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Shoulder Pain Blog

August 15, 2016

I Have a Frozen Shoulder? But Spring Just Started!

Despite its name, frozen shoulder actually has nothing to do with being cold. It does, however, mean that your shoulder mobility becomes very limited, much like if it were frozen in place. The medical term for frozen shoulder is “adhesive capsulitis”.

Our shoulders are ‘ball and socket’ joints which are surrounded by a structure called a joint capsule. This capsule is like “Saran-Wrap” that holds the fluid in the joint and can help to stabilize the shoulder. With frozen shoulder, this capsule becomes inflamed (“capsulitis”), shrinks, and becomes stuck to the shoulder joint itself. As a result, this can severely limit the range of motion of the shoulder.

 

illustration of the shoulder joint

(image taken from: https://orthoinfo.aaos.org/en/diseases–conditions/frozen-shoulder)

The progression of frozen shoulder can be broken down into three stages:

⦁ Freezing Stage

This is the initial stage of the condition and when most people start to notice changes and seek treatment. It is often characterized by intense pain with movement, especially fast movements, but only mild restrictions in range of motion.

⦁ Frozen Stage

It is in this middle stage where you will see the most restriction in your shoulder range of motion. The pain does not worsen, and may even decrease slightly, but the shoulder will feel very stiff and be difficult to move.

⦁ Thawing Stage

This is the final stage of the condition. The pain in the shoulder lessens and the range of motion will gradually begin to improve.

What caused my frozen shoulder?

Frozen shoulder usually occurs one of two ways: 1) insidiously (for no known reason); or 2) as a progression of another injury.

⦁ Insidious Onset

There is limited research and understanding as to why frozen shoulder occurs. One theory currently being investigated is that it may be related to changing hormone levels as we reach middle age. This can affect both sexes, but it does tend to be more common in women (up to 70% of people with frozen shoulder are female).

Another theory states that it can be more likely to develop in individuals with certain diseases. These can include:

⦁ Diabetes (10-20% of people with diabetes develop frozen shoulder)
⦁ Hyper- or hypothyroidism
⦁ Cardiovascular disease
⦁ Tuberculosis
⦁ Parkinson’s disease.

⦁ Progression of Another Injury

A more common cause of frozen shoulder is immobility of the joint that can result from another injury. A lot of times when we have shoulder pain or an injury, we tend to stop using it and restrict its movement to avoid causing further pain. While rest is often required to help with healing, prolonged immobilization can increase the risk of developing frozen shoulder. This prolonged immobility may be a result of:

⦁ Rotator cuff injury
⦁ Broken arm
⦁ Stroke
⦁ Surgical recovery

It’s important that you see a physiotherapist when you start to experience shoulder pain. Your physiotherapist can provide you with some gentle exercises that will help to maintain your mobility, while minimizing pain, thus reducing the risk of frozen shoulder.

Can my frozen shoulder be treated?

If you do nothing to treat it, a frozen shoulder can recover on its own, but this process can take 2-5 years. There are, however, other treatment options that can reduce pain and help shorten this recovery time.

X-ray or Ultrasound Guided Cortisone Injections

If it’s caught at the right time, a series of cortisone injections into the joint space within the capsule can help to decrease the inflammation and stretch out the capsule in order to decrease pain and help increase range of motion. This should be completed by an Interventional Radiologist who will use either an x-ray or ultrasound imaging machine to help make sure that the injection goes into the right spot. It is often encouraged that these injections are followed by physiotherapy treatment so that the therapist can perform manual techniques to further stretch the joint and provide appropriate exercises to maintain the increase in mobility.

Physiotherapy

The physiotherapists at EPA can provide certain modalities to help with controlling pain. These may include:

⦁ Acupuncture
⦁ Intramuscular stimulation (IMS)/dry needling
⦁ Therapeutic ultrasound
⦁ Interferential current (IFC) or TENS

Your physiotherapist can also provide specific manual therapy techniques and individualized exercises to help improve your mobility and speed up your recovery time.

If you suspect that you have a frozen shoulder, give one of our clinics a call and book an appointment with one of our many qualified therapists.

You can also visit http://myshoulderpain.ca/ for more information about shoulder treatment options.

 


What does it mean when I’m told that I have shoulder impingement syndrome?

 

Shoulder impingement syndrome is a term used to describe what happens when certain structures within the shoulder joint become intermittently jammed or compressed during movement. The structures most often involved include the subacromial bursa and/or the rotator cuff tendons.

The ball and socket joint of the shoulder sits beneath another joint called your acromioclavicular joint (AC joint). The space between the two is referred to as the ‘subacromial’ space. It is within this space that the impingement of the bursa and tendons can occur, thus resulting in pain.

 

diagram of ball and socket joint

(image taken from: https://www.howtorelief.com/shoulder-impingement-syndrome-symptoms-causes-diagnosis-treatment/)

With normal shoulder function, the subacromial space should remain large enough throughout movement that impingement does not occur. However, for some of us, this is not the case. Most often, affected individuals will experience pain when they reach overhead, behind their back, or across their body. It is with these movements that impingement is most likely to occur. Over time, if these mechanical issues are not addressed, then it can lead to other conditions such as bursitis or tendonitis of the rotator cuff.

 

What is causing my shoulder impingement?

 

Shoulder impingement can be divided into two main categories:

  • Primary (Structural) Impingement

This type of impingement is a result of structural differences in the shoulder joint. Not all joints are created equally, and as a result, some of us will just naturally have a narrower subacromial space than others. This could be caused by a decreased angle of the AC joint, or osteoarthritis which could result in the growth of bony spurs in the subacromial space. As a result of these structural changes, the bursa and rotator cuff tendons will be more susceptible to being trapped within the space during day-to-day movements.

 

  • Secondary (Dynamic) Impingement

This type of impingement is usually a result of poor posture, joint hypermobility/instability, and/or trauma that results in muscular weakness. These issues can all result in the shoulder blade not sitting in its proper orientation, or the ball not sitting properly centred in the socket. This can ultimately result in narrowing of the subacromial space as you move through range because your body lacks the control to help stabilize the joint.

 

What are some symptoms of shoulder impingement?

 

Common symptoms include (but are not limited to):

  • Pain in the shoulder that occurs when working at shoulder height, overhead, or when reaching behind your back (e.g. reaching into a cupboard, pulling on a pair of pants, tucking in your shirt, reaching into the back seat of the car)
  • Pain can radiate as far down the arm as the elbow
  • Pain while sleeping on that side
  • Pain or weakness with lifting, pushing, and pulling
  • Pain reaching across the body (e.g. reaching for a seatbelt)

 

How is shoulder impingement diagnosed?

 

At Eramosa Physiotherapy Associates, our staff is well trained in the assessment of shoulder impingement syndrome. At your first appointment, your physiotherapist will run through a series of observations and tests that can help to identify the cause of your impingement. Based on your findings and your goals, you and your therapist will develop a personalized treatment plan that will help to reduce your pain and restore your function.

In some cases, your therapist or your family doctor may recommend an ultrasound of the shoulder joint. An ultrasound can be helpful in identifying shoulder impingement, as well as other conditions such as bursitis, tendonitis, and rotator cuff tears. Talk to your therapist or doctor to see if an ultrasound is appropriate for you.

 

Can my shoulder impingement be treated?

 

Physiotherapy has been shown to be very effective in the management of shoulder impingement syndrome. At Eramosa Physiotherapy Associates, we pride ourselves in being specialists in the management of shoulder injuries and consistently monitor the scientific research to keep up-to-date on methods of treating shoulder pain. Your treatment program (as designed with your therapist) may include: ultrasound, TENS, taping of the shoulder joint, manual therapy techniques to improve range of motion, and a progressive home exercise program that is tailored to your specific findings. Whether you’re an athlete, student, office worker, or manufacturing worker, we can help you!

If you suspect that you have shoulder impingement syndrome, give one of our clinics a call and book an appointment with one of our many qualified therapists.

 

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