Related to: Frozen shoulder (adhesive capsulitis)
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 of the shoulder capsule fibers get thicker than normal and stiff
Risk factors
This is a condition of the shoulder seen between ages 40-60 and can occur without an 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 physical exam testing. Depending on the phase the person is experiencing the pain is sometimes severe to move 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 to get through 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 is crucial to improving. Taking anti-inflammatory medications like ibuprofen is 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 takes up to 2-3 three years to improve, it is appropriate to wait this long before making the decision to proceed with surgery. Surgery would involve cutting down tight portions of the shoulder capsule and manipulating the shoulder while under anesthesia. Physical therapy following surgery for this is crucial to maintain the motion achieved while in surgery.
Scapular dysrhythmia
There are several muscles that support the shoulder joint and the shoulder blade to work together. When an injury occurs, an imbalance in the muscles can cause the shoulder blade to move or rest in a position that is abnormal. Dyskinesia translates to “deviation” (dys-) of “motion” (-kinesia).
Risk factors
Other soft tissue injuries or fractures involving the shoulder can cause the shoulder blade to become weak or move abnormally. An injury to the nerves that control the muscles of the shoulder can cause scapular dyskinesia.
Symptoms
Pain, popping and weakness are common symptoms.
Diagnosis
Physical exam testing where the examiner watches the shoulder blades move from 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
Re-training the muscles that are not working properly is the number one priority in treating scapular dysrhythmia. Weight training balance, heat therapy and paying better attention to better posture can also help improve the motion of the shoulder blade.
Subacromial bursitis and impingement syndrome
There are bursa all over the body to lower the amount of friction that occurs between bones and tendons. These bursa are small fluid filled sacs that can become very irritated when the space they are in become smaller or 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 are at risk for developing subacromial bursitis. Other contributing risk factors include:
- AC joint arthritis
- Rotator cuff tears
- Scapular dyskinesia
- Repetitive overhead motion
Symptoms
There is a pinching feeling at the top of the shoulder 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 there is popping under the roof of the shoulder with motion then it’s a more obvious diagnosis.
Treatment
Non-surgical treatment is the first approach and mirrors the treatment for AC joint arthritis, which include:
- 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 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 do 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, there are many treatment options for 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 more narrow than usual on an X-ray of the shoulder. There might also be visible bone spurs around the joint. No other imaging would be necessary 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 make the joint space wider.