Shoulder Problems

The most common cause of acromioclavicular joint arthritis is wear and tear through over use. For this reason it is most common in people who are aged 50 or older and in athletes who place a lot of stress on the joint.

Bicep Problems

The most common shoulder conditions affecting the biceps are injuries to the cartilage and tendons that attach the biceps muscle to the shoulder bones. These include SLAP lesions, tendonitis, and tendon rupture.

Calcific Tendonitis

Calcific tendonitis is a build-up of calcium deposits within one or more of the four tendons that meet at the top of the shoulder joint. Together these four tendons are known as the rotator cuff.

Frozen Shoulder

Frozen shoulder is a condition where the ball and socket joint of the shoulder appears to "freeze". This causes loss of motion with stiffness in all directions. Typically the shoulder joint is stiff and initially painful.

Shoulder Arthritis

Glenohumeral arthritis is also known as shoulder arthritis. It is a progressive type of arthritis that is normally caused by damage to the cartilage surfaces of the shoulder's glenohumeral (ball and socket) joint.

Shoulder Instability

This is when the ball of your shoulder slips in certain position or completely comes out of joint (dislocates). There are a number of types of instability and it can get worse with time.

Rotator Cuff Injuries

The rotator cuff is the group of four tendons that surround the shoulder joint and control its movement. The tendons can become inflamed, degenerate or tear and can lead to pain and weakness, particularly with sudden movements.

Snapping Scapula

Snapping scapula is a general term applied to a range of disorders that can result in a painful clicking or snapping sensation in the shoulder blade (scapula).

Subacromial Impingement

Subacromial impingement is a condition that causes pain in the shoulder and upper arm. It happens when the tendons of the shoulder joint are strained or injured.

Winging Scapula

Winging scapula is the description for a condition where the shoulder blade protrudes from your back, giving the impression of a wing. In most cases, only one shoulder blade is affected.

Pectorals Major Repair

Pectoralis Major Repair

Please check amount of time muscle/tendon was ruptured before repair and quality of tendon. Also NB Does the patient have a h/o heavy weight training or steroid intake

On Ward

Shoulder Sling for 4-6 weeks dependant on repair size.

Teach scapula neutral position with upward shrugs of scapula.

Hand,wrist and elbow with fist clenches/ball squeezes.

Active assisted exercises with weight of arm supported, 0-90 degrees in flexion with MR initially and LR to neutral. Keep in pain free zone. DO NOT FORCE OR STRETCH

Week one - three

Active assisted exercises in protected ‘box’ zone – keeping hands in line of vision.

Closed chain exercises with weight of arm supported – ball on table.

Week three to six

Progress Closed chain to Open chain exercises in safe pain free zone, Avoid over stress in extension, abduction and LR.

Commence isometric post deltoid and LR initially then add MR and ant deltoid.

Wean off sling.

Do not force or stretch.

Week six to twelve

Progress to open chain exercises in all ranges as tolerated.

Progress isometric thro range to light resistance training with free weights and light bands.

Observe good RC activation and reduced pec major fixation.

Start controlled weight bearing with 10% body weight – ball on plinth.

May do light gym work starting in sagittal plane and progress into rotational plane of movement. Always high reps with low weights and ensure upward regulation of RC. May need looped band with commencing heavier weights.

AVOID hyperextending in bench press or flyes or pec-deck. Always warm up RC before gym.

Week twelve onwards

Functional specific programme. Gradual loading.

Unsure efficient use of kinetic chain.

Andrew Cole6 November 2018

Pectorals Major Repair

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Southampton Shoulder Clinic

Southampton Shoulder Clinic

Mr Cole’s Shoulder Clinic