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Frozen Shoulder?
by James Wilson BSc (Hons) Ost Med. DO - find out more about James.
Our shoulder joints are pretty impressive really. They have the largest range of movement of any single joint in our body yet in certain positions are strong enough to enable us to lift, push and pull some very heavy objects.
The trade-off for this huge range of movement is the potential for instability. Ligaments (which join bone to bone) do not stretch very far, so instead of having large thick ligaments as so many of our other joints do, our shoulder joints rely almost entirely on a group of muscles for support.
The shoulder, or Glenohumeral joint, is formed by the articulation of the humerus of the upper arm and the shoulder blade (scapula). The scapula articulates with the clavicle (collar bone) at the acromioclavicular joint. The scapula also forms a false joint on the back of the ribs. Collectively these joints make up the Shoulder Girdle.
The shoulder joint is primarily held in place by four muscles known as the Rotator Cuff. Additionally several muscles attach around the shoulder girdle to aid in producing movement but also to help stabilise the joints.
So what can go wrong?
Unfortunately due to the amount and the ways in which we use our shoulders quite a lot! For example:
- Rotator Cuff tears, impingement and tendonitis
- Other muscle tears (strains) commonly biceps and deltoid
- Frozen Shoulder (adhesive capsulitis)
- Dislocation (with or without Fracture)
- Clavicle and upper humerus fractures
- Referred pain from the neck, heart, lungs and gallbladder
- Rheumatoid and Osteoarthritis
The vast majority of shoulder problems we see have arisen because of imbalance in the musculature around the joint. This will lead to the joint being used in awkward positions which in turn will lead to problems such as strains and tendonitis. The root-cause for these sorts of problems is mostly postural where problems in the neck and mid-back will cause disruption of the shoulder girdle. I would go so far as to say that if the spine/rib and postural issues had been addressed in the first instance, the vast majority of shoulder problems would not occur in the first place.
There are of course direct injuries to the joint or surrounding musculature which are completely independent of any pre-existing postural issue.
Frozen shoulder or Rotator Cuff impingement?
I have chosen these two conditions above any other partly because they are quite common, but also because unfortunately the two can be confused which can lead to ineffective treatment and management.
Both conditions can lead to very significant pain and restriction of movement / activity. Both can frequently occur after trauma or just gradually increase, apparently for no good reason. Both can cause significant pain at night and disturb sleep.
The differences are that an impingement will normally be painful in one or two ranges of movement and clear in others, where as Frozen Shoulder will frequently be stiff and sore in all ranges of movement. Impingement issues are often easily treated, where as true Frozen Shoulder is a particularly difficult ailment to shift; frequently lasting 18 months from start to finish.
Early assessment and intervention is important for both conditions. Manual treatment by an Osteopath or Physiotherapist can significantly help in decreasing the duration and intensity of symptoms and also in the management of more long-standing cases. Acupuncture can be effective in the very acute stages also.
So what can I do to help myself?
My last topic on neck pain included some stretch exercises which would also be useful here. I also touched on posture, which as I mentioned above in this article is very important when thinking about the root cause of shoulder issues – improving your posture has to be helpful.
Overall, with exercises for either condition, do them gently. Many patients will try to force movement through their pain which unfortunately is more likely to make things worse than better. Without assessing individual shoulders first it is very difficult to prescribe many exercises.
One of the most effective early stage exercises is to simply hold a can of beans (or similar) and let your arm swing slowly back and forth like a pendulum for several minutes. As your range of movement improves, try leaning to the side slightly and swing the arm in a clockwise direction. Repeat in an anti-clockwise direction.
Should the above exercise become very easy to do, try this: Start below waist height and crawl your hand up the wall in front of you towards shoulder height. Do be careful here though – if it pinches when you reach a certain level then stop and work within the pain free range. Repeat this to the side of you with the same care not to pinch it.
Gradually your range of movement should improve over 2-3 weeks. Should you see no improvement at all in the first 10 days then you should seek further advice and assessment.
Further information is available on our website www.molfordhousesurgery.co.uk. Alternatively I am always pleased to answer any questions you may have. You can call me at Molford House Surgery on 01769 574830.
The information provided on these pages is intended as a general guide only and in no way constitutes a complete service for diagnosis or treatment. You must not rely solely on this information and it is therefore your responsibility to seek a professional opinion should you be concerned about your particular case.
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