Question:My orthopedic doctor gave me two steroid injections in my shoulder. The next step is to see a physical therapist. What will this do for me?
Answer:Physical therapy may be helpful when there is a subacromial (SA) bursitis or impingement syndrome. SA bursitis is a condition caused by inflammation of the bursa. The SA bursa is a small, fluid-filled sac that forms a cushion between bones and tendons or between muscles and joints.
SA impingement or pinching of the bursa and tendon occurs when the arm is raised up overhead. The supraspinatus tendon of the shoulder and its bursa get pinched between the head of the humerus and the end of the clavicle (collarbone). The bursa is the area where the steroid injection is directed.
Once the inflammation is under control, the therapist will help you learn how to move your arm properly. The goal is to avoid pushing the supraspinatus tendon up against the acromion (end of the clavicle). In some cases, this condition occurs because of injury or weakness to the supraspinatus. This tendon is part of the shoulder rotator cuff.
In other cases, weakness or imbalance of the scapula (shoulder blade) contributes to the problem. This is called scapular dyskinesia. The scapula and shoulder move together in a smooth and rhythmical way. When this is disrupted by scapular dyskinesia, then shoulder impingement can occur. The therapist will guide you in getting back your normal scapular position and motion.
If the shoulder is unstable, physical therapy is aimed at improving the function of the muscles that provide dynamic shoulder stabilization. A strengthening program to restore normal movement patterns may be needed.John G. Skedros, MD, and Todd C. Pitts. The Use and Misuse of Injectable Corticosteroids for the Painful Shoulder. In The Journal of Musculoskeletal Medicine. February 2008. Vol. 25. No. 2. Pp. 78-9
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