Shoulder Physiotherapy

Physiotherapy of the shoulder is a specialised area and usually requires the supervision of a physiotherapist. In the presence of a shoulder dislocation, subluxation, rotator cuff tendonitis, calcific tendonitis or biceps tendonitis, pain relief may be achieved by the use of ultrasound, faradism or laser treatment. Strengthening exercises should concentrate on the muscles which pull the arm down to the side and those which twist the arm. Activities involving moving the arm out away from the side generally only cause more shoulder inflammation and pain.

The depressors of the shoulder are strengthened by squeezing the elbow in to the side over a pillow or against a resistance band available from the physiotherapist. The contraction should be held for 10 seconds and then the shoulder relaxed for 10 seconds. The exercise should be repeated perhaps 10-50 times.

The internal rotators of the shoulder are strengthened by holding the elbow in to the side whilst twisting the hand in across the stomach against the resistance of a pillow, door post or resistance band. The external rotators are strengthened by holding the elbow in the waist whilst twisting the hand out to the side. These exercises should be repeated in the same way. Exercise should be undertaken for perhaps 30 minutes 3 times each day. After perhaps 2-6 weeks when any pain has settled, the resistance can be increased and weight training started. Initially for the first 2-4 weeks of weight training, only very light weights should be used.

Medication

Anti-inflammatory tablets are commonly used in the treatment of tendonitis and joint inflammation (Ibruprofen, diclofenac, vioxx etc). These tablets reduce inflammation as well as acting as pain killers. The tablets may cause a stomach upset and should therefore be taken with food. If, despite this, the stomach pain continues, then the dose should be reduced or even stopped if necessary.

Steroid Injection

Injection of steroid and local anaesthetic into the inflamed tendon or into the shoulder joint can help the inflammatory process to settle down. The steroid is only active in the local area of the injection and has no effect on the surrounding bones or the general metabolism. The injection may be painful for several minutes, but an improvement in the pain is then noticed. The improvement may last for several weeks or months or indeed be permanent. If the symptoms return, one or two further injections may be helpful, more than this rarely has any advantage and may damage the joint. If two or three injections have been undertaken without any lasting effect then alternative treatment and possibly surgery should be considered.

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