How do you assess and treat limited shoulder movement?

Assessment and Treatment of Limited Shoulder Movement

A comprehensive approach to limited shoulder movement should begin with a thorough assessment of shoulder function followed by targeted interventions to improve range of motion, strength, and function.

Assessment

• Conduct baseline assessment of shoulder function including strength, range of motion, and impingement signs 1
• Evaluate for tenderness over the proximal humerus and lateral aspect of the proximal humerus 1
• Assess for scapular dyskinesis, which may contribute to rotator cuff injury and limited movement 1
• Examine shoulder for impingement signs and scapular assessment for winging or dyskinesia 1
• Consider radiography as an initial imaging modality for evaluation of shoulder pain to assess for structural abnormalities 1
• For persistent symptoms, MRI may be indicated to evaluate soft tissue abnormalities and potential nerve impingement 2

Non-Pharmacological Treatment

• Refer patients with shoulder movement limitations to a rehabilitation specialist to improve range of motion and ability to perform daily tasks 1
• Implement active, active-assisted, or passive range of motion exercises to prevent complications and improve mobility 1
• Focus strengthening exercises on neck, rotator cuff, and posterior shoulder girdle muscles while addressing anterior shoulder girdle flexibility 1
• Gradually increase active range of motion in conjunction with restoring alignment and strengthening weak muscles in the shoulder girdle 1
• Consider gentle stretching and mobilization techniques, typically focusing on increasing external rotation and abduction 1
• For persistent cases, a functional dynamic orthosis may facilitate repetitive task-specific training 1
• Local application of heat before exercise can be beneficial for improving tissue extensibility 2

Pharmacological Management

• If there are no contraindications, analgesics such as acetaminophen or ibuprofen can be used for pain relief 1
• For more severe pain, consider NSAIDs at the lowest effective dose and for the shortest duration 2
• Topical NSAIDs may be preferred over systemic treatments for mild to moderate pain 2

Interventional Approaches

• For shoulder pain related to spasticity, injections of botulinum toxin into the subscapularis and pectoralis muscles may be considered 1
• Subacromial corticosteroid injections can be effective when pain is related to injury or inflammation of the subacromial region 1
• For intra-articular corticosteroid injections in the shoulder joint, dosage typically ranges from 20 to 80 mg 3
• Proper technique for shoulder joint injection is essential - the needle should be inserted into the synovial space using sterile technique 3

Special Considerations

• In cases of rotator cuff dysfunction, which often presents with pain during movement, decreased velocity, and precision, targeted rehabilitation is essential 1
• For patients with adhesive capsulitis ("frozen shoulder"), more aggressive interventions may be needed, including manipulation under anesthesia in severe cases 4
• In cases where traditional physical therapy techniques have plateaued, consider the use of an elevation splint to provide prolonged stretch to tight structures 5
• Movement system impairment diagnosis (such as humeral anterior glide with scapular downward rotation) can guide specific treatment approaches 6

Follow-up and Monitoring

• Regularly reassess shoulder function to monitor progress and adjust treatment plan as needed 1
• If symptoms persist or worsen despite appropriate treatment, further diagnostic evaluation may be necessary 2
• Continue to monitor for signs of complications such as adhesive capsulitis or rotator cuff tears 1

Treatment Pitfalls to Avoid

• Delaying rehabilitation can lead to further restriction and potentially adhesive capsulitis 4
• Overly aggressive stretching can exacerbate inflammation and pain 1
• Failing to address scapular dysfunction when treating shoulder movement limitations 1
• Neglecting to evaluate and treat the entire kinetic chain, including cervical spine and thoracic mobility 1