Shoulder exercises

Since one of the primary manifestations of shoulder arthritis is stiffness, our patients have taught us that gentle exercises, starting with gentle stretching, may be of help in improving comfort and function and delaying the progress of the arthritis. Patients have also shown us that exercises should not be continued if doing them worsens the symptoms in any way. Here are a few exercises that have been helpful to patients with shoulder arthritis. Each exercise is best done when the shoulder is relaxed. Ten to twenty repetitions are often effective, trying to get just a bit more motion with each one. Five gentle sessions a day will often keep the shoulder as loose as it can be. Here are some tips about the art of stretching.

We have also posted some videos of these exercises.

For stretching exercises, be sure to hold the stretch for a full two minutes.

I. The supine stretch in flexion. The shoulders are relaxed. The better arm is used to raise the stiffer arm up and toward a position parallel to the floor. 

II. The forward lean. The shoulder is relaxed. The forearm is placed on a table while the person is seated. By leaning forward and sliding the seat back, the shoulder is gently stretched upward.  

III.  The pulley. With a pulley securely fixed above a seat, one arm pulls gently down, lifting the other arm up overhead.

IV. The gravity swing. With a light weight in the and and with the body bent over at a right angle, the arm is allowed to swing gently back and forth, side to side, and around in circles.

V. The lat pull. With minimal weight, the hands hold the bar allowing the weight to pull the arms up. The shoulders relax while the weight pulls them up.

The bar is brought down under the chin for a few seconds and then the shoulders are relaxed again as they are pulled up.

VI. The row (with all apologies to my patients who are real rowers). With the shoulders relaxed, the hands grasp the bar of the rowing machine. 

Using the muscles of the legs and back, the bar is gently and slowly pulled backwards.

Using the muscles of the legs and back, the bar is gently and slowly pulled backwards. 

Again, all exercises are started slowly and gently and progressed slowly. No exercise should be continued if it makes the symptoms worse.

Also thirty to sixty minutes of aerobic exercise a day (stair climber, treadmill, brisk walking, stationary bike, elliptical, water exercises) are most helpful in keeping the shoulder flexible.

These exercises are quite similar to those we use after shoulder joint replacement.

To see some exercise videos click here.

A word of caution about exercises to avoid is shown here.

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Follow on facebook: https://www.facebook.com/shoulder.arthritis
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Here are some videos that are of shoulder interest
Shoulder arthritis - what you need to know (see this link).
How to x-ray the shoulder (see this link).
The ream and run procedure (see this link).
The total shoulder arthroplasty (see this link).
The cuff tear arthropathy arthroplasty (see this link).
The reverse total shoulder arthroplasty (see this link).
The smooth and move procedure for irreparable rotator cuff tears (see this link).
Shoulder rehabilitation exercises (see this link).

Drugs for arthritis: the good and the bad

Oral medications are often used to manage the symptoms of shoulder arthritis. While drugs such as Enbrel or Humira can modify the course of rheumatoid arthritis, there is little evidence that medications can change the course of osteoarthritis, chondrolysis, or capsulorrhaphy arthropathy, the commonest forms of shoulder arthritis.

The most common medications used for the symptoms of shoulder arthritis are basic pain relievers and NSAIDs (non-steroidal anti inflammatory medications). Taking these medications is not without risks -some of which are substantial - such as the increased risk of heart attack and stroke, bleeding, ulcers, interactions with alcohol, interactions with other medications (including blood thinners, heart medications, blood pressure medications, seizure medications, antibiotics and over the counter medications), kidney failure, liver failure, pregnancy or breast feeding problems, dizziness, vision changes, allergic reactions and increased risk of surgery.

I've listed some of the more commonly used drugs below. If you click on the name of the drug, it will take you to the National Library of Medicine Public Health site that tells you of the potential side effects and risks of the medication. If you are taking or considering taking any of these medications, you may wish to review the material the government has provided.

Tylenol (also a part of many compound drugs)
Asprin/Bufferin
Advil/Motrin
Aleve/Naproxen
Orudis
Torodol
Clinoril
Indocin
Feldene
Dolobid
Relafen

The Arthritis Foundation has a useful drug guide.

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Use the "Search the Blog" box to the right to find other topics of interest to you.

You may be interested in some of our most visited web pages including: shoulder arthritis, total shoulder, ream and run, reverse total shoulder, CTA arthroplasty, and rotator cuff surgery.

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Is the shoulder stiff?

One of the common ways shoulder arthritis presents itself is with stiffness of the shoulder, that is a lack of the normal range of motion. We like to be able to measure the range of motion in a standardized way so we can determine the severity of the stiffness as well as the progress with treatment. There are several motions that are important. We'll illustrate each with a figure drawn by my colleague Steve Lippitt who practices in Akron, Ohio.

I. Internal and external rotation with the arm at the side (measured in terms of degrees from vertical)

II. Forward elevation (measured in terms of degrees from the horizontal)

III. Internal rotation up the back (measured in terms of the part of the back that can be reached with the thumb).

IV. Cross-body reach (measured as the distance from the elbow to the opposite shoulder).

V. Internal rotation with the arm out to the side (measured as degrees from the vertical).

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To see our new series of youtube videos on important shoulder surgeries and how they are done, click here.

Be sure to visit "Ream and Run - the state of the art"  regarding this radically conservative approach to shoulder arthritis at this link and this link. Also see the essentials of the ream and run.

Use the "Search" box to the right to find other topics of interest to you.

How you can support progress in shoulder surgery

You may be interested in some of our most visited web pages   arthritis, total shoulder, ream and run, reverse total shoulder, CTA arthroplasty, and rotator cuff surgery

Rotator cuff disorders - how do they figure in?

The photograph above shows a surgical view looking down on the top of a shoulder with a rotator cuff tear. The muscle of the rotator cuff is at the upper left.  The edge of the rotator cuff tendon should be attached to the area to the side of the humeral head near the metal retractor at lower left. When this tendon is not attached, the muscle cannot deliver its force to the arm, resulting in weakness.

The rotator cuff is a common source of shoulder problems.  Use this link <rotator cuff > to take you to some useful information about the evaluation and management of rotator cuff problems.
These disorders may require surgical treatment if the symptoms are substantial and if gentle exercises are not of benefit. We had the opportunity to write a comprehensive article for the New England Journal of Medicine on this topic. You can see it here.

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Use the "Search the Blog" box to the right to find other topics of interest to you.

You may be interested in some of our most visited web pages including: shoulder arthritis, total shoulder, ream and run, reverse total shoulder, CTA arthroplasty, and rotator cuff surgery.

See the countries from which our readers come on this post.

Shoulder: arthritic or frozen?

There are three common conditions of the shoulder that are often confused: rotator cuff tear, shoulder arthritis and frozen shoulder. Shoulder stiffness is a common symptom of each of them. Shoulder stiffness is diagnosed as shown here.

A detailed discussion of rotator cuff problems can be found here.

A detailed discussion of shoulder arthritis can be found here. The reasons for stiffness in arthritis are shown here. The photo below shows an arthritic humeral head as seen at surgery.

A frozen shoulder is, like shoulder arthritis, one of the conditions that can result in a stiff shoulder. The difference is that in a frozen shoulder, the joint surfaces are normal and the shoulder motion is limited because the tissue around the joint - the joint capsule - has tightened down. Frozen shoulders are thought to arise from inflammation within the joint. Frozen shoulders can be particularly problematic in individuals with diabetes. It was once believed that frozen shoulder was associated with personality disorders, but recent evidence does not support this contention. We diagnose a frozen shoulder when the shoulder has limited motion, without a history of prior injury or surgery and with AP and Axillary x-rays showing a normal joint space as diagrammed below.



Frozen shoulders usually respond to home exercises.

Our basic approach to rehabilitation of a frozen shoulder is shown in the post on stretching (see this link) and in the post on strengthening (see this link)

If this is not successful, consideration can be given to a gentle manipulation under full muscle relaxation and anesthesia. If this is not successful an arthroscopic or open surgical release of the tight capsule can be considered.

You can support cutting edge shoulder research that is leading to better care for patients with shoulder problems, click on this link.

Follow on twitter: https://twitter.com/shoulderarth

Follow on facebook: click on this link

Follow on facebook: https://www.facebook.com/frederick.matsen

Follow on LinkedIn: https://www.linkedin.com/in/rick-matsen-88b1a8133/

Here are some videos that are of shoulder interest

Shoulder arthritis - what you need to know (see this link).

How to x-ray the shoulder (see this link).

The ream and run procedure (see this link).

The total shoulder arthroplasty (see this link).

The cuff tear arthropathy arthroplasty (see this link).

The reverse total shoulder arthroplasty (see this link).

The smooth and move procedure for irreparable rotator cuff tears (see this link).

Shoulder rehabilitation exercises (see this link).

X-rays in chondrolysis

If we look back at the March 23 post, we see the joint space was lost and bone responded to osteoarthritis by building up new bone (osteophytes), this is can be called a hypertrophic response. By contrast in conditions such as chondrolysis the joint space is lost but the bone does not respond, this can be called an atrophic response.

The image above is the AP X-ray of a recent patient who developed post arthroscopic glenohumeral chondrolysis. In contrast to the X-rays of a patient with degenerative joint disease shown in the March 23 post, there are minimal bone spurs and the density of the bone is reduced. The two white arrows are suture anchors used in the arthroscopic procedure.

The image above is the Axillary X-ray of the same patient showing again the atrophic response of the bone to chondrolysis. Additional examples can be see here.

A recent post on the causation of chondrolysis can be found here

The lack of a hypertrophic response in chondrolysis may be one of the reasons that total shoulder arthroplasty may be the preferred joint replacement in this condition as opposed to procedures that do not replace both the ball and socket aspects of the joint.

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Use the "Search the Blog" box to the right to find other topics of interest to you.

You may be interested in some of our most visited web pages including: shoulder arthritis, total shoulder, ream and run, reverse total shoulder, CTA arthroplasty, and rotator cuff surgery.

See the countries from which our readers come on this post.

Mental Health and Arthritis Symptoms

From time to time, I'll reflect a bit on articles published in the peer reviewed orthopaedic literature that relate to shoulder arthritis.

The most recent Journal of Bone and Joint Surgery contains an article on the association between depression and osteoarthritis symptoms. While the study concerns patients with arthritis of the knee, it is likely that it is just as relevant to individuals with arthritis of the shoulder. The authors reported that for individuals with mild to moderate arthritis of the knee (as judged from their x-rays), knee pain, stiffness and disability were greater when the person had evidence of depression. There was no such correlation when the arthritis of the knee seen on x-ray was severe.

This publication is consistent with our findings published over a decade ago on the effect of co-morbidities, such as depression, on shoulder function.

The 'take away' message is that if an individual has severe joint symptoms in the absence of severe x-ray changes, it may be advisable to consider an evaluation for depression before proceeding to a surgery for arthritis.

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Use the "Search the Blog" box to the right to find other topics of interest to you.

You may be interested in some of our most visited web pages including: shoulder arthritis, total shoulder, ream and run, reverse total shoulder, CTA arthroplasty, and rotator cuff surgery.

See the countries from which our readers come on this post.

Two X-rays for shoulder arthritis

The image above is the AP X-ray of a patient from our surgical schedule this week with osteoarthritis (degenerative joint disease) of the shoulder. Note the loss of the normal joint space, the flattened joint surface and the bone spurs above and below the joint.

The image above is the Axillary X-ray of our patient with osteoarthritis (degenerative joint disease) of the shoulder. Note the loss of the normal joint space and the displacement of the ball towards the back of the socket (downward on this image) so that the 'golf ball' is not sitting centered in the 'tee'.

The image above is the AP view of this shoulder in the recovery room after a ream and run procedure. Note the ball of the humeral prosthesis sits centered in the contoured glenoid bone. The staples for wound closure and the drain are seen at upper left. 

The image above is the Axillary view of this shoulder in the recovery room after a ream and run procedure. Note the ball of the humeral prosthesis sits centered in the contoured glenoid bone. The 'golf ball' is back in the 'tee'.

In the normal shoulder, the ball of the humeral head and the glenoid socket of the scapula are covered with smooth articular cartilage. This cartilage gives the joint a coefficient of friction less than that of an ice skate on ice. It is this cartilage that is destroyed in shoulder arthritis.
Cartilage cannot be seen on X-rays, but the thickness of cartilage can be detected by observing the separation of the bones, the 'radiographic joint space'.


Let's take a look at how the shoulder should be x-rayed to diagnose shoulder arthritis and to plan a joint replacement.

In the shoulder, two X-ray views are essential for determining the 'joint space', the AP (anteroposterior) and the axillary views.

An AP view of a normal shoulder looks like this:

and an axillary view of a normal shoulder looks like this:

In each view one can see the separation of the ball from the socket due to the presence of cartilage in this normal right shoulder.

These views must be taken carefully to make sure that poor technique does not hide the true condition of the joint.

More about x-rays in arthritis can be found at this link.

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You can support cutting edge shoulder research that is leading to better care for patients with shoulder problems, click on this link.

Follow on twitter: https://twitter.com/shoulderarth

Follow on facebook: click on this link

Follow on facebook: https://www.facebook.com/frederick.matsen

Follow on LinkedIn: https://www.linkedin.com/in/rick-matsen-88b1a8133/

Here are some videos that are of shoulder interest

Shoulder arthritis - what you need to know (see this link).

How to x-ray the shoulder (see this link).

The ream and run procedure (see this link).

The total shoulder arthroplasty (see this link).

The cuff tear arthropathy arthroplasty (see this link).

The reverse total shoulder arthroplasty (see this link).

The smooth and move procedure for irreparable rotator cuff tears (see this link).

Shoulder rehabilitation exercises (see this link).

X-rays for shoulder arthritis

In the normal shoulder, the ball of the humeral head and the glenoid socket of the scapula are covered with smooth articular cartilage. This cartilage gives the joint a coefficient of friction less than that of an ice skate on ice. It is this cartilage that is destroyed in shoulder arthritis.
Cartilage cannot be seen on X-rays, but the thickness of cartilage can be detected by observing the separation of the bones, the 'radiographic joint space'.


Let's take a look at how the shoulder should be x-rayed to diagnose shoulder arthritis and to plan a joint replacement.

In the shoulder, two X-ray views are essential for determining the 'joint space', the AP (anteroposterior) and the axillary views.

An AP view of a normal shoulder looks like this:

and an axillary view of a normal shoulder looks like this:

In each view one can see the separation of the ball from the socket due to the presence of cartilage in this normal right shoulder.

These views must be taken carefully to make sure that poor technique does not hide the true condition of the joint.

More about x-rays in arthritis can be found at this link.

You can support cutting edge shoulder research that is leading to better care for patients with shoulder problems, click on this link.

Follow on twitter: https://twitter.com/shoulderarth

Follow on facebook: click on this link

Follow on facebook: https://www.facebook.com/frederick.matsen

Follow on LinkedIn: https://www.linkedin.com/in/rick-matsen-88b1a8133/

Here are some videos that are of shoulder interest

Shoulder arthritis - what you need to know (see this link).

How to x-ray the shoulder (see this link).

The ream and run procedure (see this link).

The total shoulder arthroplasty (see this link).

The cuff tear arthropathy arthroplasty (see this link).

The reverse total shoulder arthroplasty (see this link).

The smooth and move procedure for irreparable rotator cuff tears (see this link).

Shoulder rehabilitation exercises (see this link).

The SST in tracking recovery of comfort and function after shoulder reconstruction, for example after a ream and run procedure.

One of the operations we offer to patients with shoulder arthritis is the ream and run procedure. We will discuss this operation more in subsequent posts, but in brief it is a method of shoulder joint replacement arthroplasty that avoids the potential risks associated with a plastic socket.

The chart above shows how the Simple Shoulder Test (SST) is used to document the recovery of patient self-assessed comfort and function after a ream and run procedure for shoulder arthritis. The data represent the average recovery from a consecutive series of over 100 patients with at least two years of post surgical follow-up. The vertical axis represents the total number of SST questions answered 'yes', while the horizontal axis represents the years after surgery. The dots show individual data points and the lines show the average (plus or minus one standard deviation) for all the patients.
Since, on average, patients having the ream and run live over 500 miles from our center, routine office visits are impractical for them.  Because patients mail or email their results to us, we have been able to keep close tabs on their recovery using the Simple Shoulder Test.

The full article was recently published in the JBJS and discussed in this post.
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We have a new set of shoulder youtubes about the shoulder, check them out at this link.

Be sure to visit "Ream and Run - the state of the art" regarding this radically conservative approach to shoulder arthritis at this link and this link

Use the "Search" box to the right to find other topics of interest to you.

How you can support progress in shoulder surgery

You may be interested in some of our most visited web pages arthritis, total shoulder, ream and run, reverse total shoulder, CTA arthroplasty, and rotator cuff surgery as well as the 'ream and run essentials'

An example, the SST in Degenerative Joint Disease of the Shoulder

To illustrate the way in which the  Simple Shoulder Test (SST) characterizes the status of the shoulder, here are the average SST results from over 2000 patients that came to us for total shoulder replacement for arthritis. Keep in mind that this represents the patients' assessment of their own shoulders. It serves as the starting point for treatment and for measuring the effectiveness of the treatment selected.

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We have a new set of shoulder youtubes about the shoulder, check them out at this link.

Be sure to visit "Ream and Run - the state of the art" regarding this radically conservative approach to shoulder arthritis at this link and this link

Use the "Search" box to the right to find other topics of interest to you.

How you can support progress in shoulder surgery

You may be interested in some of our most visited web pages arthritis, total shoulder, ream and run, reverse total shoulder, CTA arthroplasty, and rotator cuff surgery as well as the 'ream and run essentials'

The Simple Shoulder Test

The goal of treating a person with a shoulder problem is to improve his or her  comfort and function. With this purpose in mind, we developed the Simple Shoulder Test (SST) to enable each individual to evaluate each of their shoulders in their own terms before and sequentially after treatment. The SST, as it has come to be known, is convenient for both the patient and the doctor - it can be completed at home and emailed in to the doctor's office - so that the course of the shoulder can be followed for long periods of time. The SST is now used in many languages the word over as a 'universal currency' by which patients, shoulder conditions, and results of different treatments can be compared.  This simple tool enables orthopaedic surgeons to achieve long term follow-up on the course of recovery and the durability of different approaches to reconstruction of the arthritic shoulder. The abstract of one of our early publications using the SST is shown below.

The Simple Shoulder Test

Name _________________                       


Date this form is completed: ________

Please answer YES or NO for BOTH of your shoulders		RIGHT		LEFT
		YES	NO	YES	NO
1	Is your shoulder comfortable with your arm at rest by your side?	£	£	£	£
2	Does your shoulder allow you to sleep comfortably?	£	£	£	£
3	Can you reach the small of your back to tuck in your shirt with your hand?	£	£	£	£
4	Can you place your hand behind your head with the elbow straight out to the side?	£	£	£	£
5	Can you place a coin on a shelf at the level of your shoulder without bending your elbow?	£	£	£	£
6	Can you lift one pound (a full pint container) to the level of your shoulder without bending your elbow?	£	£	£	£
7	Can you lift eight pounds (a full gallon container) to the level of your shoulder without bending your elbow?	£	£	£	£
8	Can you carry twenty pounds at your side with this extremity?	£	£	£	£
9	Do you think you can toss a softball under-hand twenty yards with this extremity?	£	£	£	£
10	Do you think you can toss a softball over-hand twenty yards with this extremity?	£	£	£	£
11	Can you wash the back of your opposite shoulder with this extremity?	£	£	£	£
12	Would your shoulder allow you to work full-time at your regular job?	£	£	£	£

 F. A. Matsen

Matsen, F. A., 3rd, D. W. Ziegler, et al. (1995). "Patient self-assessment of health status and function in glenohumeral degenerative joint disease." J Shoulder Elbow Surg 4(5): 345-51.

One hundred three consecutive patients with primary glenohumeral degenerative joint disease completed standard questionnaires regarding their general health status (Short Form-36) and the function of their shoulder (Simple Shoulder Test). These patients' self-assessed health status indicated overall bodily pain, physical functioning, and physical role fulfillment scores that were significantly below those of population-based control groups. Self-assessed shoulder functions were likewise consistently below those of patients with normal shoulders. These deficits clearly indicated the problems that the patients desired to have resolved by treatment. The use of self-assessment questionnaires to routinely characterize patients with shoulder conditions is practical in the context of a busy practice. These data enable surgeons to understand the condition from the patient's perspective. This understanding should be central to the planning of treatment and to the evaluation of treatment effectiveness.




The simple shoulder test is responsive in assessing change following shoulder arthroplasty.


Responsiveness statistics are a useful means to compare different outcomes in terms of their ability to detect clinical change. While the responsiveness of the SST has been established for rotator cuff repair, it has not been determined for patients undergoing arthroplasty.


Patients undergoing shoulder arthroplasty (n=120) were evaluated prior to surgery and 6 months after. The evaluation included the SST, Disabilities of the Arm, Shoulder and Hand questionnaire, range of motion, and isometric strength. Responsiveness to change was assessed using standardized response mean (SRM), while longitudinal construct validity was evaluated using Pearson correlation. Receiver operating characteristics curves were plotted to determine clinically important difference of SST.

The SST and Disabilities of the Arm, Shoulder and Hand questionnaire were highly responsive (SRM, >1.70) for this population. For the assessment of impairment, range of motion (SRM, 0.64-1.03) was moderately to highly responsive, while isometric strength was minimally to moderately responsive (SRM, 0.32-0.69). The clinically important difference of the SST was established at 3.0 SST points. Pearson correlations indicated moderate associations between the change scores of the SST and the Disabilities of the Arm, Shoulder and Hand questionnaire (r=0.49).

The SST has been previously shown to be valid and highly reliable. The present results show that the SST is also responsive following shoulder arthroplasty and that it has a clinically important difference of 3.0 SST points. This should provide confidence to clinicians who wish to use a brief shoulder-specific measure in their practice.

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To see our new series of youtube videos on important shoulder surgeries and how they are done, click here.

Be sure to visit "Ream and Run - the state of the art"  regarding this radically conservative approach to shoulder arthritis at this link and this link. Also see the essentials of the ream and run.

Use the "Search" box to the right to find other topics of interest to you.

How you can support progress in shoulder surgery

You may be interested in some of our most visited web pages   arthritis, total shoulder, ream and run, reverse total shoulder, CTA arthroplasty, and rotator cuff surgery