Degeneration of the articular surface of the humeral head and glenoid, which forms the shoulder joint, causes shoulder osteoarthritis (OA). It damages cartilage structure, causes inflammation, an increase in mechanical stress on joints and surrounding muscles, bony changes, thickening of joint capsules and ligaments, and synovial proliferation. OA can be classified as primary or secondary OA. Primary OA has no definite cause, whereas secondary OA can be caused by repetitive dislocations, trauma, surgery, avascular necrosis, major rotator cuff tears, and other inflammatory arthropathy. This affects the quality of life and activities of daily living (ADLs). Physical therapy intervention is an effective non-surgical approach that helps to improve quality of life and ADLs and reduce pain.
RISK FACTORS
- Due to shoulder overuse, repetitive motion injuries can cause shoulder OA.
- Occupations or sports, including excessive use of the upper extremities
- History of trauma or subluxation.
SIGNS AND SYMPTOMS
- Initially, pain is localized in the deep and posterior parts of the shoulder.
- In the advanced stages, pain is sufficiently severe to wake the patient up at night.
- Crepitus: clicking sounds from the shoulder joint during movement.
- Joint movement limitation: loss of ability to perform basic ADLs, such as eating, dressing, and self-care.
- Hypotrophy (loss of muscle fibers) is caused by disuse.
THE ROLE OF PHYSICAL THERAPY
Physical therapy plays an important role in the management of SD by reducing pain, improving joint mobility, and strengthening surrounding muscles.
- Pain management: Modalities and exercises are used together to reduce inflammation and increase blood circulation, which in turn works on pain reduction.
- Joint mobility: mobilization techniques and stretching exercises are used to improve mobility.
- Strengthening program: Strengthening of selective muscles around the joint helps in better loading with the shoulder movements.
- Joint movement limitation: loss of ability to perform basic ADLs, such as eating, dressing, and self-care.
- Prevent further progression: Education of the condition along with dos and don’ts helps prevent the flare ups or progression.
REHABILITATION
- Pain management: Modalities like heat therapy, ultrasound, and electrical stimulation will reduce pain and inflammation.
- Stretching exercises: stretching of the capsule, trapezius, latissimus dorsi, the biceps, and neck muscles such as the sternocleidomastoid, scalene, and cervical spine extensors. Stretches are supposed to be held for 30-45 seconds with 3-5 reptations. This increases the elasticity of tissues and decreases contractures.
- Joint mobility exercises: All movements like shoulder flexion, abduction, adduction, internal and external rotation, and extension in the supine can be progressed to semi-sitting and sitting to standing, which help in the range of the joint. The contralateral arm can be used to increase the range of movement, or devices such as canes or sticks can assist the movement with the contralateral arm.
- Strengthening exercises: deltoid, scapular girdle, and rotator cuff muscles are incorporated by isometric exercises. Dumbbells and Thera bands are used for concentric exercises. Open and closed kinetic chain exercise techniques can be combined with strengthening.
- Manual therapy: joint mobilization techniques, soft tissue manipulation, and PNF approaches help with pain and range.
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