Thoracic Outlet Syndrome (TOS) can be an extremely painful and debilitating condition of the upper extremity. It is caused by the compression of structures in the thoracic outlet, a space just behind the clavicle (collar bone) and just above the 1st rib. Because of a multitude of signs and symptoms that can lead to a diagnosis of Thoracic Outlet Syndrome, the incidence rates of this condition are currently unknown. Physical Therapy is very instrumental in easing the symptoms of Thoracic Outlet Syndrome and restoring upper extremity function in those individuals.
The shoulder joint is one of two ball and socket joints in the body (the other being the hip), making it one of the most mobile joints. However, possessing significant mobility comes with inherent instability, making it very prone to injury. Over time, this mobility can lead to injuries of the shoulder, including rotator cuff tears which, unfortunately, are fairly common. Statistics show that rotator cuff surgeries are performed on between 75,000 and 250,000 individuals per year in the United States, even with several studies indicating high failure rates. While there are numerous factors associated with these failure rates, Physical Therapy has been advocated as a first line of defense by many to avoid surgery.
The rotator cuff is a group of 4 muscles that are responsible for stability of the shoulder. Unfortunately, rotator cuff injuries are very common, either from repetitive overuse or from trauma to the shoulder. These injuries can occur at any age, but are more prevalent later in life. We often think of athletes or heavy laborers as being the most commonly affected, but older adults can injure the rotator cuff when they fall or strain their shoulder, such as when walking a dog on a leash and the dog lurches. If left untreated, this injury can cause significant pain and severely hamper your ability to use your arm.
Acromioclavicular (AC) Joint injury is an injury occurring to the top (point) of the shoulder (where the front of the shoulder blade, called the acromion, meets the collarbone, or clavicle). It can be caused by repetitive overuse, especially with overhead motions, or by a traumatic event, such as a fall directly on the outside of the shoulder. AC Joint injuries most commonly occur in individuals younger than 35 years of age, with males 5 times more likely to sustain a more traumatic AC Joint injury than females. This age population is more prevalent due to the participation in high risk and collision activities, such as football, biking, snow sports, rugby, and ice hockey. The great news is that AC Joint injuries can be identified and effectively treated by a Physical Therapist, often avoiding the need for surgery.
Technically called “Adhesive Capsulitis,” this painful condition occurs in roughly 2% to 5% of the general population. Women tend to be more affected than men, and the age of onset is typically 45 years and older. For those individuals unfortunate enough to experience this debilitating condition, 20% to 30% will tend to get it in the other shoulder.
WHAT IS FROZEN SHOULDER (ADHESIVE CAPSULITIS)?
Frozen Shoulder is the stiffening of the shoulder due to scar tissue, resulting in painful movement and loss of motion. The actual cause of Frozen Shoulder is debatable. Some believe it is caused by inflammation of the lining of the joint, while others believe it is a result of autoimmune reactions, where the body launches an “attack” against its own tissues. Other possibilities include:
Immobilization of your arm, such as in a sling, after fracture or surgery
Reactions after trauma or surgery
Pain from other conditions, such as arthritis, bursitis, tendinitis, or rotator cuff tear, that has caused limited mobility of the shoulder due to pain
HOW DOES FROZEN SHOULDER PROGRESS?
Frozen Shoulder is generally broken down into 4 stages (some theories condense Stages 1 and 2 into 1 Stage). Most individuals start with worsening pain followed by a loss of range of motion.
WHAT IS SHOULDER IMPINGEMENT?
Shoulder Impingement occurs as a result of chronic and repetitive compression of the rotator cuff tendons in the shoulder, causing pain and mobility issues. Individuals who perform repetitive or overhead arm movements, such as manual laborers (e.g., painters, drywall installers) or athletes who raise their arms repeatedly overhead (e.g., swimmers, tennis players, baseball pitchers) are most at risk for developing a Shoulder Impingement.
WHAT ARE THE PRIMARY CAUSES OF SHOULDER IMPINGEMENT?