Faris Aziz

Period 1 / 11AP

2/12/17

The Rehab App: A communication method to strengthen recovery in shoulder

injury patients

Capable of turning at least 5730 degrees per second, the shoulder is the most versatile

joint in the human body (Ryan). The shoulder is prominent in daily life, since it is used for many

everyday activities, such as sports, jobs, and driving, therefore it is important that it must be kept

in good condition. Regardless, peoples bodies eventually wear out with time, so the process of

fixing these injuries must be most accurate and effective. The shoulder is the most complicated

joint in the body because of the complexity of its muscles and tendons, and the structure of the

ball and socket which allow for the maximum rotation in the shoulder. Since the shoulder is the

most complicated joint in the body, it is the most difficult joint for to treat. Thus, a new method

to improve shoulder recovery must be implemented. Communication between the doctor and the

patient should aid the patients recovery by allowing the patient to gain relevant information such

as their progress in recovery and also will ensure the patient will be even more motivated to keep

up in their exercises and thus have a more efficient treatment.

 There are several bones that make up the shoulder. It contains the humerus, the bone that

makes up the upper part of the arm, the scapula, more commonly known as the shoulder blade,

and the clavicle, the collarbone that joins the neck and the shoulder. The humerus, clavicle, and

scapula join at a place called the ball and socket, where the humerus can freely move along the

constraints of the socket and the head can rotate like a ball (Shoulder Anatomy and

Physiology). The muscles of the shoulder pull the bones in several different directions along the

ball and socket and provide shoulder movement and strength. The shoulder has several

muscles and tendons that give it its flexibility. The most important muscle is the rotator cuff,

which controls much of the movement in shoulder activity. The rotator cuff is a group of

muscles, which include the supraspinatus, infraspinatus, teres Minor, and the subscapularis.

These muscles control different movements and rotations of the shoulder and arm (Harrison).

The supraspinatus muscle serves for abduction or moving the humerus outwards away from the

body. The supraspinatus muscle is also the most commonly injured muscle. The teres Minor does

the reverse, it adducts the humerus by moving the bone towards the body. The infraspinatus

muscle is responsible for the lateral rotation or the external rotation of the humerus. The

subscapularis muscle allows the humerus to rotate medially or inwards towards the body

(Kleweno).

The shoulder is prone to different injuries due to the structure of the muscles and bones

such as rotator cuff tears, arthritis, and dislocation. Rotator cuff tears are the most frequent

shoulder injuries. These occur when a muscle or tendon in the rotator cuff tears and causes

the shoulder to experience weakness and pain in the shoulder joint. Rotator cuff tears are

classified as either acute tears or degenerative tears. Acute tears are caused by a sudden injury

such as falling or putting too much stress on the shoulder muscles at a certain point of time.
Degenerative tears are caused by the wearing and tearing of the shoulder muscle (Armstrong).

After many years, some patients can tear their rotator cuff due to the frequent use of it during

their lifetime. Symptoms of rotator cuff injuries include pain while raising or lowering the

patients arm, pain while lying down on the shoulder at night, and weakness while lifting or

rotating the patients arm. The muscle could also be tender and the injured individual could have

difficulty moving the arm in different directions (Fields).

Management for shoulder injuries include expectant, medical and surgical options.

Patients can rest their shoulder and modify their activities so they do not have to use their

shoulder as often as they used to before the tear. Patients may also cope with shoulder pain and

small partial thickness rotator cuff tears by undergoing physical therapy to strengthen the

shoulder. Medical options include anti-inflammatories, pain killers, or oral steroids to cope with

the pain. As a last resort to minimize the pain, the doctor can inject cortisone into the shoulder to

remove any inflammation, the main source of the pain. If none of these treatments work, then the

patient usually will go into surgery (Armstrong).

To surgically repair rotator cuff tears, the surgeon first removes anything that would

conflict with the muscle movement such as bone spurs, sharp protruding parts of the bone, and

extra tissues that are covering the space in which the ball and socket can move that would

provide more friction to the shoulder muscle. Then the surgeon sews together the torn muscle by

anchoring screws into the rotator cuff and by using both (Rotator Cuff Repair Arthroscopic

Shoulder Surgery Dr. Eric Janssen).

A rotator cuff post-surgery rehabilitation time will usually take between six months to

one year before the shoulder can achieve its maximum fitness. This is because the muscle needs
time heal and to scar or reattach itself properly to the bone. After surgery, the shoulder muscle

may still not be at its original strength or flexibility. The shoulder may still be very stiff in which

it cannot move as well as it used to and needs time to work out at physical therapy to gain its

original function in its flexibility and its strength.

During rehabilitation, the patient can stretch the shoulder to improve flexibility and ease

the pain off the shoulder. The patient can do these stretches at home or at physical therapy

centers. Some stretches the patient can perform at the home include sleeper stretches, which

help with vertical internal rotation, wall stretches or climbing stretches, which work with

external and internal rotation, and passive rotations, which help ease the flexibility in the certain

directions the patient decides to rotate. At physical therapy, the therapist will pull the arm in

different directions to ease the flexibility in those directions. (Rotator Cuff and Shoulder

Conditioning Program) After working on flexibility, the patient will slowly start to work on

shoulder strength. The patient will use different rubber bands and weights to strengthen the

different muscles in the arm. This can be done at both physical therapy and at home. This will

improve the function of the arm and allow the arm to regain its ability to raise and lower itself

once again. By improving the flexibility and strength of the arm, although it will not be as great

as it originally was, it may regain much of its original function (Ryan).

The current rehabilitation process for shoulder injuries is that it is not as effective as it

could be. During rehabilitation, the patient spends time away from the doctor for months and

may not communicate with the doctor information on their progress of recovery. The patient

also does not receive feedback on how well their shoulder is improving. If the patient and their

doctor are in constant communication, there is less room for potential errors that may arise
during the rehabilitation of the patient. Constantly communicating about the patients Range of

Motion, or the range in which the shoulder can rotate, reveals the flexibility of the shoulder, so

the more flexible it is, the more the patient has recovered. By using the goniometer on the app,

the patient can measure their range of motion and get an accurate idea of their improvement. This

information can help the patient and doctor move on to new treatment plans to adjust in regards

to the patients recovery speed.

In todays world, excessive communication is key to ensure the progress of any problem.

This principle can be applied to medicine in the form of this rehabilitation app. An app that can

allow effective communication between the doctor and the patient will be useful to ensure the

recovery of the shoulder. By motivating patients to take extra action towards the recovery of their

shoulder, patients will use the app to recover efficiently and faster than normal. By measuring the

patients recovery speed by measuring range of motion with a goniometer, a machine that can

measure the range of motion, and communicating pain levels and other information through

questionnaires on patient performance, this app will allow the rehabilitation of the patient to

be greatly improved, leading to a more effective patient recovery.

*REST OF RESEARCH PAPER COMPLETION AFTER THE PRODUCTION OF THE APP*

Works Cited

Armstrong, April D. "Rotator Cuff Tears." OrthoInfo, American Academy of

Orthopaedic Surgeons, May 2011
Fields, Peter A. "Orthopedic/sports medicine: rotator cuff shoulder injuries." Townsend Letter,
Aug.-Sept. 2013: 114+. Student Resources in Context. Web.

Harrison, Levi. "Avoid Shoulder Injury by Strengthening the Rotator Cuff."

Breaking Muscle

Kleweno, Conor, and Gillian Lieberman. "Shoulder MRI for Rotator Cuff Tears." PowerPoint
Presentation.

"Rotator Cuff and Shoulder Conditioning Program." American Academy of Orthopedic

Surgeons

Rotator Cuff Repair Arthroscopic Shoulder Surgery Dr. Eric Janssen. Youtube, uploaded by
SportsMED Orthopaedic Surgery & Spine Center, 12 Feb. 2012

Ryan, David. "Shoulder Fix-It 101!" Body Building, BodyBuilding.com

"Shoulder anatomy and physiology." World of Sports Science. Ed. K. Lee Lerner and Brenda
Wilmoth Lerner. Detroit: Gale, 2007. Science in Context. Web