Research Articles – Shoulder

Large-scale review shows that exercise therapy
is one of the best available treatments for a common shoulder condition

Shoulder pain is a common problem, especially in women and people between ages 45-64. About 36% of these individuals have a condition called shoulder impingement syndrome, which is a generic term for several shoulder disorders that all lead to pain and disability. There are many conservative (non-surgical) treatments available for shoulder impingement syndrome and lots of research on their effectiveness, but there is yet to be a comprehensive overview that has compared all of these studies. For this reason, a powerful pair of studies was conducted to provide this needed overview on conservative treatments for shoulder impingement syndrome. On the whole, results were supportive of exercise and a hands-on form of therapy called manual therapy. In particular, manual therapy was found to be superior to no treatment or a sham treatment for reducing pain, and this effect was even greater when it was combined with exercise. In addition, exercise was found to be superior to no treatment for reducing pain and improving function, and it was also more effective than non-exercise modalities – like ultrasound and electrical stimulation – for improving flexibility.

Many patients with no shoulder pain have MRI findings that show a tear

The labrum is a piece of cartilage attached to the rim of the shoulder that secures the shoulder socket and keeps the ball of the joint in place during movement. This structure can tear either from injury or because of the aging process, and the resulting labral tear may or may not cause symptoms. These tears are difficult to diagnose, and the methods used for evaluation – like physical exams – and MRIs are not very consistent at identifying the injury. In fact, it’s possible that many patients are told they have a labral tear and then go on to have surgery, even though the tear itself may not be responsible for their pain. To investigate this matter, a study was conducted on middle-aged individuals with no shoulder pain, and the results showed that labral tears were in fact quite common. The first radiologist interpreted 38 (72%) of the MRIs as containing a labral tear, while the second radiologist found labral tears in 29 patients (55%). This shows why patients should carefully process the results of their MRI and understand what they mean before giving any consideration to surgery.

Six weeks of physical therapy leads to several improvements
for athletes with a dislocated shoulder

The shoulder is the most frequently dislocated joint in the body, and shoulder dislocations are common in sports like rugby, football and hockey. Unfortunately, after the first injury, the shoulder tends to become unstable, which increases the chances of another dislocation occurring. This is why it’s so important to prevent these injuries from occurring in the first place and rehabilitate them properly when they do occur. Physical therapy that focuses on strengthening the shoulder is one of the best ways to accomplish this, but it’s not clear which exercises are most effective to accomplishing these goals. A study was therefore conducted on the use of elastic bands and other strengthening exercises to improve strength in patients with a first-time shoulder dislocation, and the results were promising. After the six-week exercise program, patients experienced considerable improvements in strength and flexibility of more than 90%, and the values between the injured and uninjured shoulders were extremely similar in the final measurements. These findings suggest that a physical therapy rehabilitation program that includes elastic resistance bands and weight machines can be effective for improving strength and flexibility in patients who dislocate their shoulder.

For patients with long-term shoulder pain, general mindset
can have a significant impact on their level of pain and disability

When shoulder pain lasts for more than three months, it’s referred to as chronic shoulder pain. Unfortunately, patients who have pain for this long often do not have positive outcomes, and about 60% of them continue to deal with symptoms one year after first noticing it. Current treatments like physical therapy generally help patients in the initial stages of shoulder pain, but are less effective when it progresses into the chronic phase after several months. This may be due to psychological factors like depression, anxiety and fear of pain, which may actually impact how a patient perceives their pain. To better understand the connection between these factors and chronic shoulder pain, a review of 27 studies was conducted, and the results clearly showed that patients’ attitudes and perceptions had a significant impact on their levels of pain and disability. This means that in some cases, there is more to the experience of pain than actual damage to the body. Psychological factors can also play a significant part, and it’s therefore important to consider and possibly address these factors when treating chronic shoulder pain.

Pitching on consecutive days in youth softball leads to pain and weakness
that can be addressed with pitch counts and physical therapy

Fast-pitch softball is one of the most popular and fastest growing sports among young females, but unlike baseball, studies on the mechanics of the windmill pitch and its impact on the body are lacking. The number of injuries in fast-pitch softball is very high and it’s been suggested that it may place a similar amount of stress on the shoulder as baseball, but the details surrounding these injuries are poorly documented. There are also no pitching limitations in fast-pitch softball, which means that some softball pitchers can pitch multiple games in a single day, up to three days in a row. With this in mind, researchers performed a study to investigate the effects of windmill pitching consecutive days on strength, fatigue and pain. It was found that in general, pitchers had a significant increase in shoulder pain and fatigue and a decrease in their strength, and the more days in a row they pitched, the greater these changes were. These types of changes can lead to shoulder damage and increase the risk for injury in young softball players if they continue to pitch on consecutive days without regulations. It is therefore recommended that pitch count limits be implemented in softball similar to those used in baseball to address this potential problem and reduce the likelihood of injury in these athletes.

Exercises that strengthen the neck and shoulders
are found to reduce neck pain in office workers

Studies have suggested that up to 63% of office workers are affected by neck pain, and between 34-49% of these workers report a new episode of neck pain each year. This poses a serious problem in the workplace, as those who are unable to return to work within a few months are at a high risk for developing disability and possibly being incapable of working in the long term. It is therefore important to develop interventions to alleviate office workers’ neck pain and reduce the burden of this condition on the workplace. For this reason, a powerful pair of studies was conducted to determine if any workplace interventions are actually capable of reducing neck pain in office workers. Results were generally supportive of workplace-based interventions, and the programs that included strengthening exercises for the neck and shoulder muscles were most effective in the office workers who had neck pain. In addition, it was found that the longer these office workers participated in the exercise intervention, the greater the reduction in their neck pain. Business owners and policymakers should therefore consider incorporating one of these types of programs into their workplace to address the growing problem of neck pain in that environment.

Research review shows that strengthening exercises are recommended
for addressing instability of the shoulder

Shoulder instability is a condition that occurs when the head of the upper arm bone falls out of the shoulder “socket,” and it affects approximately 2% of the general population. Patients with shoulder instability generally experience pain and weakness in the front and back of the shoulder joint, as well as a possible tightening and/or clicking sensation in the back of the shoulder. Several treatments are available to address the condition, but there is a need for clear guidelines to better assist medical professionals making treatment decisions. For this reason, a powerful study called a systematic review was conducted on the topic. Results showed that strengthening exercises for specific areas of the shoulder were most effective for treating shoulder instability by reducing pain and instability, as well as increasing function. Based on these findings, researchers recommend a rehabilitation program that focuses on strengthening and stabilization exercises. Patients dealing with shoulder instability to any degree should therefore view physical therapy that includes these components as a strong option to address their condition and help them improve.

The addition of strengthening exercises to standard treatment improves outcomes in patients with shoulder condition

Adhesive capsulitis, or frozen shoulder, is a condition in which tissues that surround the shoulder become inflamed and stiff. Individuals with frozen shoulder experience pain and have difficulty performing most activities that require rotating the shoulder, and the condition can last for up to 18 months or longer. Physical therapy that includes strengthening exercises is commonly recommended to treat frozen shoulder, but no studies have specifically investigated just how effective these of exercises are. Based on this, a powerful study called a randomized-controlled trial was conducted to determine if adding strengthening exercises to a standard physical therapy program would lead to greater benefits in patients with frozen shoulder. The findings showed that patients who were treated with physical therapy and strengthening exercises experienced the most significant improvements overall. In particular, they reported greater decreases in pain and greater increases in flexibility and physical function. This shows that strengthening exercises should be a necessary part of physical therapy, and individuals dealing with frozen shoulder should therefore seek out this type of treatment in order to experience significant benefits.

Adding hands-on movements from a physical therapist to stretching exercises is more beneficial for patients with shoulder condition

Adhesive capsulitis, or frozen shoulder, is a condition that causes stiffness and pain in the shoulder joint. It restricts the function and motion of the shoulder, which makes it difficult to perform many activities normally. One of the many treatments available for frozen shoulder is called joint mobilization, in which a physical therapist moves the shoulder in different directions to increase its flexibility and reduce pain. Another is manual stretching exercises, which are stretches that are also performed by a physical therapist for the same purpose. Research has found both of these treatments to be effective for frozen shoulder, but they have not been evaluated when used in combination. Therefore, a study was conducted to investigate this, and it found that the patients who received the combination experienced better outcomes than those who had stretching exercises only. These findings suggest that adding joint mobilizations to manual stretching exercises leads to the best possible outcomes for frozen shoulder, and makes a case for physical therapists including both treatments whenever dealing with these patients.

Surgery is not found to be any more effective than non-surgical treatment for tears of the rotator cuff

The rotator cuff is a network of tendons and muscles in the shoulder that keep it stable and allow it to move in a variety of directions. This region is also a common site for injuries like tears, especially in the athletic population and older adults. Treatment for rotator cuff tears usually consists of either surgery or a non-surgical (conservative) approach like physical therapy; however, there is no clear evidence that shows one treatment is superior to the other. For this reason, a powerful study called a meta-analysis was conducted, which analyzed all available research on the topic to determine which of these treatments should be used. Results showed that after one year, no significant differences were found between patients who had surgery compared to those who had conservative treatment. Individuals with this injury should therefore seek out physical therapy first before even considering surgery, which is a more expensive approach that comes with far greater risks.

Performing a preseason screening on young
baseball pitchers may help predict injury

Baseball is an extremely popular sport in the U.S., and of the approximately 11.5 million athletes that play, the majority are between the ages of 8-18. Pitchers have the highest risk of injury in all age groups, and are most prone to injuries of the elbow and shoulder. Measures like controlling pitch type and limiting pitch count have been taken in attempts to address this problem, but the rates for injuries in pitchers still remain the same. Shoulder range of motion – the measurement of the pitcher’s movement around the shoulder – is considered a risk factor for injury in higher-level baseball, but it hasn’t been studied in younger pitchers. For this reason, a study was conducted to see if the same held true for youth and adolescent pitchers, and the results showed that there were in fact differences in certain pitchers that increased their chances of experiencing a shoulder or elbow injury. Monitoring pitchers’ shoulder range of motion and making necessary changes over time may therefore be an effective strategy to help reduce the risk for injury in younger pitchers.

Hands-on physical therapy effective for
patients with common shoulder condition

Shoulder problems are a fairly common problem, and the most prevalent condition that causes pain is called shoulder impingement syndrome, which usually results from too much overhead activity like playing baseball or tennis. Physical therapy is often recommended as the first line of treatment for shoulder impingement, and it is generally regarded as effective. One type of physical therapy called mobilization with movement has been found to be effective for other conditions, but it has not been well studied for shoulder impingement. This led to the creation of a study in which some patients received mobilization with movement and others received a similar treatment that was not meant to be effective. Results showed that patients receiving the actual treatment improved much more significantly than the others, which suggests that this treatment may be incorporated into future physical therapy programs.

Non-surgical treatment just as effective as
surgery for patients with shoulder fractures

Fractures of the proximal humerus, the top of the upper arm bone that connects to the shoulder, are particularly common in adults over the age of 65 who have osteoporosis. These types of fractures can be treated with surgery or conservatively (non-surgically), and though the rates for surgery are increasing, there’s no hard evidence that it’s a more effective treatment. To evaluate which treatment was more effective, a study was conducted in which 250 patients with shoulder fractures were either given one of two types of surgery or partook in a rehabilitation program led by a physical therapist. Results showed that there were no significant differences between all three groups for up to three years, which suggests that both types of surgery and rehabilitation led to very similar results, and that surgery may not be necessary in many cases.

Looking into common injuries to mature
athletes’ shoulders and their treatments

The shoulder, the most mobile joint in the human body, is particularly activated in overhead sports like baseball, tennis and swimming. For this reason, older athletes who have been active in these types of sports for a long time often experience an increased risk of certain injuries like rotator cuff tears, osteoarthritis and frozen shoulder. Proper treatment for each of these injuries is essential, and this is usually dependent on the age and activity level of the athlete. Surgery has been found to be effective for older athletes with rotator cuff tears or severe osteoarthritis, while the same has not yet been confirmed for younger athletes. For frozen shoulder, physical therapy is effective and should be the first line of treatment before surgery is considered.

Non-surgical treatment may be just as effective
as surgery for common shoulder pain

Shoulder impingement syndrome is an extremely common source of shoulder pain that usually results from too much overhead movement in sports like tennis and baseball. When the condition becomes severe and doesn’t respond well to other treatments, surgery may be recommended, but there is no strong evidence to support this approach over physical therapy. Based on this uncertainty, a powerful review of all available literature on the topic was conducted to determine if surgery is worth it. The review found no significant benefits of surgery over physical therapy, and instructed patients with shoulder impingement to consider this when making treatment decisions.

Identifying which pitchers are at risk for injury
in minor and major league baseball

Assessing injury risk for professional athletes is an incredibly important duty that has the potential to save sports franchises large sums of money if performed correctly. When it comes to major and minor league pitchers, the task is weighted even greater, since so much rides on pitchers’ health as it is, and because they’re more likely to sustain injuries than any other players. For this reason, it’s essential to attempt to determine which pitchers are more likely to experience a throwing-related injury during the season by indicators they show during the preseason. Therefore, a study was created that sought to define risk factors that could lead to injury, and found weaknesses in particular shoulder muscles to be a likely cause for future injury.

Non-operative treatment for labrum
tears proven to be just as effective as surgery

Superior labrum anterior posterior (SLAP) tears, which can be extremely painful and debilitating injuries, occur most frequently in athletes who participate in overhead sports such as baseball, tennis and swimming. Treatment options are typically reserved to surgical intervention or the non-operative route of physical therapy and medication, though research is minimal on the latter. To better establish an understanding of the non-surgical option, a case series was performed and the results showed that treatment without surgery provided outcomes that were very similar to those from surgical intervention, suggesting that surgery is not always necessary.

Shoulder muscles with pendulum exercises and
light activities during rotator cuff rehab

Tears and other injuries to the rotator cuff are seen in a variety of sports and usually occur due to the stress that repetitive throwing motion puts on the shoulder. Some studies claim that 75% of patients who repair large rotator cuff tears will go on to re-tear their rotator cuff in the future, meaning proper rehab is extremely important. One study sought to get a better understanding of activities that could be harmful to a healing shoulder, and found that the commonly prescribed pendulum exercises, when done incorrectly, as well as drinking out of a water bottle, could have a detrimental effect on shoulder rehab and should be performed with caution.

The effects of exercise intervention
on elite swimmers posture

Swimmers who compete at a competitive level rotate their shoulders an average of 16,000 times a week, a motion that over time can have serious complications and lead to sidelining injuries. Consequently, some studies show that as many as 47% of collegiate swimmers report pain, or swimmer’s shoulder, for three weeks or more at some point in their career. Exercise interventions aimed at strengthening weak muscles and stretching tight ones are believed to alleviate pain and reduce the risk for injury, and to better understand the potential benefits of such an intervention, a study was performed on a group of Division I collegiate swimmers.

An investigation of physical therapy intervention
for adhesive capsulitis (frozen shoulder)

Adhesive capsulitis, also known as frozen shoulder, is a condition defined by pain, stiffness and a reduced range of motion and can have long-term implications if left untreated. The amount of research on nonsurgical treatments such as physical therapy for the disorder is extremely small, prompting a group to conduct an extensive randomized control trial that evaluated the effectiveness of specific therapy interventions. Certain interventions were shown to be beneficial while others proved more likely to impede rehabilitation rather than help it.

Innovative developments on the horizon
for rotator cuff injuries

The rotator cuff, a network of tendons and muscles in the shoulder that enable shoulder movement, remains one of the more commonly-injured areas of the body, with 3 to 4 million Americans visiting physicians yearly for cuff-related issues. Injuries may occur due to repetitive use–usually in sports like tennis, football or baseball–and can also stem from bone spurs or the aging process. While minor injuries to the rotator cuff are typically treated with physical therapy or anti-inflammatory medications alone, tears of any significant degree require surgery.

Carrying the world upon their shoulders:
Handbags and their weight