Shoulder Problems

Frozen shoulder (adhesive capsulitis)

Chronic Problems

This condition occurs in phases of pain and stiffness and can last for up to three years. It is the process in which the shoulder capsule fibers get thicker than normal and stiff

Risk factors

This shoulder condition occurs between ages 40-60 and can develop without injury. Those with diabetes or thyroid disease are also at higher risk for developing this debilitating condition.

Symptoms

Adhesive capsulitis makes it hard to move the shoulder joint on your own (active range of motion) or with help (passive range of motion). 

Diagnosis

This is a fairly easy diagnosis with a physical exam. Depending on the phase, the person is experiencing pain that is sometimes severe when moving the shoulder, even with help. The phases of adhesive capsulitis are:

Freezing – pain is slowly starting to set in and the motion of the shoulder is close to normal. This phase is about 6 to 9 months long. 

Frozen – pain is minimal; however, the motion of the shoulder is severely limited, making normal daily activities very challenging. This phase may last up to 6 months. 

Thawing – pain is improving and so is the motion of the shoulder. This stage takes the longest, lasting between 6 months and 2 years. 

No specific imaging is necessary to diagnose Frozen Shoulder. 

Treatment

Physical Therapy is the mainstay of Frozen Shoulder. Daily stretching and range-of-motion work are crucial for improvement. Anti-inflammatory medications like ibuprofen are also extremely helpful. Steroid injections may also be recommended if medications and physical therapy have not helped the person to make enough progress. 

Arthroscopic surgery is reserved for the most severe cases that are not improving after years of conservative treatment. Because the condition can take up to 2-3 years to improve, it is appropriate to wait this long before deciding to proceed with surgery. Surgery would involve cutting down tight portions of the shoulder capsule and manipulating the shoulder while under anesthesia. Physical therapy after surgery is crucial to maintain the motion achieved during surgery. 

Scapular dysrhythmia

Several muscles support the shoulder joint and shoulder blade and must work together. When an injury occurs, muscle imbalance can cause the shoulder blade to move or rest in an abnormal position. Dyskinesia translates to “deviation” (dys-) of “motion” (-kinesia).

Risk factors

Other soft tissue injuries or fractures involving the shoulder can weaken the shoulder blade or cause it to move abnormally. Nerve injury to the muscles that control the shoulder can cause scapular dyskinesia. 

Symptoms

Pain, popping and weakness are common symptoms. 

Diagnosis

Physical exam testing in which the examiner watches the shoulder blades move while standing behind the person. With the arms moving to the side or in front of you, the shoulder blades might look different while in motion or at rest. The shoulder blade might “wing” or make loud noises known as “snapping” scapula. 

Treatment

Retraining the muscles that aren't working properly is the top priority in treating scapular dysrhythmia. Weight training, heat therapy and better posture can also help improve shoulder blade movement. 

Subacromial bursitis and impingement syndrome

There are bursae all over the body to lower the amount of friction that occurs between bones and tendons. These bursae are small, fluid-filled sacs that can become very irritated when the space they are in becomes smaller or is injured. The bursa in the shoulder is located under the acromion and above some of the rotator cuff tendons.

Risk factors

Anyone who might perform repetitive overhead activities is at risk for developing subacromial bursitis. Other contributing risk factors include: 

• AC joint arthritis
• Rotator cuff tears
• Scapular dyskinesia
• Repetitive overhead motion

Symptoms

A pinching feeling at the top of the shoulder occurs when reaching across the body or overhead. Other symptoms include popping or cracking with shoulder movements.  

Diagnosis

There are a few physical exam tests that help pinpoint this diagnosis, such as pain with reaching across the body or above the head. If you hear popping under the roof of the shoulder with motion, the diagnosis is more obvious. 

Treatment

Non-surgical treatment is the first approach and mirrors the treatment for AC joint arthritis, which includes:

• Anti-inflammatory medications like ibuprofen
• Corticosteroid injections into the AC joint
• Physical therapy to improve the range of motion
• Ice the joint
• Modify activity

Surgical treatment is for the worst cases that fail non-surgical treatment. This would entail an arthroscopic surgery with a small camera and instrument that can help clean around the subacromial space and ultimately take down the bursa that is causing the pain. Recovery from this type of surgery is fairly fast and does best with physical therapy to help regain muscle strength and range of motion.

AC joint arthritis

The joint space between the end of the clavicle and the acromion can be injured from repetitive trauma or sudden impact to the side of the shoulder. The cartilage at the ends of these bones can become injured, like any joint in the body, where arthritis can form. Although there is no cure for arthritis, many treatment options can help manage the pain it may cause. 

Risk factors

Football players are most at risk for developing AC joint arthritis after repetitive tackling. However, anyone who might perform repetitive overhead activity is also at risk.

Symptoms

Pain with reaching across the body or overhead activity is common. There may also be tenderness at the top of the shoulder when that joint has pressure applied to it. 

Diagnosis

The joint space may look narrower than usual on a shoulder X-ray. There might also be visible bone spurs around the joint. No other imaging is usually needed for diagnosis. 

Treatment

The treatment for AC joint arthritis is mainly focused on treating the symptoms. 

Non-surgical treatment includes: 

• Anti-inflammatory medications like ibuprofen
• Corticosteroid injections into the AC joint
• Physical therapy to improve the range of motion
• Ice the joint
• Modify activity

Surgical treatment would be reserved for the most severe cases that fail all non-surgical treatment. The surgeon may discuss a “distal clavicle resection,” or Mumford procedure, which involves making a small incision over the joint and removing a small piece of the end of the clavicle to widen the joint space.