Posts Tagged ‘Shoulder pain’

Frozen shoulder

Thursday, July 2nd, 2009

The shoulder is a ball and socket type joint.  The spherical end of the upper arm bone (humerus) rests in the socket of the shoulder blade (scapula).  This joint is surrounded by a flexible capsule.  The shoulder capsule is fully stretched when the arm is raised above the head and hangs down loose and folded when the arm is by the side.  In frozen shoulder the capsule becomes inflamed and sticky and folds of the capsule stick together preventing the capsule stretching and therefore restricting movement of the arm.  Frozen shoulder (adhesive capsulitis) also causes pain and stiffness in the shoulder, which reduces normal movement and in some cases all movement is lost. Usually, just one shoulder is affected, but in 20% of cases the condition spreads to affect the other shoulder.

Causes and affected groups

Frozen shoulder is usually found in individuals over 40 years of age.  Around 3% of the population will be affected at some stage in their life.  The exact causes of frozen shoulder are unknown but there are risk factors that make it more likely to develop the condition.

  • Shoulder injury or surgery. Immobilisation of the shoulder after injury or surgery may cause the shoulder capsule to tighten due to lack of use.
  • Poor posture. Rounded shoulders, cause shortening of the shoulder ligaments which may contribute to the condition.
  • Diabetes. Diabetics are 2-4 times more likely to develop frozen shoulder.  Symptoms are also more likely to develop in both of shoulders, and symptoms may be more severe.
  • Women. Hormonal factors are thought to account higher incidence amongst women
  • Asians are more likely to develop the condition.
  • Other health conditions.  Increased risk with heart or lung disease, an overactive thyroid gland (hyperthyroidism), post stroke or Parkinson’s disease.

Symptoms of Frozen shoulder

Frozen shoulder is a painful, long term stiffness of the shoulder joint that significantly reduces the mobility of the shoulder.
Symptoms progress slowly and are usually experienced in three stages as outlined below.

Stage one – Painful phase

  • Gradual onset of aching pain and stiffness, before becoming very painful.
  • Pain is often worse at night and aggravated by lying on the affected side.
  • Duration 2-9 months.

Stage two – Adhesive stage

  • Increasing stiffness with difficulty in performance of everyday tasks
  • Pain does not normally get worse.
  • Muscle wasting due to lack of use
  • Duration 4-12 months

  • Stage three – Recovery or Thawing stage

  • Gradually increasing mobility – full range of motion may not be achieved
  • Pain decreases although it may recur from time to time as the stiffness eases.
  • Duration 5-12 months

What you can do

  • Seek help quickly as early intervention can help to prevent long-term stiffness and pain in your joint
  • Try to keep the shoulder moving within the pain free range
  • Anti inflammatory medication – speak to doctor or pharmacist about a suitable product

What we can do

Treatment of frozen shoulder varies according to the stage of the condition, and the level of pain and stiffness.   The aim of treatment is to control pain and keep the shoulder joint mobile with regular, gentle exercise.  Disuse of the shoulder can cause muscles wasting and exacerbate stiffness. Therefore, if you are able you should continue using your shoulder as normal

  • Prescription of pain free exercises to retain mobility
  • Physical therapy to maintain flexibility
    • Cross friction massage to surrounding tendons to maintain flexibility
    • General massage to decrease muscle stiffness
    • Myofascial capsular stretches to joint capsule
    • Traction and distraction of shoulder

Further treatment options

  • Tens Transcutaneous electrical nerve stimulation to control pain
  • Nerve block to provide short term pain relief
  • Referral for corticosteroid injection
  • Surgery if above treatments are unsuccessful

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Impingement Syndrome (Throwers shoulder)

Thursday, July 2nd, 2009

Impingement syndrome (aka Throwers shoulder) is caused by various structures including the rotator cuff tendons and bursa getting irritated as they pass through a restricted area called the subacromial space. This area located beneath the subacromial arch – the bony area above the head of the humerus (near end of the upper arm bone).  The most commonly irritated structure is the supraspinatus tendon.  The primary symptom is pain at the front/side of the shoulder as the arm is abducted (taken out to the side).

There are various causes of impingement syndrome.

  • Bony abnormalities may exist within the acromial arch either congenital (born with) or abnormalities which develop as we grow older and small bony outgrowths develop
  • Poor muscle balance can cause impingement.  Weakness in the serratus anterior and tightness of the pectoralis minor
  • Poor scapular (shoulder blade) stabilisation allows the scapular to tip upwards during abduction of the arm thus reducing the subacromial space.
  • Poor rotator cuff function.  Normally the head of the humerus should glide downwards as the shoulder is abducted due to the action of the rotator cuff muscles.  Failure of this sliding mechanism can cause the head of the humerus to jam into the acromial arch
  • A rounder shoulder posture causes shoulders to internally rotate and makes impingement more likely

The condition is more common amongst individuals who perform large amounts of overhead activity with the arm due to occupation or sport e.g. tennis, swimming, throwing or decorating

Symptoms of impingement syndrome

  • Painful arc of abduction.  Pain is experienced at the front and or side of the shoulder between 60 and 90 degrees of abduction of the arm
  • Pain aggravated by sleeping on affected shoulder
  • Pain and weakness in the supraspinatus and bideps
  • Tenderness when area pressed

What you can do

  • Rest with gradual return to aggravating activities
  • Ice therapy

What we can do

  • Reduce inflammation by using traction and distraction techniques
  • Assess muscular balance/function of muscles that stabilise the scapular and provide exercises to redress imbalance
  • Prescription of exercises to improve rotator cuff function
  • Treatment and advice to improve posture to reduce impingement

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Rotator Cuff Injury

Tuesday, June 30th, 2009

The rotator cuff is a group of muscles that run from the shoulder blade and attach to the head of the humerus (near end of upper arm bone).  They function to rotate the shoulder and form a cuff or sleeve of muscle around the shoulder joint.  This sleeve of muscle helps stabilise the shoulder which has a very shallow socket to allow for a high level of mobility.  The rotator cuff are also important for controlling the position and movement of the head of the humerus.  The muscles include:

  • Supraspinatus
  • Infraspinatus
  • Teres minor
  • Subscapularis

This shoulder problem may develop quickly due to an injury (acute), or it may develop slowly over time due to routine activity that causes a repetitive strain (chronic). Occasionally, a trivial movement e.g. putting on a coat can trigger a rotator cuff injury.  The third variation of rotator cuff pathology is tendinitis.

Rotator Cuff Injury Causes

Chronic tear

  • Found among individuals in occupations or sports involving excessive overhead activity e.g.decorators, tennis players
  • Variations in the shoulder structure leading to narrowing under the outermost edge of the clavicle (collarbone)

Acute tear

  • Sudden forceful raising of the arm against resistance e.g. in an attempt to cushion a fall on the shoulder
  • Injury often associated with a significant degree of force in individuals younger under 30 years

Tendinitis

  • Degeneration of the muscles as individual gets older
  • Repetitive overuse of the muscles due to everyday activities

Rotator Cuff Injury Symptoms

Chronic tear

  • More common on an individuals dominant arm
  • More commonly found among individuals older than 40 years – especially men
  • Pain normally worse at night and may affect sleep
  • Gradually increasing pain levels with an associated weakness
  • Decreasing ability to move the arm, especially abduction (raising out to side) – therefore difficulty performing activities at or above shoulder level.

Acute tear

  • Sudden sensation of tearing followed by severe pain spreading through the arm
  • Movement limited by pain and muscular spasm
  • Acute pain due to bleeding and protective muscle spasm that usually subsides within in a few days
  • Specific area of tenderness at the site of rupture
  • With significant tears, individual unable abduct arm (raise the arm out to the side) without help

Tendinitis

  • More common in 35-50 age group – especially women
  • Pain felt as a deep ache in the shoulder
  • Tenderness over specific areas
  • Pain develops gradually and aggravated by lifting the arm to the side or turning it inward
  • May develop into to a chronic tear

What you can do

  • Rest the injured shoulder
  • Apply ice therapy
  • Apply heat therapy after 2-3 days of applying ice.
  • Take an anti-inflammatory medication such as ibuprofen or naproxen sodium to decrease the pain and swelling.  You must speak to your pharmacist or doctor first to ensure that the medication is suitable for you.

Treatment

Chronic tear

  • Prescription of exercises to increase range-of-motion
  • Referral for steroids injection or surgery is some cases

Acute tear

  • Rest the arm by supporting the arm in a sling.
  • Referral for imaging may be needed to determine the extent and muscle tear.
  • Early surgical intervention (within three weeks) to repair the tendon maybe required if the injury is severe.  Indications for surgical treatment:-
    • Individuals under 60 years of age
    • Failure to improve after six weeks of conservative treatment
    • If individual is in an occupation requiring constant shoulder use

Tendinitis

  • Rest shoulder in a sling for short periods.  Extensive use of the sling can lead to stiffness, weakness, and reduced range of motion.
  • Progress to contrast bathing as symptoms improve
  • Prescription of exercises to increase range of motion of shoulder without placing stress on damaged muscles
  • Massage therapy to reduce muscular tension in muscles of shoulder
  • Stretches and joint articulation to improve range of motion
  • Referral for steroid injection if symptoms do not resolve.

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