While there are many tests that can be done to assess the shoulder and determine the tissue that is injured looking for abnormal shoulder mechanics is the most important. This also becomes the goal for treatment. Any treatment plan should have a focus on restoring normal artho-kinematics or tracking of the shoulder. A chronic shoulder dyskinesia will cause further and progressive injury as continued shoulder use is attempted. Starting with an exercise program does not make sense in this situation and is a reason while therapy programs can fail.
The goal of every treatment is to restore normal shoulder motion.
Treatment should begin with restoring normal mobility prior to any strengthening. Too often treatment approaches focus on weight training that can further hurt the shoulder. Stretching needs to be targeted and assessed to see if the shoulder mobility is being restored. Most stretches are not specific and do not target joint motion effectively. Sometimes increased tension or strain can occur with stretching. How you know treatment is working? The shoulder problem does not return.
Do not start a shoulder treatment program with strengthening exercises!
- Treat the underlying joint dysfunction or loss of motion
- Treat the muscle imbalances and trigger points
- Restore normal tracking and shoulder motion
- Strengthening programs can be introduced at this point
- Prevent further injury through behavioral and habit changes
Screening the shoulder can include a diagnostic ultrasound. This is an incredible tool to assess for rotator cuff tears, inflammation and swelling, bursal swelling, and even cartilage degenerative changes. Cornerstone Physical Therapy routinely screens shoulders with diagnostic ultrasound. This helps guide treatment and speeds up decision making on when to refer to different specialists or further imaging such as an MRI. It is safe, fast, and there is no radiation.