Sancheti Physiotherapy and rehabilitation departmetn Shoulder club
The shoulder joint is a ball-and-socket joint formed by the articulation between the rounded head of the arm bone (humerus) and cup-like depression (glenoid fossa) of the shoulder blade (scapula), called the glenoid fossa., also involving collar bone (clavicle).
The shoulder joint allows the arm to move in a circular rotation and also towards and away from the body, thus is the most mobile joint of the body. The muscles, ligaments, capsule and cartilage of the shoulder joint reinforce its structure and provide stability to the joint.
The rotator cuff is made up of four muscles which connect the shoulder blade to the arm bone. Thus rotator cuff muscles are important for stabilizing the shoulder joint specially during motions. The other important role of the rotator cuff is to help with movement of the arm, particularly overhead movements and rotation of the arm.
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Sancheti Physiotherapy and rehabilitation departmetn Shoulder club
Rotator cuff pathology has a wide spectrum of presentation including-bursitis, tendinitis, rotator cuff fraying, partial rotator cuff tear, complete rotator cuff tear, and rotator cuff tendinosis .
Bursitis - Above the rotator cuff there is a bursa, or bag of fluid, that covers and protects the rotator cuff from friction as it comes into close contact with bones around the shoulder. When the rotator cuff is injured or damaged, it can lead to inflammation of the bursa, called bursitis.
Rotator cuff impingement - Impingement syndrome is where these tissues are squeezed between the bones around the shoulder.
Rotator cuff tendinosis - While some rotator cuff injuries can occur in younger people due to trauma, most injuries result from aging and degeneration of the rotator cuff, mostly older than 40 years.
Rotator cuff tear - Damage to the rotator cuff can vary from minor strains or fraying to complete tears.
Common Causes of rotator cuff pathologies :
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Overuse- in the form of repitative overhead activities
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Trauma- accidents, falls, direct blow.
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Sancheti Physiotherapy and rehabilitation departmetn Shoulder club
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Degeneration of either rotator cuff tendon or Joint –older than 40 years of age generally (osteoarthritis or rheumatoid arthritis)
Periarthritis of shoulder also commonly called Frozen shoulder/Adhesive capsulitis
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Common in people over 45 years of age
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Onset-insidious, after trauma or surgery
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Commonly associated with Diabetes.
It has 3 stages namely: i. Painful (pain is the main feature,which worsens at night) ii. Frozen (restriction of motion is more than pain) and iii. Thawing (No pain, only restriction of motion)
Shoulder Instability is a relatively common condition characterized by loosening of the ligaments and capsule surrounding the shoulder therefore allowing excessive movement resulting in an unstable joint.
Types:
Anterior (slipping popping or sliding may be present, apprehension with moving shoulder outwards and externally rotating the shoulder)
Posterior (slipping or popping of the upper arm bone out the back, associated with moving shoulder forwards and internal rotation while the shoulder is under a compressive load.)
Multidirectional instability with the anterior accounting for nearly 90%. (Looseness in all directions)
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Causes: traumatic (fall or a direct blow to the shoulder) or could be nontraumatic.
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Sancheti Physiotherapy and rehabilitation departmetn
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Commonly associated with Ligamentous laxity.
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Shoulder club
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Shoulder Dislocation is caused due to severe instability in a particular direction.In this condition the arm pops out of the socket and the excessive mobility causes the shoulder to slip out of place and could result in chronic instability and weakness.
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Approximately 25% of shoulder dislocations has associated fractures.
It is degeneration or wear and tear in the joints of the shoulder complex because of aging process, commonly affecting people over 40 years of age. Although less commonly seen in shoulder, but the symptoms are debilitating. If it is because of aging, it is known as osteoarthritis or else rheumatoid arthritis.
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Pain during overhead reaching for any object or during a particular range (midrange) while elevating arm
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Weakness
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Restricted motion
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Catching/ locking
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Feeling of instability - subluxation – dislocation
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Inability to lift arm in case of tear
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Sancheti Physiotherapy and rehabilitation departmetn Shoulder club
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Loss of function
The symptoms are usually aggravated in certain activities, such as reaching backwards to fasten a seat belt or to reach to the back pocket or lifting with the arm outstretched.
Symptoms are worse when the arm is elevated overhead, especially if the elevated arm is loaded.
Therefore strengthening of the shoulder cuff muscles is paramount in treatment of all patients with shoulder problems.
Routine Management
(A) Conservative Management
Includes the following-
1) Medications- Analgesics, Anti-inflammatory drugs (pain killers), Muscle relaxants
2) Physiotherapy
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Modalities- Ultrasound, Laser, IFT, etc.
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MobilizationMaitland’s mobilization, Kaltenborne mobilization, Mulligan’s manual therapy
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Taping-Kinesio taping, Rigid taping
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Exercises- Strengthening, stretching and proprioceptive training exercises, theraband exercises
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Ultrasound Therapy for shoulder pain Joint mobilization

Sancheti Physiotherapy and rehabilitation departmetn Shoulder club
Kinesio Taping for painful shoulder
(B) Injection for pain relief
(C) Surgical Management
Surgery is usually rare. It is advocated in cases of fractures around the shoulder, complete tear of muscles and other major injuries, when patient doesn’t respond to other treatment options.
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Sancheti Physiotherapy and rehabilitation departmetn Shoulder club
____ Repetitions
SHOULDER FLEXION- Sitting. Support your affected arm with your other hand under the elbow. Gently lean forward. Rock your hand backward and forward.
_____ Repetitions
SHOULDER ABDUCTION- Sitting.
Support your affected arm with your other hand under the elbow. Gently lean forward. Rock your hand side to side.
____ Repetitions
SHOULDER LATERAL ROTATION:
Sitting-keep your elbow at your side and hold affected arm ’ s wrist.gently move the hand to 90 degrees.do not move further than this.
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Sancheti Physiotherapy and rehabilitation departmetn Shoulder club
To prevent stiffness and weakness in adjacent muscles and joints (viz. neck, elbow and hand), following exercises should be involved in standard regimen of exercises
---- Reps
Move your head front and back so as to touch your chin to your chest and backwards so as to take your chin away from the chest.
Move your neck sideways so as to touch your ear to your shoulders.
---Reps
Rotate your head to your right and left sides.
----Reps
Move your hand towards your shoulder and straighten it.
------Reps.
Turn your hand facing downward and upward alternately.
------Reps.
Bend your hand forward and backward alternately.
-----Reps.
Move your hand sideways.
----- Reps.
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Sancheti Physiotherapy and rehabilitation departmetn
Shoulder club
Shoulder flexors- Stand facing the wall.
Attempt to push your fist forward to the wall. reps hold
Shoulder extensors- Stand with your back to the wall. Attempt to press your elbow against the wall.
reps hold
reps hold
reps hold
reps hold
Shoulder abductors- Stand with outside of your affected arm in contact with the wall, attempt to move the whole arm out to the side against the wall.
Shoulder adductors- Stand with the small rolled up towel under your affected arm.attempt to squeeze the whole arm to the side.
External rotators- Stand with outside of your affected hand against a wall. Attempt to move the affected hand outwards. Do not allow your elbow to move away from your side.
Internal rotators- Stand with inside of your hand of the affected arm held against a wall. Attempt to move the affected inwards. Do not allow your elbow to move away from your side.
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reps hold

Sancheti Physiotherapy and rehabilitation departmetn Shoulder club
Stand while bending from hips with one arm supported on a table. Keep affected arm freely hanging. Shake it front and back and then in and out freely like a pendulum.
times or mins reps hold reps hold
Lie down on your stomach & lift your shoulder backwards. Now lift your hands up maintaining the shoulders.
Head should be supported all the time.
Stand in front of mirror. Take your shoulders backwards. Don’t lift shoulders up. Hands should be by the side of body.
Stand in front of mirror take your shoulder backwards & bend your hand through elbow. Now rotate your hand outwards & inwards stretching the theraband. reps hold reps hold
Stand in the corner of room. Spread your arms on the walls & try to push your chest into the corner. You should feel stretch over your chest.
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Sancheti Physiotherapy and rehabilitation departmetn times
Shoulder club
Hold stick as shown in figure in both hands. Take your hands upwards, both from front and sides till the point of pain without bending from elbow.
Come down.
Take towel in hand across back & with upper hand try to pull your lower hand upwards & vice versa. reps hold
Stretch one arm with the help of other arm as shown in the figure while standing or sitting on a chair. reps hold reps hold reps hold
Lie on your back. Keep the arm at right angle from body with elbows bend. Bring the hand down in the inner side rotating the shoulder. Do the same while taking hand outside.
Stand holding on end of the band in one hand and putting other end under foot, measuring the length as much as your arm and forearm. Lift the hand straight up without bending form spine or shoulder.
Place one hand on the opposite shoulder. With the other hand pull the elbow so as to feel a stretch in the shoulder as shown. reps hold
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Sancheti Physiotherapy and rehabilitation departmetn Shoulder club
Lie on the affected side and keep the shoulder and elbow at 90 degrees.
Hold the wrist with the other hand and pull it down as shown in the picture.
Reps Hold
Reps Hold
Stand with the band held in both hands overhead and elbows at shoulder levels. Join both shoulder blades together and stretch the band as shown.
Hold the center of band behind your upper back holding both the ends.
Move hands forwards, stretching the band, joining the hands in front.
Reps Hold
Reps Hold
Hook the band on front at shoulder level, elbows and shoulders at 90 degrees, rotate arm upwards maintaining the position.
Stand with similar position as above, hook band behind at shoulder level.
Rotate arm forward and downwards as shown.
Reps Hold
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Sancheti Physiotherapy and rehabilitation departmetn Shoulder club
Place center of band below the feet, holding the ends as shown. Lift both hands sideways from shoulder with elbows slightly bend.
Reps Hold
Hook center of band overhead. Hold both ends, pull shoulder blades back and down (inset).
Reps Hold
Hold both ends of band and hook the center in front at elbow level. Pull both elbows backwards, squeezing shoulder blades together.
Reps Hold
Reps Hold
Lie on your stomach, both elbows bend at elbows at the side of the shoulders. Pull both elbows backwards squeezing both shoulder blades together.
This comprises of exercises to bring the patient back to their normal activity level (preinjury state). That could be sports specific, recreational or sedentry for the patient.
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Sancheti Physiotherapy and rehabilitation departmetn
Use slings and supports as per doctors’ advice.
Always maintain good posture.
Take adequate breaks during the work.
Don’t sleep on the painful shoulder.
Don’t lift anything heavy from affected shoulder.
Don’t carry bags on the painful shoulders.
Avoid forward neck posture.
Avoid exercises in severe pain & contact your doctor and Physiotherapist.
Shoulder club
Always carry heavy objects close to your body.
Use good body mechanics standing straight with your shoulders back.
Avoid undue pressure on the affected shoulder by lying on the other side.
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Sancheti Physiotherapy and rehabilitation departmetn Shoulder club
Shoulder unit is a unit equipped with all the modern modalities for treatment of shoulder including sports specific rehabilitation. We have a team of specially trained experienced physiotherpaist to supervise and guide you through the healing/rehabilitation process.
Timings
Physiotherapy OPD
:
: +912028999713
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