| The function of the human arm is to allow placement | | | | down on the socket and allow the more powerful |
| of the hand in useful positions so the hands can | | | | muscles to perform shoulder movements. |
| perform activities where the eyes can see them. | | | | As a person ages, the rotator cuff develops |
| Because of the huge range of positions required the | | | | degenerative changes in its tendinous structures, |
| shoulder is very flexible with a large motion range, but | | | | causing small tears in the tendons which can enlarge |
| this is at the expense of some reduced strength and | | | | until there is no continuity between the muscles and |
| greatly reduced stability. A "soft tissue joint" is often a | | | | their attachments. This leads to loss of normal shoulder |
| description of the shoulder, indicating it is the tendons, | | | | movement and can be very painful but is not always |
| muscles and ligaments which are important to the | | | | so and "Grey hair equals cuff tear" is a common |
| joint's function. Shoulder treatment and rehabilitation is a | | | | saying. Physios work at rotator cuff strengthening, |
| core physiotherapy skill. | | | | whilst in massive tears the main shoulder muscles can |
| The gleno-humeral joint is made up of the ball of the | | | | be progressively strengthened to improve function. |
| humerus and the socket of the shoulder blade which is | | | | Surgery is possible for massive, moderate and small |
| called the glenoid surface. The top of the arm bone, | | | | rotator cuff tears and physiotherapists manage the |
| the humeral head, is large and carries many of the | | | | post-operative protocols. |
| tendon insertions for the stability and movement of the | | | | Osteoarthritis (OA) more commonly affects the hips |
| shoulder. The socket or glenoid is a relatively small and | | | | and the knees, however the shoulder can be severely |
| shallow socket for the large ball but is deepened | | | | affected in which cases physiotherapy can help with |
| slightly by a fibrocartilage rim called the glenoid labrum. | | | | advice, mobilization of the joints and work on strength |
| Above the shoulder is the acromio-clavicular joint, a | | | | and joint motion. Once physiotherapy treatment has |
| joint between the outer end of the collar bone and | | | | been tried then total shoulder replacement is the only |
| part of the shoulder blade, a stabilizing strut for arm | | | | remaining treatment option, surgical replacement |
| movement. | | | | occurring of the head of the arm bone and the socket |
| The glenohumeral and scapulothoracic joints of the | | | | of the shoulder blade. As the shoulder is referred to as |
| upper limb are acted on by large, strong, prime mover | | | | a "soft-tissue joint" it is the balance and strength of the |
| muscles as well as smaller stabilizers. The major back | | | | tendons, muscles and ligaments that determines a |
| and hip muscles keep the shoulder stable to allow | | | | good outcome for the replacement. Physiotherapists |
| strong movements, the thoracic stabilizers keep the | | | | closely follow the surgical protocols to get the optimal |
| scapula stable so that the rotator cuff can act on a | | | | results. |
| stable humeral head. The deltoid can then perform | | | | Many other shoulder conditions are managed by |
| shoulder movements on the background of a solid | | | | physiotherapists, such as hyper-mobility, dislocations |
| base and allow precise placement and control of the | | | | and fractures, impingement and tendinitis. Physios |
| arm for hand function to be optimal. | | | | manage shoulder hyper-mobility by patient education |
| Around the shoulder all the muscles narrow down into | | | | and stability training and abnormal muscle activity by |
| flat, fibrous tendons, some larger and stronger, some | | | | teaching correct patterns by repetition and |
| thinner and weaker. All these tendons are anchoring | | | | biofeedback. Physiotherapy for impingement involves |
| themselves to the humeral head, allowing their muscles | | | | rotator cuff strengthening, sub-acromial injection or |
| to act on the shoulder. The rotator cuff includes a | | | | surgical management by acromioplasty and tendinitis |
| group of relatively small shoulder muscles, the | | | | by local treatment and strengthening. Dislocations and |
| subscapularis, the supraspinatus, the infraspinatus and | | | | fractures are managed according to the type and |
| the teres minor. The tendons form a wide sheet over | | | | severity of injury and according to the trauma surgical |
| the ball, allowing muscle forces to act on it. The rotator | | | | and physiotherapy protocols. |
| cuff, despite its name, acts to hold the humeral head | | | | |