The cause of frozen shoulder is still unknown but is found more often in those with diabetes, those between 40 and 60 years of age, those with heart disease or after a shoulder injury or operation. There are three main phases to this condition with the first being the ‘freezing’ stage where the shoulder is very painful without any exact reason for this pain and there is gradual loss of shoulder movement. The second stage is the ‘frozen’ stage where there is a lot of stiffness and reduced movement of the shoulder but with less pain. The final stage is the ‘thawing’ phase where the shoulder gradually increases its range of movement. This condition is self-limiting and usually runs its course between 12 months to 2 years. In this time physiotherapy can be very beneficial to restore movement and function, decrease pain levels and help to guide management of this condition. The main symptoms associated with frozen shoulder are a dull or aching pain in your affected shoulder, which is often worse at night or when you move your shoulder joint. Another symptom is stiffness around your shoulder joint that may stop you from moving your shoulder normally. This can make it difficult to do everyday tasks such as driving or dressing yourself.
Often now referred to as ‘Rotator Cuff Related Shoulder Pain’ or ‘Sub-Acromial Pain Syndrome’ (both very long names it must be said!) this term typically refers to a specific sort of pain associated with lifting the arm or reaching behind your back. It’s often felt as a pain in the shoulder itself or the upper arm. It typically does not radiate down to the hand. Most people will not associate it with a specific injury per se, but rather that it came on over a few days or weeks. In most cases, the small tendons that operate the ball and socket joint of the shoulder will be the ‘pain driver’. Muscles and tendons can start to generate pain for different reasons but one of the most common causes is thought to be a gradual deconditioning or under-loading of the muscles over time. Once painful, the tendons then react to being used (eg lifting the arm), inducing pain and making simple tasks very difficult. Resting the arm often makes the pain ease in the moment but doesn’t address the underlying cause.
Trying to keep the shoulder mobile is advisable with this condition. Gentle strengthening exercises that don’t cause too much discomfort can also be performed, but if pain persists then it’s usually advisable to get a physio assessment so that a more specific plan to recovery can be worked out.
Rotator Cuff Tears
The small muscles or tendons of your shoulder can be torn through trauma or as we age resulting in a small, moderate or large tear. Indications of having a rotator cuff tear is having shoulder pain along with upper arm pain, weakness when lifting your arm and an audio click/crack when moving your arm. Additional symptoms are pain when lying on the affected shoulder, pain when reaching behind your back, pain during activity and better at rest.
Rotator cuff tears are rare in young people and more commonly seen in people 40 years old or older.
The rotator cuff is a set of four muscles that surround the ball and socket of the shoulder. Their role is to assist in smooth controlled movement of the shoulder for example when throwing a ball, brushing your hair or put your seat belt on.
If you have experienced a traumatic injury or age-related muscle or tendon tear a physiotherapist will be able to discuss your management options. Physiotherapists are well placed to refer on for orthopaedic opinion. Evidence supports strengthening the muscles surrounding the shoulder improves symptoms, function and movement that can take 3-12months.
Shoulder Dislocations & Instability
Dislocations are linked to two main categories. Traumatic dislocation following an abrupt high force injury to the shoulder joint that can occur during contact sports or falls on an out stretched arm. This will require emergency care and can require surgery. Following a traumatic shoulder dislocation, it is advised to follow an individualised rehabilitation programme with a physiotherapist to restore strength and control whether you have had surgery or not.
Secondly, a non-traumatic shoulder dislocation is generally due to long standing abnormal muscle activity around the shoulder. Having a fear of movement, hypermobile joints and psychological factors such as childhood trauma or high stress levels are linked to this condition. Physiotherapists can carry out a detailed assessment that will take into consideration these factors and be able to develop a specific management plan liaising with other health care professionals if indicated.
Acromioclavicular Joint Injuries:
The acromioclavicular joint, or ACJ for short, is a small but important joint that connects the collar bone (clavicle) to the top of the shoulder blade (acromion). The joint is there to provide stability but also as a pivoting point around which the shoulder blade can articulate when we reach up, reach across or when we shrug our shoulders. This particular joint is separate to the main call and socket joint of the shoulder but works in partnership.