Tendon, Ligament or Nerve Problems

Joint, Tendon, Ligament or Nerve Problems

Orthopaedic Injuries are Musculoskeletal Injuries that involve the Muscles, Joints, Tendons, Ligaments, Bones, or Nerves. Essentially all injuries can be considered orthopaedic injuries, however, there are some common types of injury that don’t fall under any particular category such as Sports or Work Related Injuries. Orthopaedic Injuries are injuries that occur in day-to-day life to normal members of the general public.

Most Orthopaedic Injuries are manageable with Physiotherapy, however, they can be extremely debilitating.




  • Frozen Shoulder/Adhesive Capsulitis


  • Plantar Fasciitis


  • Piriformis Syndrome


  • Sciatica


  • Nerve Compression Syndrome/Trapped Nerve


  • Adverse Neural Tension/ANT


  • Bursitis


  • Osteoarthritis/OR/Degenerative Arthritis/Degenerative Joint Disease


  • Anterior Knee Pain/Patellofemoral Pain Syndrome


  • Acromioclavicular Ligament Injury


  • Glenoid Labrum Tear/SLAP Lesion


  • Hip Labral Tear/Acetabular Labrum Tear


  • Dislocated Shoulder


  • Patellar Dislocation/Dislocated Kneecap



Rotator Cuff Injury


The Rotator Cuff is a group of 4 muscles around the shoulder that provide control and coordination to all shoulder and arm movements. They are essentially stabiliser muscles and because of this are relatively weak in comparison to other muscles around the shoulder. The Rotator Cuff are also very intricately placed and balanced within the shoulder joint and as a result, can be susceptible to damage due to Overuse, or trauma.


Rotator Cuff Impingement Injury/Impingement Syndrome/Sypraspinatus Syndrome/Painful Arc Syndrome/Thrower’s Shoulder/Swimmer’s Shoulder


The most likely injury to the Rotator Cuff is called a Rotator Cuff Impingement Injury. An Impingement Injury is basically where a structure is becoming trapped, or pinched by another structure. In the case of the shoulder, the top of the arm bone, and the underside of the shoulder blade impinge the Rotator Cuff. The most common Rotator Cuff Impingement is to the Supraspinatus Muscle. Overuse or over exertion of certain movements in the shoulder, particularly overhead movements, place a large amount of stress on the tendons of the Rotator Cuff. Overtime, these can become inflamed and ‘thickened’ due to Scar Tissue. This ‘thickening’ reduces the available space within the shoulder joint causing the shoulder to trap, or pinch, or Impinge the Rotator Cuff tendons as the arm moves. Due to the anatomy within the shoulder, this ‘Impingement’ usually only occurs during particular movements or activities. It is common to see Rotator Cuff Impingement Injuries in competitive Swimmers, due to the repetitive overhead action, and Weight Lifters, due to the great deal of stress placed on the shoulder during training.


Rotator Cuff Tear


With repeated injury, Overuse, or sudden Trauma, parts of the Rotator Cuff can actually become dethatched from the shoulder completely. Rotator Cuff Tears are common in those sports and activities where repeated arm movements are necessary, particularly overhead movements, and where forcefully pulling or lifting something is common. Rotator Cuff Tears can also occur following direct trauma to the shoulder. Examples include trying to break a fall with an outstretched arm, colliding heavily with a player during a hockey game, or landing directly on the side of the shoulder after being tackled in a game of Rugby. In terms of the injury process, Rotator Cuff Tears present the same as any other Tendon Rupture.



The tail tail sign of any Rotator Cuff Impingement Injury is the so called ‘Painful Arc’ This is where outwards movement of the arm from the side is painful from about 80 degrees to roughly 110 degrees. Functionally this can cause pain when putting clothes on or brushing your hair. Lifting can carrying can be painful too, along with any other resistance type exercise.


Acute Rotator Cuff Tears resulting from trauma will usually be extremely painful. Pain will normally radiate out from deep within the shoulder. Movement will be extremely painful and limited and there will tenderness over the point of the tear, which is usually located within the Supraspinatus Tendon (the outer and upper most part of the shoulder joint). Movements out to the side are usually the most seriously affected. In the days that follow, bruising may appear down the arm. In more serious cases, the Rotator Cuff Tendon can actually be Avulsed (see Bone Injuries) from its attachment. This will show up on an X-ray, and is usually the case where movement is severely limited for longer than a week.


Chronic Rotator Cuff Tears are usually much less painful and due to the increased length of time they take to materialise. Often there can be no major symptoms other than a worsening ache over the outside and front of the shoulder joint. You will notice a progressive weakening of the shoulder muscles and difficulty taking the arm out to the side and front. Sleep may be difficult as lying on the affected side will produce pain. Cracking sensations can often be felt and heard from within the shoulder during movement.



Rotator Cuff Impingement Injuries usually respond very well to Physiotherapy. Treatments can include Sports Massage, Mobilisation, Acupuncture, and Sports Specific Rehabilitation. It is also very important to rest from all irritating activities for at least 4 weeks. For acute injuries follow the principals of PRICE and consult your GP for advice on oral anti-inflammatories. Physiotherapy usually last for 6-8 weeks and can involve up to 8 weekly treatment sessions. If not symptoms are not significantly improved after 6 weeks steroid injections are sometimes required. In extreme cases Debridement surgery is the only way to alleviate symptoms.


Acute Rotator Cuff Tears and Avulsion injuries can be treated surgically if diagnosed early enough. However, most are treated conservatively as the results post surgery is often not much better than if they are left to repair naturally. Chronic Rotator Cuff Tears are normally just treated with Physiotherapy. Physiotherapy usually involves Sports Massage, Mobilisation, Acupuncture, and Functional Rehabilitation. It is important to rest from activates that irritate the tear. Physiotherapy treatment can last anything from 8-12 weeks depending on the severity of injury. This can involved anything from 6-20 treatment sessions.



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