In Caring For Your Shoulders Part 1, we discussed the basics of issues that may occur with your shoulders. In part 2 we are going to discuss the treatments available and the benefits of such treatments.
From a physical therapy perspective, a general goal is to have 50% or better symptom resolution after 2-4 weeks of care with the non-traumatic/non-surgical patient. Progress of this magnitude allows one to extrapolate that the balance of symptoms should be able to be resolved via periodic formal care and a diligent effort with one’s home daily exercise. Symptom resolution will follow the path of a bell curve; initially a speedy recovery which slows as more chronic underlying issues are addressed in order to resolve the last lingering symptoms.
Failure to attain the above noted symptom reduction in 4 weeks will prompt further formal examination, especially if the patient is self-referred to the physical therapy office. The physical therapy care to that point is not wasted however, noting that the initial improvement, though below the desired goal, needs to occur regardless and the return of the patient to the shoulder orthopedic specialist is done to further assess and thus set the framework for a speedier recovery via objective studies such as X-ray, MRI (to classically address ligamentous and rotator cuff function), medication change or injection.
Conservative Care
In approximately 70-80% of all cases, conservative care including physical therapy will resolve symptoms and dysfunction over the course of up to 6 months. Formal physical therapy care may last for 1-2 months on average with the patient actively working on their home exercise in daily fashion moving forward. Additional formal visits are appropriate it there is a significant regression or if the patient is no longer challenged by home exercise.
Of the 20-30% that needs to be treated by the shoulder specialist following a course of physical therapy care, changes in medication and or injection followed by a short course of physical therapy care will generally resolve symptoms and dysfunction in an additional 10-20% of the remaining patient pool. Approximately 10-20% of the total cases will require surgical intervention (again noting that this describes the wear and tear progression for approximately 95% of those with shoulder issues).
Surgical Intervention
For those requiring surgical intervention, formal physical therapy care is resumed after the appropriate period of immobilization, generally progressing thereafter per physician protocol. One must keep in mind that a protocol is a general guideline which is followed with respect to bony and soft tissue healing constraints and biomechanical movement progressions specific to the surgery performed. The expertise of the therapist is to subtly modify, within the bounds of the protocol, implementation as per each individual patient. The physician and therapist cohesively determine patient specific short and long term goals which are conveyed to the patient to assist in the efficiency of the process.
Appropriate patient selection with respect to surgery followed by an encompassing formal rehab program with diligent effort on the patient’s part regarding home exercise should allow for the attainment of established long term goals in 3-12 months depending on the surgical procedure.
If you are experience shoulder issues, we would love to speak with you about your options. Please feel free to contact us at (952) 922-0330 or please email us at: staff@orthorehabpt.com.