the tendon to repair itself. What results is a net breakdown of the tendon…this is rotator cuff degeneration in a nutshell. Unfortunately age plays a large role. The literature suggests that those people over the age of forty have a reduced ability to keep up with this degeneration / rebuilding process and perhaps explains the prevalence of shoulder pain in those over forty.

Treatment for Rotator Cuff Degeneration

With respect to treating rotator cuff degeneration, it’s important to combine all the information and formulate a plan that reflects your specific situation. For example, if you’re over the age of 40, have bony changes in the shoulder joint on your x-rays, you show altered movement patterns on examination and you like doing dumbbell shoulder press exercises, it may be necessary to get some professional help. Consulting with one of our physiotherapists or chiropractors may be helpful in limiting the rate of degeneration. This can be accomplished through the prescription of the appropriate rehabilitative exercises, guidance with exercise selection or therapeutic treatment using modalities like laser therapy or active release technique.

For more information about our services and the ways we treat rotator cuff degeneration, shoulder pain or shoulder impingement, please call us or email at info@burlingtonsportstherapy.com.

References
Nho S, Yadav H et al. Rotator cuff degeneration etiology and pathogenesis. American Journal of Sports Medicine. 2008; 36(5): 987-993.
Seitz AL, McClure PW, Finucane S et al. Mechanism of rotator cuff tendinopathy: intrinsic, extrinsic or both? Clinical Biomechanics 2011; 26: 1-12.

Frozen shoulder is a relatively common condition that can have a significant impact on a person’s life. A person with a true frozen shoulder usually experiences a significant loss of motion and experiences a significant amount of pain.

About Frozen Shoulder

Frozen shoulder affects approximately 2-5% of the population. Also called adhesive capsulitis, frozen shoulder can be linked to certain health conditions (such as diabetes or rheumatoid arthritis) but not always. For many patients, frozen shoulder occurs for no apparent reason.

Why is my shoulder stiff?

The precise mechanism of frozen shoulder is still relatively unknown. That being said, it is generally understood that some form of “event” causes the cells in your shoulder to change their activity. Inflammation likely causes the different tissues in the shoulder to contract or “bear down” on the joint. As a result it is very difficult to move since there is a type of “debris” in the way.

Symptoms of Frozen Shoulder

A person with frozen shoulder will likely experience pain when they move their shoulder to the end of available range. Often, the shoulder won’t hurt with movement in a short range and will not really hurt at rest. Contrary to popular belief, the muscles are not damaged or weakened in any significant way. Although it seems like the muscles must be damaged or torn, they usually aren’t. The joint just won’t move!

Tests for Frozen Shoulder

Unlike many conditions, there really aren’t any imaging findings for a practitioner to look for. When a person presents to our clinic with pain, loss of movement and no obvious findings on x-ray, diagnostic ultrasound or MRI, frozen shoulder is a diagnostic possibility.

Phases of Frozen Shoulder

It’s important for people with frozen shoulder to realize the expected healing rate (according to the published literature).  Although some lucky individuals recover from their frozen shoulder relatively quickly, many patients experience symptoms for over a year. According to the literature, the first phase of frozen shoulder lasts approximately 3-9 months. This is the “freezing” period which involves progressive pain and loss of motion.

Second Phase of Frozen Shoulder

The second phase of frozen shoulder occurs between 9-15 months since onset. At this point the shoulder is stiff…frozen shoulder has arrived!

Recovery from Frozen Shoulder

The last phase of frozen shoulder is often referred to the “thawing” phase. It can often occur between 15-24 months and involves a relatively gradual improvement in mobility.

Treatment for Frozen Shoulder

The treatment for frozen shoulder really depends on the phase of development and the amount of pain the patient is experiencing. Conservative treatment (like chiropractic or physiotherapy) is usually recommended and involves such things as stretching, assisted stretching, active release technique and other forms of manual therapy, laser therapy, interferential current, graston and acupuncture. Sometimes a combination of these approaches does the job. For those with very painful frozen shoulder, corticosteroid injections can be helpful. Surgery is also an option for those who fail to respond to conservative treatment (like physiotherapy or chiropractic). Unsure if you even have a true frozen shoulder? Want to know your options for treatment?

Call or email us – info@burlingtonsportstherapy.com. We can help you!

References
Favejee M, Huisstede BM, Koes BW. Frozen shoulder: the effectiveness of conservative and surgical interventions – systematic review. British Journal of Sports Medicine 2011; 45: 49-56.
Johnson AJ et al. The effect of anterior versus posterior glide joint mobilization on external rotation range of motion in patients with shoulder adhesive capsulitis. Journal of Orthopaedic & Sports Physical Therapy 2007; 37(3): 88-99.
Kelley MJ, McClure PW, Leggin BG. Frozen shoulder: evidence and a proposed model guiding rehabilitation. Journal of Orthopaedic & Sports Physical Therapy 2009; 39(2): 135-148.

Many patients come to our clinic believing they have shoulder bursitis. Shoulder bursitis is a condition in which the bursa of the shoulder gets inflamed and generates pain. What is a bursa you ask? Let’s start from the beginning…

Bursitis Shoulder

Bursa and Bursitis

Bursa are anatomical structures that are present throughout our body. A simple way to explain them is that they are “spacers” to separate different tissues in our body to prevent friction…think of a balloon filled with pudding.  Under normal circumstances we don’t even know we have them. They are present in our shoulders, knees, hips (and other major joints) and they usually don’t cause any symptoms or signs of dysfunction. When provoked, these structures can become inflamed. When this happens they swell with fluid and create the painful condition called “bursitis”.

Shoulder Bursitis

Most forms of bursitis are not visible but some can be. In these cases, you might actually see an area of collected fluid which correlates with the painful area. Keep in mind that bursitis doesn’t have to be painful though! In the most common case of shoulder bursitis, the bursa underneath the acromion (the pointy bone on top of your shoulder) gets inflamed. This is called subacromial bursitis. Since there isn’t a lot of extra space in that area to begin with, things get compressed. This is usually painful.

Symptoms of Shoulder Bursitis

A broad area of pain in the shoulder is common for shoulder bursitis. It usually doesn’t involve a specific point area of tenderness, but rather a “spread out” ache. Shoulder bursitis is usually aggravated with overhead activity, compression (like lying on that shoulder) and excessive use. Diagnostic ultrasound and MRI can be helpful in determining whether there is swelling in the bursa.

Treatment of Shoulder Bursitis

There are various treatments for shoulder bursitis. Anti-inflammatory or cortisone injections can be provided by a medical professional. Consistent with the literature, our clinic offers conservative treatment options through our chiropractors and physiotherapists. This avenue of treatment involves various treatment modalities like laser therapy, interferential current, manual treatment (like active release on surrounding tissues), acupuncture and rehabilitative exercise.  The treatment that is right for you can depend on many different factors, such as the duration of symptoms and treatment approaches that have already been tried.  Unsure what to do?  Feel free to give us a call or email us at info@burlingtonsportstherapy.com.  

So you have a sore, painful shoulder and you’ve been told it’s a rotator cuff tear. But what does that mean? How do you treat a torn rotator cuff muscle? How do you know if your rotator cuff is torn? Let’s start with the basics…

What is a rotator cuff tear?

Rotator Cuff Muscles

A rotator cuff tear is a very common injury affecting one (or more) of four different muscles in the shoulder. A tear can be partial or complete and can sometimes involve retraction of the tissue. Rotator cuff tears can be painful but they don’t have to be. They can often be associated with a traumatic event…but they don’t have to be! Rotator cuff tears can occur after years and years of use and are much more common in those people over 60.

Symptoms of Rotator Cuff Tear

Rotator cuff tears typically cause local pain in the shoulder. The pain can also travel down the shoulder toward the elbow. Surprisingly though, you may have one right now and not even know! A 1995 study published in the Journal of Bone & Joint Surgery performed MRI’s on people without shoulder pain. They found that rotator cuff tears in 4% of patients under 40 and in 54% of those greater than 60. A similar study found tears in 40% of those older than 50.

How do you know if you’ve torn your rotator cuff?

A skilled practitioner with the appropriate knowledge to diagnose your condition is obviously essential. One benefit of seeing a chiropractor is that we can order the appropriate x-rays right away. Although a rotator cuff tear is a muscular injury, there are clues that can be found on plain x-rays. Combining this information with certain clinical tests performed during your examination can allow for an early diagnosis so treatment is not delayed.

What is the best imaging for rotator cuff tears?

MRI (magnetic resonance imaging) is known to be one of the most accurate tools for diagnosing rotator cuff injuries. In Ontario, the wait can be long so many patients are referred for a diagnostic ultrasound. Although this modality isn’t as accurate, the wait times are usually shorter and can usually provide an early diagnosis.

Surgery for Rotator Cuff Tears

Surgery is appropriate for some individuals, but there are many different factors to consider. Many rotator cuff tears “re-tear” after surgery. Despite this, surgery can still improve function and decrease pain. Delaying surgery can be a bad idea though; your tear can get larger (especially if you’re over 60 years old), it can retract, can become infused with fat tissue and it can also atrophy (shrink). Each of these events will make recovery more difficult. Surgery is usually a more obvious decision for younger patients with a new, severe tear. Older patients have to carefully discuss with their surgeon and weigh out the benefits and risks.

Should I try more conservative treatment first?

According to the evidence, it is usually a good idea to try conservative treatment (like chiropractic or physiotherapy) for approximately six to twelve weeks prior to choosing surgery. This approach is most suitable for those people who still have some strength in their shoulder. Thinking of waiting to see if it improves? It is generally understood that larger tears will not heal with time. In fact, it would be more likely to get worse and retract. Significant retraction can make surgery more difficult.

Physiotherapy for Shoulder Pain

Our Burlington Chiropractic and Physiotherapy clinic offers many different ways to treat rotator cuff tears. Exercise, interferential current, laser therapy, acupuncture, graston or hands on treatment (like Active Release) are some of our “tools”. The best treatment for rotator cuff tears depends on many factors. Age, the duration of your symptoms, your x-ray findings and clinical findings (like strength) all play a role in the decision making process. Give our clinic a call and start with a diagnosis…we’ll help you figure it out!
Email – info@burlingtonsportstherapy.com

References
Hansen M, Otis J, Johnson J et al. Biomechanics of massive rotator cuff tears: implications for treatment. The Journal of Bone and Joint Surgery 2008; 90(2): 316-325.
Keener JD, Wei AS, Kim HM et al. Proximal humeral migration in shoulders with symptomatic and asymptomatic rotator cuff tears. The Journal of Bone and Joint Surgery 2009; 91: 1405-1413.
Maman E, Harris C, White et al. Outcome of nonoperative treatment of symptomatic rotator cuff tears monitored by magnetic resonance imaging. The Journal of Bone and Joint Surgery 2009; 91: 1898-1906.
Sher JS, Uribe JW, Posada A et al. Abnormal findings on magnetic resonance images of asymptomatic shoulders. Journal of Bone & Joint Surgery 1995; 77:10-15.
Wolf B, Dunn W, Wright R. Indications for repair of full-thickness rotator cuff tears. Americal Journal of Sports Medicine 2007; 35: 1007-1016.
Zingg PO, Jost B, Sukthankar A et al. Clinical and structural outcomes of nonoperative management of massive rotator cuff tears. The Journal of Bone and Joint Surgery 2007; 89: 1928-1934.