Shoulder physical therapy, physiotherapy: Focus Fizikal, Belgrade✓

The shoulder joint consists of three bones: the upper part of the upper arm (humerus), the scapula and the clavicle. The entire shoulder joint is surrounded by a joint capsule filled with fluid that lubricates the joint and makes it function properly.

If the joint loses its mobility or a part of its mobility, as a consequence there is a reduced secretion of that fluid and further complications (arthrosis, crepitations, frozen shoulder, contractures in the joint itself). The walls of the capsule are made up of ligaments that connect the muscle to the bone.

Dynamic stabilizers of the shoulder are made up of four muscles: supraspinatus, infraspinatus, teres minor and subscapularis. They are responsible for the humerus standing firmly in the cup. The shoulder is the most mobile joint in our body, so injuries are very common.

Pain in the shoulder can continue due to calcification, that is, the accumulation of calcium in the tendons of the rotator cuff. Additionally, shoulder pain can be a result of a rotator cuff injury. Ruptures of the rotator cuff occur more often in later life, but they can also occur in younger people, mostly athletes.

This injury occurs in the elderly as a result of falling or straining the shoulder while lifting.

The clinical presentation of shoulder joint problems develops gradually, but the symptoms are very pronounced and directly indicate the degree of soft tissue compromise. At the Fizikalna Terapija Focus center, we carefully analyze every manifestation of pain and movement limitation, as early recognition of these signs allows us to prevent permanent adhesion of the joint capsule.

The most common symptoms include:

• Sharp pain during arm elevation (Painful arc): A characteristic pain that occurs when the patient attempts to lift the arm to the side or overhead, most commonly between 60° and 120°, clearly indicating mechanical impingement of the tendons in the subacromial space.
• Night pain and inability to sleep on the affected side: Intense, dull, and pulsating pain that worsens in the lying position. The patient cannot sleep on the affected side, and the pain often radiates down the upper arm to the elbow.
• Progressive loss of range of motion (Stiffness): Inability to raise the arm, reach behind the back (e.g., when fastening clothing or taking a wallet), or externally rotate, which is a primary sign of developing capsulitis (frozen shoulder).
• Crepitus and sensation of “catching” or “popping”: Audible and palpable clicks, grinding, or scraping within the joint during circular arm movements, caused by the presence of calcifications or inflamed bursae.
• Weakness and instability in the shoulder: Feeling that the arm lacks sufficient strength to hold a weight overhead or perform sudden movements, often accompanied by unconscious elevation of the entire scapula and shoulder toward the ear to compensate for the lack of power.
• Local tenderness to touch: Clearly defined painful points on the anterior, lateral, or posterior shoulder that are highly sensitive to palpation, often accompanied by warmth and mild swelling of the entire shoulder girdle.

At the Fizikalna Terapija Focus center, recognizing these signs in the early phase is a key step toward successful recovery, as it allows timely intervention to prevent acute inflammation from progressing into chronic tissue damage or permanent loss of joint function.

• Arthrosis - loss and damage of cartilage
• Arthritis - inflammation of the joints
• Crepitations - clicking and scratching from the joints
• Frozen shoulder - inflammation of the shoulder capsule

The development of shoulder pain and dysfunction can result from acute trauma, but it is far more often the consequence of cumulative stress and prolonged biomechanical overload. At our center, through detailed analysis of posture and movement habits, we identify the primary cause that has weakened the shoulder stabilizers.

The main causes of shoulder problems are:

• Subacromial impingement (Collision syndrome): Narrowing of the anatomical space between the shoulder roof (acromion) and the head of the humerus, which causes constant mechanical friction and impingement of the rotator cuff tendons and bursa with every arm elevation.
• Rotator cuff lesions and tears: Partial or complete tearing of the muscles that stabilize the shoulder (most commonly the supraspinatus) due to sudden movements, lifting heavy loads, or long-term degenerative changes at tendon attachments.
• Calcifying tendinitis (Calcium deposits in the shoulder): Pathological deposition of calcium salts in the shoulder tendons as a response to chronic inflammation and poor tissue blood supply, resulting in extremely intense and sharp pain episodes.
• Adhesive capsulitis (Frozen shoulder): A condition in which the joint capsule becomes thickened, inflamed, and prone to forming scar tissue (adhesions), leading to dramatic and prolonged loss of all shoulder movements.
• Poor ergonomics and upper cross syndrome: Hours of computer work with rounded shoulders and a forward head posture. This position chronically shortens the chest muscles while weakening the back muscles, altering the natural scapular position and the biomechanics of the entire shoulder.
• Sports overuse (Overuse syndrome): Repetitive overhead arm movements, characteristic of swimmers, tennis players, volleyball or water polo athletes, which lead to chronic muscle fatigue and microtrauma in the tendon apparatus.

It is very important to start shoulder physical therapy as soon as possible when the first symptoms of shoulder pain appear. Please call us as soon as possible when you feel pain in your shoulder that has been bothering you for more than two days.

Treatment of calcifications in the shoulder

Treatment in most cases is non-operative. After a detailed examination of the patient and ultrasound diagnosis, the treatment begins, which consists of the application of various physical therapy techniques. The main goal of physical therapy is to reduce tendon inflammation, and shockwave therapy is mostly used for this goal. After successful treatment, it is necessary to carry out adequate kinesitherapy to restore the full range of motion of the shoulder.

Treatment of rotator cuff tendon tears

The treatment depends on several factors: the age of the patient, the work the patient does and the degree of damage to the shoulder. Treatment aims to reduce pain and restore normal shoulder function. Treatment can be non-operative (rest, cessation of all shoulder activities) or operative (surgery). 

Correctly prescribed physical therapy by a physiatrist is a key factor in the treatment process of shoulder tendon rupture. Physical therapy aims to reduce pain, improve circulation in the shoulder itself, and speed up the healing process of the injury. The rehabilitation itself requires a multidisciplinary approach and constant monitoring of the patient's condition.

Treatment of shoulder pain is most often performed using:

• Shockwave therapy - a very important technique of physical therapy, which uses a shock wave with a radial effect to blood the shoulder and affects the breakdown of calcifications in the shoulder.  This therapy also helps with inflammation of the tendons of the shoulder girdle and certainly shortens the recovery time for complex complaints that patients have.
• Laser therapy - application of a laser as a source of coherent monochromatic light, a highly directed beam affects the faster recovery of the shoulder. The laser represents stimulated radiation where all emitted photons are equal, have the same wavelength, the same direction of movement, so the resulting light is monochromatic, coherent and directional;
• Ultrasound therapy - penetrates deep into tissue and is most absorbed in ligaments and tendons (structures with a high collagen content).
• Kinesitherapy - the application of movement in the treatment of patients. Kinesitherapy is the basis of functional treatment and training of patients after injuries and painful conditions. Treatment of injuries in rehabilitation cannot be imagined without kinesitherapy.
• Electrotherapy - has an analgesic effect on pain, which means it reduces pain by stimulating receptors in the skin and releasing endogenous opioids, as well as improving blood and lymph circulation.
• Cryotherapy – cryomassage of the injured region, cooling of painful tissue and pain relief.