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Patient Guide to Frozen Shoulder

Frozen shoulder, also known as adhesive capsulitis, is a condition characterized by stiffness and pain in your shoulder joint. Signs and symptoms typically begin gradually, worsen over time and then resolve, usually within one or two years.

Your risk of developing frozen shoulder increases if you’re recovering from a medical condition or procedure that affects the mobility of your arm — such as a stroke or a mastectomy.

Treatment for frozen shoulder involves stretching exercises and, sometimes, the injection of corticosteroids and numbing medications into the joint capsule. In a small percentage of cases, surgery may be needed to loosen the joint capsule so that it can move more freely.

SYMPTOMS OF FROZEN SHOULDER

Frozen shoulder typically develops slowly, and in three stages. Each of these stages can last a number of months.

  • Painful stage. During this stage, pain occurs with any movement of your shoulder, and your shoulder’s range of motion starts to become limited.
  • Frozen stage. Pain may begin to diminish during this stage. However, your shoulder becomes stiffer, and your range of motion decreases notably.
  • Thawing stage. During the thawing stage, the range of motion in your shoulder begins to improve.

For some people, the pain worsens at night, sometimes disrupting normal sleep patterns.

CAUSES OF FROZEN SHOULDER

The bones, ligaments and tendons that make up your shoulder joint are encased in a capsule of connective tissue. Frozen shoulder occurs when this capsule thickens and tightens around the shoulder joint, restricting its movement.

Doctors aren’t sure why this happens to some people and not to others, although it’s more likely to occur in people who have recently experienced prolonged immobilization of their shoulder, such as after surgery or an arm fracture.

RISK FACTORS OF FROZEN SHOULDER

Although the exact cause is unknown, certain factors may increase your risk of developing frozen shoulder.

Age and sex
People 40 and older are more likely to experience frozen shoulder. Most of the people who develop the condition are women.

Immobility or reduced mobility
People who have experienced prolonged immobility or reduced mobility of their shoulder are at higher risk of developing frozen shoulder. Immobility may be the result of many factors, including:

  • Rotator cuff injury
  • Broken arm
  • Stroke
  • Recovery from surgery

Systemic diseases
People who have certain medical problems appear to be predisposed to develop frozen shoulder. Examples include:

  • Diabetes
  • Overactive thyroid (hyperthyroidism)
  • Underactive thyroid (hypothyroidism)
  • Cardiovascular disease
  • Tuberculosis
  • Parkinson’s disease

TESTS AND DIAGNOSIS:

During the physical exam, your doctor may ask you to perform certain actions, to check for pain and evaluate your range of motion. These may include:

  • Hands up. Raise both your hands straight up in the air, like a football referee calling a touchdown.
  • Opposite shoulder. Reach across your chest to touch your opposite shoulder.
  • Back scratch. Starting with the back of your hand against the small of your back, reach upward to touch your opposite shoulder blade.

Your doctor may also ask you to relax your muscles while he or she moves your arm for you. This test can help distinguish between frozen shoulder and a rotator cuff injury.

Frozen shoulder can usually be diagnosed from signs and symptoms alone. But your doctor may suggest imaging tests — such as X-rays or an MRI — to rule out other structural problems.

TREATMENTS AND DRUGS:

Most frozen shoulder treatment involves controlling shoulder pain and preserving as much range of motion in the shoulder as possible.

Medications
Over-the-counter pain relievers, such as aspirin and ibuprofen (Advil, Motrin, others), can help reduce pain and inflammation associated with frozen shoulder. In some cases, your doctor may prescribe stronger pain-relieving and anti-inflammatory drugs.

Therapy
A physical therapist can teach you stretching exercises to help maintain as much mobility in your shoulder as possible.

Surgical and other procedures
Most frozen shoulders get better on their own within 12 to 18 months. For persistent symptoms, your doctor may suggest:

  • Steroid injections. Injecting corticosteroids into your shoulder joint may help decrease pain and improve shoulder mobility.
  • Joint distension. Injecting sterile water into the joint capsule can help stretch the tissue and make it easier to move the joint.
  • Shoulder manipulation. In this procedure, you receive a general anesthetic so you’ll be unconscious and feel no pain. Then the doctor moves your shoulder joint in different directions, to help loosen the tightened tissue. Depending on the amount of force used, this procedure can cause bone fractures.
  • Surgery. If nothing else has helped, you may be a candidate for surgery to remove scar tissue and adhesions from inside your shoulder joint. Doctors usually perform this surgery arthroscopically, with lighted, tubular instruments inserted through small incisions around your joint.

PREVENTION OF FROZEN SHOULDER:

One of the most common causes of frozen shoulder is the immobility that may result during recovery from a shoulder injury, broken arm or a stroke. If you’ve had an injury that makes it difficult to move your shoulder, talk to your doctor about what exercises would be best to maintain the range of motion in your shoulder joint.

CURE YOUR FROZEN SHOULDER TODAY! CALL +65 6471 2744 OR EMAIL TO: info@boneclinic.com.sg TO SCHEDULE FOR AN APPOINTMENT

Shoulder Tendonitis

What is shoulder tendonitis/bursitis?

Shoulder bursitis and tendonitis are common causes of shoulder pain and stiffness. They indicate swelling (inflammation) of a particular area within the shoulder joint.

The shoulder joint is kept stable by a group of muscles called the rotator cuff as well as the bicipital tendon (the tendon that keeps the upper arm bone within the shoulder socket). When the rotator cuff tendon or the bicipital tendon becomes inflamed and irritated it is called rotator cuff tendonitis or bicipital tendonitis.

An area called the subacromial bursa lies in the space between the shoulder tendons. The bursa is what protects these tendons. Subacromial bursitis occurs when the bursa becomes inflamed.

Both conditions (shoulder bursitis and tendonitis) can cause pain and stiffness around the shoulder and may exist together.

What causes shoulder tendonitis/bursitis?

Tendonitis occurs as a result of sports injuries, by repetitive minor impact on the affected area, or from a sudden, more serious injury. For instance, professional baseball players, swimmers, tennis players, and golfers are susceptible to tendonitis in their shoulders, arms, and elbows. Improper technique in any sport is one of the primary causes of overload on tissues including tendons, which can contribute to tendonitis. But you don’t have to be a professional athlete to develop this condition. Anyone can get tendonitis, but it is more common in adults, especially those over 40 years of age. As tendons age, they tolerate less stress, are less elastic, and tear more easily.

Shoulder tendonitis/bursitis typically results from one or more of these factors:

  • Age: 40 and over
  • Frequent use of the arm in an overhead position or throwing motion, as in:
    • tennis or other racquet sports
    • swimming
    • baseball
  • Jobs such as overhead assembly work, butchering, or using an overhead pressing machine, heavy lifting
  • Direct blow to the shoulder area or falling on an outstretched arm
  • Other diseases or conditions that weaken shoulder muscles, such as rheumatoid arthritis, gout, psoriasis, or an unusual drug reaction
  • Infection (rare)

How is shoulder tendonitis/bursitis treated?

Treatment goals include reduction in pain and inflammation, as well as preserving mobility and preventing disability and recurrence.

The treatment recommendations may include a combination of rest, splints, heat and cold application. You may need more advanced treatments including:

  • Corticosteroid injections from your health care provider. They work quickly to decrease the inflammation and pain.
  • Physical therapy that includes range of motion exercises and splinting. This can be very beneficial.
  • Surgery, if you are not responding to other treatments.

When should you seek medical advice?

Most cases of tendonitis go away on their own over time. It may take weeks to months to recover, depending on the severity. See your doctor if you experience pain that interferes with your normal day-to-day activities, have soreness that doesn’t improve despite self-care measures, if you have recurrence, or if you have a fever and the area affected by tendonitis appears red or inflamed (swollen, warm). These signs and symptoms may indicate that you have an infection.

In addition, see your doctor if you have other medical conditions that may increase your risk of an infection, or if you take medications that increase your risk of infection, such as corticosteroids or immunosuppressants.

How can you prevent shoulder tendonitis/bursitis?

Because most cases of tendonitis are caused by overuse, the best treatment is prevention. It is important to avoid or modify the activities that cause the problem. Underlying conditions such as improper posture or poor technique in sports or work must be corrected.

Apply these basic rules when performing activities:

  • Take it slow at first and gradually build up your activity level.
  • Use limited force and limited repetitions.
  • Stop if unusual pain occurs.

CURE SHOULDER TENDONITIS TODAY! CALL +65 6471 2744 OR SMS TO +65 92357641 FOR APPOINTMENT

Frozen Shoulder

Frozen shoulder, also known as adhesive capsulitis, is a condition characterized by stiffness and pain in your shoulder joint. Signs and symptoms typically begin gradually, worsen over time and then resolve, usually within one or two years.

Your risk of developing frozen shoulder increases if you’re recovering from a medical condition or procedure that affects the mobility of your arm such as a stroke or a mastectomy.

Treatment for frozen shoulder involves stretching exercises and, sometimes, the injection of corticosteroids and numbing medications into the joint capsule. In a small percentage of cases, surgery may be needed to loosen the joint capsule so that it can move more freely.

Symptoms:

Frozen shoulder typically develops slowly, and in three stages. Each of these stages can last a number of months.

  • Painful stage. During this stage, pain occurs with any movement of your shoulder, and your shoulder’s range of motion starts to become limited.
  • Frozen stage. Pain may begin to diminish during this stage. However, your shoulder becomes stiffer, and your range of motion decreases notably.
  • Thawing stage. During the thawing stage, the range of motion in your shoulder begins to improve.

For some people, the pain worsens at night, sometimes disrupting normal sleep patterns.

Causes:

The bones, ligaments and tendons that make up your shoulder joint are encased in a capsule of connective tissue. Frozen shoulder occurs when this capsule thickens and tightens around the shoulder joint, restricting its movement.

Doctors aren’t sure why this happens to some people and not to others, although it’s more likely to occur in people who have recently experienced prolonged immobilization of their shoulder, such as after surgery or an arm fracture.

Risk Factors:

Although the exact cause is unknown, certain factors may increase your risk of developing frozen shoulder.

Age and sex
People 40 and older are more likely to experience frozen shoulder. Most of the people who develop the condition are women.

Immobility or reduced mobility
People who have experienced prolonged immobility or reduced mobility of their shoulder are at higher risk of developing frozen shoulder. Immobility may be the result of many factors, including:

  • Rotator cuff injury
  • Broken arm
  • Stroke
  • Recovery from surgery

Systemic diseases
People who have certain medical problems appear to be predisposed to develop frozen shoulder. Examples include:

  • Diabetes
  • Overactive thyroid (hyperthyroidism)
  • Underactive thyroid (hypothyroidism)
  • Cardiovascular disease
  • Tuberculosis
  • Parkinson’s disease

Diagnosis:

During the physical exam, your doctor may ask you to perform certain actions, to check for pain and evaluate your range of motion. These may include:

  • Hands up. Raise both your hands straight up in the air, like a football referee calling a touchdown.
  • Opposite shoulder. Reach across your chest to touch your opposite shoulder.
  • Back scratch. Starting with the back of your hand against the small of your back, reach upward to touch your opposite shoulder blade.

Your doctor may also ask you to relax your muscles while he or she moves your arm for you. This test can help distinguish between frozen shoulder and a rotator cuff injury.

Frozen shoulder can usually be diagnosed from signs and symptoms alone. But your doctor may suggest imaging tests such as X-rays or an MRI to rule out other structural problems.

Cure Your Frozen Shoulder Today. Call +65 6471 2744 or SMS to: +65 92357641 for Appointment

Frozen Shoulder and Physiotherapy

Frozen shoulder is the condition of pain and stiffness in the shoulder joint accompanied by loss of motion. An inflammation in or around the shoulder may trigger the body’s normal defensive response of stiffness. When the shoulder becomes stiff, it becomes too painful too move. Someone with frozen shoulder may not be able to reach above and over the head or touch the back.

While there is no definite cause of frozen shoulder, over 90 percent of patients experience full recovery. Doctors recommend physical therapy for frozen shoulder as the best treatment.

Physical therapy for frozen shoulder starts with reducing the pain and stiffness of the shoulder and increasing blood circulation through heat. One effective way of the heating method is taking a 10-minute hot shower or bath. Alternatively, the physical therapist may apply heat to your shoulder locally with the use of heating pads, wraps or towels. Hot water bottles and heat creams and ointments may also be used.

Shoulder massage is also a good way to start physical therapy for frozen shoulder as it increases the flow of blood and oxygen into the area. Once pain is reduced either through heating or through massage, the therapist proceeds with a series of physical therapy exercises.

In physical therapy for frozen shoulder, you will first perform weight and non-weight stretching exercises to improve the flexibility of your shoulder joint. The common exercises include arm swing with weights, arm raise, overhead stretch, stretching your arms across your body, and towel stretch.

It is important to note that during these stretching exercises, you should feel tension but you should not overstretch your shoulder to the point where you feel pain or severe discomfort. These exercises are done once or twice daily until the shoulder restores its normal range of movement.

Your doctor will advise you should you need to perform other exercises to tone and strengthen your shoulder muscles such as rotation exercises. Remember not to force movement in your shoulder. This does not mean you should not move it at all but instead to limit activities that may further injure your shoulder.

If physical therapy for frozen shoulder does not work for you, your doctor may recommend surgical treatment. The good news is physical therapy for frozen shoulder is usually enough for patients to get effective results that improve with time. If you have frozen shoulder, consult a physical therapist and get the treatment that you need.

Manipulation under Anaesthesia (MUA) for Frozen Shoulder

The main indication for manipulation under anesthesia is primary idiopathic frozen shoulder. It is important to distinguish between this and post-traumatic stiffness, which does not usually respond well to manipulation. The ideal time for manipulation of the frozen shoulder is at the stage when night pain is decreasing but the stiffness has reached a maximum. Physiotherapy at this stage usually makes the shoulder more painful but is of course invaluable immediately after the manipulation and possible injection.

Technique

The patient lies supine under general anesthesia with the head resting on a head ring, and if the patient is being manipulated on a trolley, the stretcher pole is removed from the affected side. The surgeon should stand at the head end of the table with one hand stabilizing the scapula in the resting position. The surgeon’s other hand should then be placed in the patient’s axilla such that the surgeon’s forearm is resting against the whole of the inside of the patient’s arm.

First, abduction is taken to the patient’s free limit, and then the patient is forcibly abducted while the scapula is maintained down in the anatomic position. The scapula must not move at any stage. This maneuver will rupture the inferior capsule. The shoulder is then forcibly adducted such that the affected elbow is pushed in front of the patient’s chin to rupture the posterior capsule. Finally, forcible external rotation and internal rotation are added, but great care is taken here because it is during these final rotation maneuvers that a spiral fracture can be caused.

Postoperative Management

For the first few days, daily physiotherapy (possible home physiotherapy) is encouraged, and a home exercise program is begun whereby the patient is asked to put the shoulder through the maximum range of movements, stretching to extremes at least three times a day. The patient should have been prewarned that this may be a very uncomfortable procedure. Majority of patients undergo physiotherapy as outpatients.

Although the shoulder may have been manipulated through a full range of movements under anesthesia, this is rarely gained immediately after recovery and it takes several weeks to regain the full range of motion. Recovery from this procedure can be extremely variable. However, if the shoulder gives with one definite snap during the manipulation, then a good result is usually achieved quite quickly.

CURE YOUR FROZEN SHOULDER TODAY. CALL (65) 64712744 OR SMS TO (65) 92357641 FOR APPOINTMENT