Frozen shoulder is the term commonly used to describe persistent shoulder pain and restricted movement. However, shoulder problems are often misdiagnosed and as with any other joint problem, the success of any treatment depends on correct diagnosis and co-operation between patient and practitioner.
Here we clarify some common misconceptions of shoulder problems.
What is frozen shoulder?
Frozen shoulder refers to loss of arm movement at the shoulder joint combined with inflammation of the tissues within the joint capsule that surrounds the shoulder. These tissues become thickened and shortened and eventually “stick together” hence the medical term – “adhesive capsulitis”.
What are the symptoms?
Initially, there is progressive limitation of all movements of the shoulder. This may follow a recent minor trauma, dislocation, prolonged immobilisation, heart attack (myocardial infarction) and sometimes neck problems (cervical radiculitis). Pain may or may not accompany this, although pain will be felt if you try to exceed the limited movement. This stage is sometimes referred to as the ‘freezing’ stage.
Eventually, the condition progresses until all movement is greatly restricted – ‘frozen’ stage. Usually, no pain is felt at this stage. The reverse of this process occurs during recovery, when pain is again experienced but once movement is restored, the pain diminishes.
Early diagnosis is vital because the condition is reversible. Once it has progressed into the adhesive/frozen stage, some persistent restriction may remain. The recovery period varies depending on how long the problem has been there and the severity of it.
Rotator Cuff Tendinitis/Tear
The rotator cuff muscles play an important role in the movement of the shoulder. They consist of the supraspinatus, infraspinatus and teres minor muscles. The rotator cuff tendon is a major source of pain and disability. If it becomes inflamed (tendonitis) or torn, voluntary abduction, elevation and rotation of the shoulder is lost. However, the practitioner will be able to move the shoulder noting only a slight loss in movement due to pain whereas with frozen shoulder, the practitioner will not be able to move the joint. Rotator cuff muscle pain is usually due to trauma or overuse of movements.
Birsas are fluid filled sacs that surround certain joints of the body and act to prevent excess friction between tissues and/or bony surfaces.
In the shoulder, you will find the subdeltoid bursa that lies underneath the deltoid muscles, (These muscles make the rounded shape of the shoulder/arm). The bursa can become inflamed or pinched, which in turn will produce pain and some limited movement of the shoulder. Slight swelling and heat production may be felt.
When joints become fixated and irritated in the lower part of the neck, pressure may occur on the surrounding nerve fibres. These nerves supply information to the muscles of the shoulder and if these nerves become inflamed, the muscles become spasmed and weakened and movement will become limited. There is no actual damage to the shoulder joint itself and no voluntary decrease in movement will be experienced.
Other causes of shoulder pain…….
Obviously, fractures and dislocation will cause pain but, due to the severity of these problems, they are treated at the A & E departments in hospitals.
Arthritis of the shoulder joint, natural wear and tear, will produce shoulder pain but usually you will have experieced previous problems.
Gall bladder inflammation (cholecystitis) can refer pain into the right shoulder joint but with no loss in actual movement of the shoulder joint.
Heart attacks can refer pain into the left shoulder and arm.
When the cause of the shoulder problem has been established, the appropriate treatment can be initiated. This can range from Chiropractic adjustments and mobilisations, icing, rest, as well as exercises to improve movement and strength when indicated.
How long you decide to benefit from Chiropractic care is, of course, always up to you but for effective long term results, always follow the Chiropractor’s recommendations.
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