21 Nov 2019

Frozen Shoulder

Frozen shoulder tends to cause stiffness and pain in the shoulder. Over the course of time, the shoulder ends up becoming very hard to move. The condition only occurs in around 2 percent of the population. Most of the time, it affects individuals who are between 40 and 60 years of age. It occurs more often in women than it does in men. The most common time to get frozen shoulder is following shoulder surgery, especially rotator cuff repair and shoulder decompression. This is probably due to the extent of arthritis in the shoulder that needed to be “cleaned-out”, which causes trauma to the shoulder. The resultant pain prevents mobility in the shoulder which then leads to stiffness. The stiffness gets worse and within two weeks the shoulder can be solidly frozen. Other issues after surgery involve the use of a sling to protect the rotator cuff. A lack of mobility to the shoulder leaves the shoulder joint at risk of developing frozen shoulder (sometimes known as secondary stiffness).

How to Treat Frozen Shoulder:

  1. Anti-Inflammatory Medication Ibuprofen and aspirin can help to reduce swelling and pain. As the swelling decreases, the amount of pain that accompanies it will diminish as well. However many therapists discourage the use of anti-inflammatories because frozen shoulder takes a long time to resolve (often many months) and using anti-inflammatories for more than 2 weeks is not recommended.
  2. Steroid Injections Cortisone is a powerful form of an anti-inflammatory medication that can be injected directly into the shoulder joint. It can give patients a step-forwards but very rarely cures a frozen shoulder.
  3. High Volume Injection Sometimes called hydrodilatation, a high volume of saline and steroid are injected into the shoulder capsule with the intension of stretch the capsule from the tight adhesions. The procedure takes about 15 minutes and is usually done under X-ray or ultrasound. Results vary but most people (around 70%) report some benefit from the injection.
  4. Physical Therapy Performing specific exercises can help to restore motion. This can be under the direct supervision of a trained therapist or performing them in the comfort of your own home. Therapy entails stretching and range of motion exercises for the shoulder joint. You can use a heat source or hot water bottle for loosening the shoulder before engaging in any stretching exercises. Therapists might also use other modalities including acupuncture, electrotherapy, ice and heat treatment and ultrasound.

Tips: • Frozen shoulder tends to occur more often in those who have diabetes, affecting around 10 to 20 percent of individuals. The reason isn’t known at this time. • Frozen shoulder often develops following a shoulder surgery that has left the joint immobilized due to the surgery, fracture or other type of injury. • Moving your shoulder soon after your surgery is one of the best methods for preventing frozen shoulder. • Pain is often aching or dull. During the early part of the disease, the pain tends to be worse when you are able to move your arm. It is located over the outer part of the shoulder and into the upper arm. • Follow the exercise rehab plan from your therapist. Failure to do regular exercises will significantly slow your recovery

Shoulder impingement syndrome

Shoulder impingement syndrome is a very common shoulder problem that causes a pinching of one of the tendons in the shoulder. It tends to occur commonly within the shoulders of the over 50s, although not exclusively, and can occur in younger patients but is rarely seen below the age of 30. When injuries to the rotator cuff tendons occur, the tendon responds by swelling similar to the way ankles do when they are sprained. Since the rotator cuff muscle is surrounded by bone, the swelling can cause numerous events to occur. As the tendon swells, there is not much space under the bone at the top of the shoulder blade, and when lifting your arm, the tendon can catch or impinge under the bone. This causes scratching or inflammation to the tendon, resulting in more swelling. The more the tendon swells, the less space there is for the tendon to move, and the impingement becomes worse, causing more swelling, and resulting in a complicated vicious circle that can take months or even years to resolve.

What Causes Shoulder Impingement? There are a number of causes of shoulder impingement:

  1. Arthritis of the ACJ Wear and tear on the ACJ can cause something known as hypertrophy which is thickening of the joint. There could also be bone spurs. This decreases the space under the joint and can cause impingement of the rotator cuff tendon.
  2. Low-lying Acromion A low lying or hooked acromion can decrease the space underneath the ACJ and cause impingement of the rotator cuff tendon. Often classified in three grades, I II and III. Grades II and III can be surgical cases.
  3. Bursitis Subacromial bursitis is a swelling of the fluid filled sac under the ACJ and if this becomes inflamed, there is less space for the rotator cuff tendon causing impingement.
  4. Poor Posture Poor posture puts the shoulders forwards and elevates the shoulder blade which can cause impingement.
  5. Repetitive Strain to the Tendon Repeated pressure and use (e.g. in golfers, or other sports people) can cause inflammation of the rotator cuff tendon (known as tendinopathy). This causes swelling, and then impingement.
  6. Rotator Cuff Tear If the rotator cuff tendon weakens enough through impingement, it can tear causing a partial thickness or full thickness rotator cuff tear.

How to Treat Impingement Syndrome:

  1. Anti-Inflammatory Medication An anti-inflammatory medication is one of the most common forms of treatment for this condition. However, caution should be advised because shoulder impingement is a chronic condition typically lasting 6-12 months, so look for more natural alternatives such as ice, heat, exercises and manual therapy.
  2. Daily Stretching Daily stretching exercises are beneficial. Your therapist will guide you.
  3. Steroid Injections If you still have persistent symptoms but have tried exercises and manual therapy, a cortisone/steroid injection into the area might be needed. A steroid commonly used is depomedrone, with a local anaesthetic called lidocaine. Depo-medrone is a strong anti-inflammatory that can help reduce pain and inflammation in the shoulder.
  4. ICE Place an ice bag on the tip of the shoulder and do this every day for a few weeks. It takes a long time but shoulder impingement is hard to shift, so doing the ice will help. Ask your therapist how long to use the ice for. If ice doesn’t help, try heat.
  5. Therapy Seek help from a physiotherapist, osteopath, chiropractor, sports massage therapist or other manual therapist because these problems are stubborn and take a lot of therapy to get them to disappear. Without treatment, there is a possibility you will have further problems.

Tips: • Impingement often results from sports that place an undue amount of stress on the shoulder. • The condition tends to develop more often in those who are aged 30 or older. • Warehouse workers, assembly-line workers and athletes are at an increased risk of developing an impingement. • Osteoarthritis, bone spurs and degenerative disease tend to leave individuals more susceptible to the condition. • Avoid sleeping with your arm raised above your head at night, or on the affected side.