Shoulder dysfunction affects the quality of life considerably. The shoulder joint is a ball and socket joint and is inherently unstable. Ligaments, rotator cuff muscles provide stability. Rotator cuff muscles control the position of the humeral head in the glenoid fossa.

Shoulder pain can be due to the rotator cuff injury, instability or referred pain in the neck. In cases of shoulder instability, there is unwanted translation, causing symptoms like pain and slipping away.

Motion, strength and stability are the three components of shoulder function that can be disrupted by an acute or chronic injury. All these can be treated effectively with therapeutic rehabilitation. The most important factor that determines the success or failure of a particular shoulder rehabilitation protocol is establishing the correct diagnosis.

Strict immobilization has been shown to be responsible for the development of functional instability in the shoulder, muscle weakness and frozen shoulder. Shoulder rehabilitation after an injury or surgery should begin with early active motion to help restore normal shoulder mechanics.

The symptoms

o Pain while performing overhead activities
o Pain during night.
o Recurrent subluxation or dead arm
o Shoulder weakness

Treatment

o Avoidance of overhead activities, abduction and external rotation such as bench press, chest fly and push-ups. Physical therapy should be initiated in the early phase of treatment.
o Electrotherapeutic modalities such as ultrasound, interferential stimulation and laser may be used.
o Massage therapy in the form of digital ischemic pressure and transverse friction massage is effective.
o Injection Corticosteroid is often helpful.
o Most of the injuries are as a result of muscle weakness. Therefore, strengthening the shoulder muscle is important.

Exercises

o Pendulum exercises
o Rope and pulley
o Scapular stabilization exercises such as scapular punch, scapular elevation/retraction against the wall, rowing, etc.
o Push-ups - knee push-ups/ wall push-ups
o Theraband-external/internal rotation. Start from the elbow at side, increasing to 90 degree abduction.
o Closed chain strengthening exercises such as walking on arms while the trunk supported by a ball or low stool.
o During the advanced strengthening phase ball exercises such as throwing and catching a ball against a wall with a bend arm.

Surgery:

If there is no progress in recovery with physical therapy for six weeks then surgical treatment is advocated.

Prevention:

Shoulder injuries can be cured by careful warm-up, stretching and strengthening of the shoulder muscles. When shoulder injury symptoms begin, early evaluation and treatment can prevent mild inflammation from becoming full-blown rotator cuff tear, frozen shoulder. A program of 20 minutes a day of shoulder stretches and muscle-strengthening exercises is recommended to increase performance and decrease the injuries.

Shoulder injuries/dysfunction should be diagnosed early and correctly so that chronic instability and dysfunction do not set in. Initiation of physical therapy should be undertaken early and there should be effective rehabilitation in order to obtain the optimum results.