Thawing Frozen Shoulders

February 10, 2010

In an earlier article, we look at what frozen shoulder was all about. In this article, we will look at some treatment options for frozen shoulders

What is the treatment for a frozen shoulder?

Flickr: nataliej

A frozen shoulder will usually resolve on its own over a period of up to 2 years. However, it can be very frustrating to live with due the pain and restriction in shoulder movement. The aim of treatment therefore, is to maintain movement in the shoulder and offer pain relief whilst waiting for the condition to resolve.

You can try taking over-the-counter painkillers such as paracetamol and nonsteroidal anti-inflammatory drugs (NSAIDS) to help reduce pain and inflammation. If these do not provide sufficient relief, see your GP for a stronger prescription.

Applying heat the shoulder can also offer pain relief. This warms up the shoulder to make it easier to move, and easier to sleep at night.

Performing stretching exercises for the shoulder can also benefit in reducing stiffness in the shoulder. Diligent exercise can reduce the chance of severe restriction in the shoulder, which can aid in faster recovery from a frozen shoulder. These exercises will be taught by the physiotherapists.

Physiotherapy can help you in the recovery from a frozen shoulder. A physiotherapist can perform treatment techniques to increase movement in the shoulder joint, as well as reducing pain. They can also show you exercises that are specific to your condition and ensure you are performing them correctly.

Severe and unrelenting pain may require a cortisone injection. This is a steroid injection which may be effective in the reducing pain in the short term. Your GP or specialist will help you decide whether this treatment option is appropriate for your condition.

When conservative treatment fails, more invasive options can be considered. Shoulder distension is a technique where saline water is injected into the joint to stretch the shoulder joint to help allow it move more easily. Another option is manipulation, which can be performed to stretch out tightened tissues. This process is conducted under anaesthesia by an orthopaedic specialist to restore mobility in severely frozen shoulders. Surgery is the last resort for a frozen shoulder. During this procedure, scar tissue and adhesions are removed through arthroscopic surgery to allow the shoulder to move more freely.

What can I do to get better?

It is advised that you see your doctor or a physiotherapist to diagnose your shoulder pain if you are unsure of the cause. If you suspect it is a frozen shoulder, some simple exercises can be performed to help prevent your frozen shoulder from worsening. These should be performed 3 to 4 times a day and should be relatively pain-free, especially if your shoulder is quite painful. See your doctor if your condition does not improve within 3-4 weeks.

Flexion

In standing, hold a stick horizontally in front of you with hands shoulder-width apart
With the arms straight, bring the stick from hip level towards the ceiling until you feel your pain come on
Hold for 5 seconds and return to starting position
Repeat 10 times

Extension

In standing, hold a stick horizontally behind you with hands shoulder-width apart
With the arms straight, bring the stick from hip level towards the ceiling until you feel your pain come on
Hold for 5 seconds and return to starting position
Repeat 10 times

External rotation

Lie on your back and hold a stick horizontal in-front of you with your hands shoulder-width apart
Bend the elbows to 90 degrees and keep them next to your body
Using the hand on the pain-free shoulder, push the stick towards the affected side whilst still keeping your hands on the stick
Hold the end position for 5 seconds and return to starting position
Repeat 10 times

Internal rotation

Stand holding a stick with the pain-free arm behind your head, and the affected hand behind your back holding the other end
Using the pain-free arm, pull the stick up towards the ceiling until you feel the onset of pain in your affected shoulder
Hold the position for 10 seconds and return to starting position • Repeat 10 times

Written by MCR · Filed Under Shoulder (NonSport) | View Comments

What’s freezing up your shoulder?

February 6, 2010

There are many types of shoulder conditions, but one in particular can creep up on you without you remembering having hurt it. This condition is called Adhesive Capsulitis, or more commonly known as Frozen Shoulder.

What is a Frozen Shoulder?

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Frozen shoulder is a condition where the shoulder joint becomes stiff and painful, often with no known cause. It usually comes on gradually, worsens over time, and then eventually resolves.

There are 3 stages in the development of a frozen shoulder which can take up to 2 years or more to complete.

Stage 1 – Freezing stage: During this stage, the affected shoulder gradually becomes more painful and starts to lose mobility. This stage can last from 6 weeks to 9 months.

Stage 2 – Frozen stage: Shoulder pain and stiffness is significantly noticeable during this stage. Daily tasks can be difficult to perform, and sleep disturbance is common as the pain is worse at night. This stage can last from 4 to 9 months.

Stage 3 – Thawing stage: The shoulder is not usually painful during this stage. The stiffness decreases as the shoulder starts to “thaw” out. This stage usually last between 5 months and 2 years.

How do you get a Frozen Shoulder?

The cause of frozen shoulder is poorly understood. It is thought that the joint capsule, the lining around the shoulder joint, becomes inflamed in a frozen shoulder. This inflammation causes adhesions and scarring to form within the capsule, resulting in pain and movement restriction. There is also a lack of fluid in the joint, further reducing joint mobility.

Research indicates that sometimes a frozen shoulder can develop after a trauma or injury to the shoulder. However, in many cases, there is no known cause. Apart from trauma, some other risk factors have been linked to frozen shoulder, including:

Age and gender – frozen shoulder tends to affect people between the ages of 40 and 60 years old. It is also much more common in women than men
Diabetes – diabetic people are more likely to develop a frozen shoulder, as well as take longer to recover due to poor blood circulation
Other systemic diseases – heart disease and Parkinson’s disease are some examples of systemic diseases linked to developing a frozen shoulder.

How can I tell if I have a frozen shoulder?

Frozen shoulder is usually diagnosed by signs and symptoms which are assessed by a docotr or physiotherapist. People who have a frozen shoulder often complain of:

Gradual worsening shoulder pain with no known cause
Aching pain on top of the shoulder and often shooting into the upper arm
Movement restriction without a loss of strength
Inability to sleep on the affected shoulder and sleep disturbance when rolling on to it
Difficulty with grooming and dressing as the condition progresses

A doctor or physiotherapist will also assess your movement and palpate the joint help confirm the diagnosis and rule out other shoulder conditions.

For treatment options of frozen shoulder, read our follow-up article on this topic, "Thawing Frozen Shoulders".

Written by MCR · Filed Under Shoulder (NonSport) | View Comments

Scapula winging

August 13, 2009

What is scapula winging?

The scapula is the anatomical term for the shoulder blade. Scapula winging describes the position of the shoulder blade sticking outwards as opposed to being flat against the ribcage. A winging scapula that is left untreated can lead to more debilitating shoulder injury like a rotator cuff tear. Doing scapula push ups will exercise the muscles that prevent scapula winging.

The normal biomechanical position of the shoulder blade should always be rested flat against the ribcage regardless of the position of the arm. The shoulder blade slides upwards, downwards, forwards, backwards as well as rotating clockwise or anti-clockwise as the arm moves, but it should not come away from the ribcage as seen in the right shoulder blade in the picture below.

Source: emedicine.medscape.com

The following video shows how a winging scapula looks like when the shoulder is moving. Look at how much the bottom tip of the left scapula sticks out compared to the right (normal) scapula.

Scapula instability causes shoulder injuries

It is important that the above mechanics occur as the stability of the scapular is an essential facet to the proper function of the shoulder complex. An analogy would be a bicycle. There are many parts that are put together to allow the bicycle to move as it is pedaled. If the chain of the bicycle is loose, not only it creates noise but it also the cyclist will have to pedal harder to reach the same speed, making it inefficient. Eventually other parts will be worn out faster than normal. Similarly, if the muscle that holds the shoulder blade against the ribcage does not work properly, causing scapular winging, inappropriate activation from other muscle groups will compensate resulting in overuse and pain in these muscles. This will lead to a cycle of pain in the muscles and poor biomechanics in the shoulder, subsequently leading to problems such as shoulder muscle (rotator cuff) impingements or tears.

Serratus Anterior Muscle

The primary muscle that stabilizes the scapula to the ribcage is the Serratus Anterior. Other muscles that offer support to that role are the middle and lower trapezius. Hence any weaknesses in these muscles due to injury, disease process or lesion in the nerve supply can result in winging. In cases where the nerve supply is intact, specific exercises targeting at the Serratus Anterior and middle and lower trapezius can be performed to rehabilitate the specific muscles affected.

Exercise

Shoulder push-ups is a good way to train the serratus anterior muscles. The idea is to push your chest away and towards the ground by moving your shoulders and not from the elbows. This exercise is demonstrated in the video below. An easier way to perform this exercise is to lean against the wall with your hands instead of on the floor.

Written by Sylvia Ho · Filed Under Shoulder (NonSport), Video | View Comments

Arthroscopic Rotator Cuff Repair

April 16, 2009

A rotator cuff tear is a common injury of the shoulder. It can be due to a traumatic event where the tendon gets torn in a fall or due to overuse where repetitive overhead activities causes wear and tear of the tendon. Pain is the most significant symptom with a rotator cuff tear followed by loss of range of movement in the shoulder. Arthroscopic rotator cuff repair, which involves minimally invasive surgical techniques, helps to heal the tendon back to the bone. Such surgeries are usually done as a day operation. Rehabilitation of the shoulder post operation takes about 6 months before patients return to functional activities.

Written by chyetuan.chng · Filed Under Injury Management, Peripheral (NonSport), Shoulder, Shoulder (NonSport), Sports Injury, Treatment Option, Uncategorized | View Comments

Thoracic Outlet Syndrome

February 2, 2009

What is Thoracic Outlet Syndrome?

Thoracic outlet syndrome refers to a condition whereby blood vessels and/or nerves that pass into the arms from the neck are compressed, due to narrowing of the thoracic outlet which is the space between the collarbone (clavicle) and the first rib. This can lead to pain, tingling or numbness along your neck, shoulder, arm and hand.

Written by Cindy Tan · Filed Under Elbow (NonSport), Shoulder (NonSport), Spinal Conditions, Thoracic, Workplace Health | View Comments

Anatomy of the Shoulder

September 30, 2008

The shoulder joint is perhaps one of the most complex in the human body. This animation demonstrates how the various bones, muscles, bursas come together.

Written by Admin · Filed Under Shoulder, Shoulder (NonSport), Video | View Comments

Self Massage for Your Neck & Shoulders

September 28, 2008

Have you ever had the burning ache in your neck and shoulders as you were working on your computer and yearn for someone to give you a nice, strong massage to ease the strain? Why wait? You can do the massage on your own now! Read more

Written by MCR · Filed Under Shoulder (NonSport), Workplace Health | View Comments