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frozen shoulder

What is Frozen Shoulder? What is the Best Treatment?

frozen shoulderFrozen shoulder is the commonly used name for ‘Adhesive Capsulitis’, which is a condition that causes the shoulder to become very pain and stiff. This can sometimes occur following minor trauma to the shoulder, but often happens due to no apparent reason, which can be both confusing and frustrating for patients.
It affects 2-5% of the population, typically between 40 to 65 years of age, with certain risk factors such as:

  •  previous shoulder injury
  • diabetes
  • thyroid disease

How Does it Happen?

The shoulder joint, by design, is an incredibly mobile joint with a very large range of motion. The shoulder joint, like other joints in the body, is surrounded by a capsule, that allows this free range of motion. The capsule is also important in  providing stability, sensory feedback, and aiding in lubrication of the joint. Tightening of this capsule due to adhesions, is what causes Adhesive Capsulitis.

The condition follows three distinct phases:
1. The Freezing Stage – This is where the joint gradually starts to stiffen over time. This initial stage is usually characterised by an achy shoulder at rest, very painful with movements, and difficulty sleeping due to the pain.
 
2. The Frozen Stage – This is the longest stage, and where the joint stiffness plateaus at it’s peak. This period is where people find greatest difficulty with performing daily tasks due to stiffness, but often the pain is less than the initial phase.
 
3. The Thawing Stage – Where the shoulder starts to gradually recover, and shoulder movement and function is restored.
 
The good news about frozen shoulder, is that for most people it will generally recover on it’s own over time. This can typically take anywhere from 9 months up to 3 years, with the average being about 18 months. Appropriate therapy is important in managing recovery.

What is the Best Treatment?

Current clinical guidelines for frozen shoulder suggest a combination of the following treatment:

 
Education – Understanding the nature of your pain, and what to expect in terms of time for recovery, can make managing it a lot easier.
 
Maintain Normal Activities – It is helpful to continue using the affected shoulder as much as possible. Not using the affected shoulder can further restrict free movement and increase sensitivity of painful structures within the joint.
 
Manual Therapy and Exercise – Treatment provided by your health practitioner  can assist in speeding up the recovery time, and reducing pain as it naturally recovers. Treatments shown to be effective include specific exercises to improve range of motion and strength at the shoulder joint, and joint mobilisation and manipulation performed by your health practitioner.
 
Joint Injections – For some people, corticosteroid injections into the joint, can be very helpful, especially when combined with joint mobilisation and manipulation.

shoulder therapy

If you need more information regarding frozen shoulder, do not hesitate to contact us at the clinic on 9581 3331, and book an appointment to discuss what type of treatment is appropriate for you.

References:
“Shoulder Pain and Mobility Deficits: Adhesive Capsulitis,” J Orthop Sports Phys Ther 2013;43(5):A1-A31. doi:10.2519/jospt.2013.0302.

5 Easy Shoulder Mobility Exercises You Can Do With a Broomstick!

Shoulder ‘stiffness’ is a common complaint from patients, and can be attributed to a number of underlying conditions. The good news is, that most shoulder complaints will benefit from some mobility exercises to improve pain-free range of motion. Here are 5 shoulder mobility exercises I find helpful for my patients, and the only equipment you need is a broomstick (or rake, mop, PVC pipe etc).

1. Shoulder Flexion

Hold the stick in both hands with your knuckles facing forwards. Gradually raise both arms up whilst keep the elbows straight. You can use your good arm to assist in elevating the injured/painful shoulder. Hold for 5 seconds and repeat 10 times.

2. Shoulder Extension

Hold the stick behind your back, again with your knuckles facing forwards. Slowly elevate the stick away from your back and hold this position for 5 seconds. Repeat 10 times.

3. Shoulder Abduction/Adduction

Hold the stick in both hands with your palms facing fowards. Keeping your elbows straight, use your good arm to elevate your injured shoulder up past 90 degrees if possible. Hold this position for 5 seconds and repeat 10 times.

4. Shoulder Internal Rotation

Hold the stick with both hands behind your back, with your uninjured shoulder behind your head, and your injured shoulder behind your back at waist-level. Move the stick up and down by bending at the elbows, with your uninjured arm (at the top) assisting the injured shoulder through gradual movements. Hold the elevated position for 5 seconds, repeating 10 times.

5. Shoulder External Rotation

This exercise is easiest performed lying on your back. Hold the stick in both hands with your palms facing upwards, and your elbows bent at 90 degrees. Ensure the back of your upper arms are resting against the floor. Use your good arm to swing your injured arm away from your body, whilst keeping the elbow of the injured arm by your side. Hold the stretch for 5 seconds and repeat 10 times.

These exercises are meant only as a guide, and should not replace proper consultation with your health practitioner. For some people, these exercises may not be appropriate, and could cause further irritation if performed incorrectly. If you are unsure as to the appropriate course of treatment for your shoulder pain, feel free to contact the clinic to book a chiropractic consultation with me.

2 Simple Exercises to Keep Your Shoulders Strong and Pain-Free

Following on from our blog last week on subacromial bursitis and shoulder impingement, I thought it would be useful to provide some information on two exercises I have found to be very helpful for my patients with various forms of shoulder pain.

Stretches are beneficial to keep soft tissue structures flexible, but strengthening is really the key to enabling the shoulder to move correctly and be stabilised. Strengthening increases the capacity of the muscles to perform the tasks we demand of them, in a pain-free manner.

 

1. Resisted External Rotation

This is an excellent and very popular exercise to strengthen the rotator cuff muscles, and will generally form part of the initial rehabilitation phase in most clinics.

With your elbows by your side at 90 degrees, hold a length or resistance band between both hands. Keep one arm still as an anchor point, and slowly rotate the opposite arm away from your body. Alternatively, you can tie the band onto a pole or hook. It is important to keep your elbow up tight against your body with the movement, to ensure the rotator cuff muscles are doing the work and not the torso trying to help out. Also ensure that the wrist stays straight, as it too can try to compensate for a weakness in the rotator cuff. The body will look for ways to cheat and avoid using the shoulder if it is painful, so keep an eye on your form!

2. Seated Rows

This exercise helps to strengthen the muscles of the upper back that help support the scapula(shoulder blade). The scapula forms the base of support from which the upper limb operates, so it important that we have a strong, stable foundation here. Issues with scapular control and stability, can often have a significant flow-on effect down the chain.

It is best to start with this exercises in a seated position, with your arms slightly elevated out to your sides. With the resistance band in each hand, have it looped around a pole or a hook in front of you. Focus on squeezing the shoulder blades together in the middle of your back, without shrugging your shoulders. Try to focus most of the strength and movement at the shoulder blades, and not the arms/elbows. Also, be careful not to jut the neck/chin forward!

 

These exercises are meant as a guide only. It is recommended that you consult with your usual healthcare practitioner prior to commencing exercises, to rule out any contraindications or underlying pathology that may need to be addressed.

Shoulder Bursitis – what is it and how is it treated?

Shoulder bursitis most commonly refers to inflammation of the subacromial bursa, which is a fluid filled sac, that sits at the outer-front aspect of the shoulder. Subacromial bursitis, is one of the most common complaint

s we see in the clinic, and it typically presents as tenderness at the outer aspect of the shoulder, more so when raising the arm, which confines the subcromial space, where the bursa is located. (1)

What is the bursa? Why is it sore?

The bursa is a thin, lubricated cushion, and acts as a barrier at points of friction, between bones and surrounding soft tissue structures. There are about 160 of them around the body, and they vary in size depending on location and the nature of the forces being applied across it. The bursa sac is made up of synovial membrane, which both produces and maintains the synovial fluid within the bursa. (2,3)

The subacromial bursa sits below a bony structure of the shoulder, called the acromion, and provides a cushion barrier between the bone and the rotator cuff muscles that run directly below it. (3)

Bursitis (or inflammation of the bursa), occurs when the synovial membrane  becomes inflamed, causing it to thicken and produce an excess of synovial fluid, causing the bursa to swell and become painful. The most common causes for this are excessive friction on the bursa, a direct injury, or an underlying inflammatory condition, such as rheumatoid arthritis. You can also get bone spurs (osteophytes) that grow down from the bottom of the acromion, narrowing the subacromial space that the bursa and rotator cuff tendons sit within. (3)

When the subacromial bursa becomes irritated, it can thicken and cause what it sometimes referred to as Shoulder Impingement Syndrome, which is a painful pinching of the soft tissue structures that sit in the small space between the acromion and the shoulder ball-and-socket joint. This space is call the subacromial space. The tendons of the rotator cuff muscles can also become inflamed, resulting in tendonitis, which contributes to the pain. (4)

 

How is shoulder bursitis treated?

Most patients generally respond well to a combination of stretches and rehabilitation

exercises provided by their health practitioner, to strengthen the muscles that support and control movement at the shoulder. This helps treat the current bursitis and tendonitis, and minimise the risk of future irritation. Manual therapy techniques including joint mobilisation/manipulation and soft tissue techniques are also often incorporated into most treatment plans.

In the initial phase, rest from activities that are causing aggravation, such as lifting, reaching and overhead work is helpful. Your practitioner can also advise you on activity modification, or changing the way you perform repetitive tasks, in order to reduce irritation on the bursa and tendons. Your doctor may also prescribed you an anti-inflammatory medication to reduce the inflammation and swelling of the bursa. In some cases, a corticosteroid injection (anti-inflammatory) into the bursa, in conjunction with an aspiration (or draining) of the bursa can be beneficial. (5)

Surgery (acromioplasty) may be considered in cases where there is significant bone spurs impinging on the bursa and tendons, that is not improving with conservative treamtment. Surgery will generally include removing part of the acromion and sometimes the bursa itself, such that there is more space for the soft tissue structures. (6)

 

Will it happen again?

Subacromial bursitis is very common, and can often recur, if the causative factors haven’t been addressed. Most bursae will settle with anti-inflammatories, but it is important to correct postural and movement patterns that are causing it to become aggravated in the first place. If there is significant spurs, and conservative measures are not resolving it, then symptoms will likely recur until this is surgically addressed.

If you are suffering from bursitis, feel free to book an appointment at the clinic for a full assessment and appropriate course of treatment.

 

References:

  1. Luime JJ, Koes BW, Hendriksen IJ, Burdorf A, Verhagen AP, Miedema HS, Verhaar JA. Prevalence and incidence of shoulder pain in the general population; a systematic review. Scand J Rheumatol. 2004;33(2):73-81. Review. PubMed PMID: 15163107.
  2. van Holsbeeck & Strouse. Sonography of the shoulder: evaluation of the subacromial-subdeltoid bursa. AJR Am J Roentgenol. 1993 Mar;160(3):561-4. PubMed PMID: 8430553.
  3. Anastasios Papadonikolakis, Mark McKenna, Winston Warme, Brook I. Martin, Frederick A. Matsen, III; Published Evidence Relevant to the Diagnosis of Impingement Syndrome of the Shoulder. The Journal of Bone & Joint Surgery. 2011 Oct;93(19):1827-1832.
  4. National Institute of Arthritis, Musculoskeletal and Skin Diseases, “Shoulder Problems.” May 2010. Accessed March 8, 2012. http://www.niams.nih.gov
  5. Codsi MJ. The painful shoulder: when to inject and when to refer. Cleve Clin J Med. 2007 Jul;74(7):473-4, 477-8, 480-2 passim. Review. PubMed PMID: 17682625.
  6. Donigan JA, Wolf BR. Arthroscopic subacromial decompression: acromioplasty versus bursectomy alone–does it really matter? A systematic review. Iowa Orthop J. 2011;31:121-6. PubMed PMID: 22096430; PubMed Central PMCID: PMC3215124.