A 69-year-old male presented with a 6-month history of pain in his right shoulder . X-ray and ultrasound revealed glenohumeral joint degeneration, partial tear in the supraspinatus, full thickness tear of the subscapularis (both rotator cuff muscles of the shoulder), as well as other degenerative and inflammatory problems. His specialist had advised surgical intervention and told him that physiotherapy treatment was not going to make any difference.
Activities such as golf, driving, and even lifting his right arm increased his pain. He also had difficulty sleeping.
He had two cortisone injections to the shoulder. The first relieved pain for a few weeks, however the pain later returned. The second time the injection did not relieve his pain. Even though the specialist did not advise physiotherapy treatment, he decided to give physio a shot anyway as he was reluctant to have surgery.
On examination we found that he had a tight upper trapezius, pec major and rotator cuff muscles. His coracoid process and anterior right C5-7 facet joints were painful and stiff to mobilise.
After 3 sessions of treatment he was able to sleep better, and the pain in his shoulder reduced. After the 4th session he was back to playing golf without any pain.
He is now able to drive and lift objects with his right shoulder and arm without any discomfort, and he did not have to undergo surgery.
This is a great example of how muscle and joint tension and weakness can contribute to dysfunction in a particular area of the body. Correcting this dysfunction can lead to significant improvements in pain and function, despite what clinical investigations(and specialists!) may say. This also highlights the benefits of trialing Physiotherapy prior to having surgery.
Written by Helen Shih.