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The shoulder Cheap Mario Lemieux Jersey , or more strictly the glenohumeral joint, is a major and important joint in the upper limb, responsible mostly for placing the hand in front of the body where the eyes can see it as it performs tasks. To allow this ability the shoulder has a very large range of movement, moderate strength and limited stability. This makes the shoulder a "soft tissue joint" Cheap Matt Murray Jersey , where the stability and satisfactory function depend on the function of the soft tissues, the ligaments, tendons and muscles. For physiotherapists the shoulder is an important joint, with much treatment and pre- and post-operative rehab required.

The humeral head and the glenoid of the scapula make up the glenohumeral joint Cheap Sidney Crosby Jersey , with the glenoid being small and flat and the humeral ball being large and partly spherical. The main ligaments and shoulder tendons insert on the humeral head, giving the movement and support the joint requires. The socket is made deeper by the glenoid labrum, a rim made of cartilage, which aids joint stability. Above the shoulder lies a joint between the outer end of the clavicle and the acromion Cheap Jake Guentzel Jersey , part of the scapula. This is a stability joint for arm movement and called the acromio-clavicular joint.

A great many muscles act on the shoulder joint and on the other joints in the shoulder girdle, the acromioclavicular, sternoclavicular and scapulothoracic joints. The glenohumeral and scapulothoracic joints are acted upon by the major stabilisers and movers in the area, varying from power muscles which allow forceful work to stability muscles such as serratus anterior and the rotator cuff to smaller movement muscles such as deltoid. The muscles must keep the relationship between the shoulder blade and the thorax and ribcage steady and under control for the glenohumeral joint to also enjoy stability and precise movement.

The shoulder muscle tendons become flatter and thinner as they approach and then insert themselves onto the head of the humerus. By this way the rotator cuff Cheap Pittsburgh Penguins Hats , a group of four muscles including the supraspinatus, infraspinatus, teres minor and subscapularis, is able to exert its forces on the humeral head. The tendons coalesce as they surround and insert onto the ball of the humerus Cheap Pittsburgh Penguins Hoodies , forming a cuff around the ball, centering the ball on the socket to counter the tendency to slide upwards under muscle activity. Keeping the ball centred on the socket means the larger and more powerful muscles can perform functional shoulder and arm movements.

With age, small degenerative tears occur in the tendons of the cuff, in some cases painful and in others not Cheap Pittsburgh Penguins Shirts , causing loss of movement and strength. As tears progress they can become massive, cutting off the cuff muscle power from the humeral head and severely reducing function. Rotator cuff strengthening work is performed by physiotherapists and if the tears are severe they concentrate on anterior deltoid strength to improve functional ability in the absence of cuff power. Shoulder surgeons can repair many rotator cuff tears and physiotherapists rehabilitate patients following the shoulder protocols.

Osteoarthritis (OA) more commonly affects the hips and the knees, however the shoulder can be severely affected in which cases physiotherapy can help with advice, mobilisation of the joints and work on strength and joint motion. Once physiotherapy treatment has been tried then total shoulder replacement is the only remaining treatment option Cheap Pittsburgh Penguins Jerseys , surgical replacement occurring of the head of the arm bone and the socket of the shoulder blade. As the shoulder is referred to as a "soft-tissue joint" it is the balance and strength of the tendons, muscles and ligaments that determines a good outcome for the replacement. Physiotherapists closely follow the surgical protocols to get the optimal results.

Physiotherapists treat many other types of shoulder problems such as impingement, tendinitis, hypermobility Cheap Phil Kessel Hat , abnormal muscle patterning, fractures and dislocations. Impingement is treated by strengthening the rotator cuff or by subacromial injection or acromioplasty operation, where the end of the acromion can be excised. Tendinitis is treated by direct treatment of the tendon and graded strengthening and hypermobility by stability work and accepting the limitations dictated by the condition. Abnormal muscle patterning is managed by teaching normal patterns functionally and fractures and dislocations by the protocols laid down by the surgeons and trauma physiotherapists.
Author's Resource Box

Jonathan Blood Smyth is a Superintendent ofPhysiotherapy at an NHS hospital in the South-West of the UK. He specialises in orthopaedic conditions and looking after joint replacements as well as managing chronic pain. Visit the website he edits if you are looking for physiotherapists in Leeds.

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