Frozen shoulder

Frozen shoulder or Adhesive capsulitis is a very painful and disabling problem. It results in severe stiffness and pain in the shoulder. It often comes on after an unresolved injury or it can occur for no apparent reason.

With a frozen shoulder, swelling of the joint makes the normally mobile parts of the joint capsule stick together – a little bit like when you slacken off Sellotape and it sticks to itself. This seriously stiffens the shoulder and causes great pain on movement.

Reasons

The cause of frozen shoulder is unknown. It may be an autoimmune reaction like hayfever, where the capsule of the shoulder is not recognised as being part of the body, and the body’s defences start to attack it, causing great inflammation.

Some unresolved shoulder problems like bursitis, rotator cuff tears, or impingement syndrome can end up leading to a frozen shoulder, which is why these conditions must be treated quickly.

Pain of Frozen Shoulder

Pain and stiffness of the shoulder in all directions tells us what your condition is likely to be. The shoulder is stiff when you move it or when your Osteopath tries to move it. Most tasks are difficult with a true frozen shoulder.

Diagnosis and Treatment

Your Osteopath will take a careful case history and then examine you in great detail, noting your ranges and quality of movement. He will do minor tests for trapped nerves and in rare cases may request an MRI scan. X-rays are usually not helpful, but an MRI scan showing the capsule and ligaments as well as the bones may be used.

When a diagnosis has been reached, your Osteopath will discuss the treatment options with you. It is essential that you seek advice quickly because, apart from getting an accurate diagnosis, evidence shows that the sooner you consult your osteopath, the quicker you will be better!

Treatment of frozen shoulder can be frustrating and slow. Most cases eventually improve, but the process may take several months. The goal of your initial treatment is to decrease inflammation and increase the range of motion of the shoulder.

Osteopathic treatment is an important part of helping you regain the motion and function of your shoulder. Treatment is directed at getting the muscles to relax, gentle stretching of the joint capsule and gradually increasing the joint’s range of movement. You will also be given exercises and stretches to do at home. You may need osteopathic treatment for 3 to 6 months before you get full shoulder movement and use back.

Your osteopath may also recommend an injection of cortisone and a long-acting anaesthetic to get the pain and swelling down as quickly as possible.

If progress is too slow, your osteopath may recommend manipulation under anaesthetic to aggressively stretch out the stiff shoulder before treatment begins.

Laser therapy can be very helpful with this problem.

If your doctor recommends an injection for your shoulder, you should plan on seeing your osteopath right after the injection. A gentle session of stretching right afterwards can help maximize the stretch to the joint capsule.

Once your shoulder is moving better, treatment is directed toward shoulder strengthening and movement. Exercises to improve the muscle power and balance will also be given.

Shoulder Pain Shoulder Pain, Rotator Cuff syndrome, Tendonitis, Bursitis, and Impingement Syndrome. These closely related conditions may occur alone or together. If the rotator cuff (the muscles that twist the arm) and bursae ( bags of fluid that stop the muscles rubbing on the bones) are inflamed, and swollen, they may become squeezed between the head of the humerus (upper arm bone) and the acromion (top of the shoulder blade). Repeated movement of the arms, or the aging process of the muscles and tendons of the shoulder can lead to shoulder pain.  Impingement syndrome occurs when the rotator cuff tendons rub against the roof of the shoulder, the acromion. Anatomy The shoulder is made up of  the scapula (shoulder blade), the humerus (upper arm bone), and the clavicle (collarbone).
The rotator cuff muscles are called: the supraspinatus, infraspinatus, teres minor, and subscapularis, and attach to the bones of the shoulder .They help move the arm outwards and rotate the arm. They also help keep the bones of the arm closely together to prevent injury.
A bursa ( sac of liquid to prevent tendons and muscles fraying as they rub over bones) is located between the acromion and the rotator cuff tendons, to stop them rubbing against each other. Shoulder Impingement Syndrome Impingement is when the tendons or bursa are pinched between the humerus (arm bone) and the acromion (top bone of the shoulder). When the arm is used above shoulder height everyone will get a bit of impingement, but this normally doesn’t cause any trouble. However, with prolonged or repeated movements, the structures can get worn, inflamed and painful. This can also cause swelling and pain in the bursa. With wear and tear bony outgrowths called spurs can occur which further irritate the area. Symptoms In the early stages you will find the shoulder just aches, particularly when moving your arm outwards or reaching for your back pocket. Later you may notice that lying on the affected side wakes you up. You may also notice that your arm becomes stiffer and more painful as it gets worse. Sometimes the supraspinatus tendon can become so worn that it snaps leading to weakness in the arm. Diagnosis and Treatment Your Osteopath will take a careful case history and then examine you in great detail, noting your ranges and quality of movement. He will do minor tests for trapped nerves, ranges of movement and power, and in rare cases may request an X ray or MRI scan. When a diagnosis has been reached , your Osteopath will discuss the treatment options with you. Although shoulder pain can be serious, the vast majority of injuries are not and can easily be helped by your Osteopath. He should normally be able to reduce your symptoms to a pain-free level and give you advice and exercise to help prevent future problems. NB Shoulder problems can take a very long time to settle down, 3-6 months would not be unusual. The sooner you seek treatment the quicker you will be better. It was once said by the tennis player John McEnroe’s Osteopath “that a shoulder problem will take one month to settle for every week you leave it!” Although not strictly true it can act as a fair rule of thumb! This is one of the most common conditions that Osteopaths treat and often a patient can be helped by carefully prescribed Osteopathic treatment and advice! Sometimes a cortisone injection or surgery would be the preferred option but your Osteopath will be able to advise you on this.