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Conditions: Advice

Frozen shoulder, Courtyard Clinic © 2011

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Frozen Shoulder

Have I got a ‘Frozen Shoulder’?
Frozen Shoulder, also called Adhesive Capsulitis, is a painful condition. It results in a severe loss of motion in the shoulder. It may follow an injury, or it may arise gradually with no injury or warning and most commonly affects patients between the ages of 40 to 60 years old, and it is twice as common in women as in men. In frozen shoulder, inflammation in the joint makes the normally loose parts of the joint capsule stick together. This seriously limits the shoulder's ability to move, and causes the shoulder to freeze. The cause of frozen shoulder is largely a mystery. One theory is that it may be caused by an autoimmune reaction. In an autoimmune reaction, the body's defense system, which normally protects it from infection, mistakenly begins to attack the tissues of the body. This causes an intense inflammatory reaction in the tissue that is under attack.

What are the symptoms of frozen shoulder?
The symptoms of frozen shoulder are primarily shoulder pain and a very reduced range of motion in the joint. The range of motion is the same whether you are trying to move the shoulder yourself or someone else is trying to move the arm for you. There comes a point in each direction of movement where the motion simply stops, as if something is blocking it. At this point, the shoulder usually hurts. The shoulder can also be quite painful at night. The tightness in the shoulder can make it difficult to do regular activities like getting dressed, combing your hair, or reaching across a table.

How Rotator cuff injuries differ
The diagnosis of frozen shoulder is usually made on the basis of your medical history and physical examination. Simple X-rays are usually not helpful One key finding that helps differentiate a frozen shoulder from a rotator cuff tear is how the shoulder moves. With frozen shoulder, the shoulder motion is the same whether the patient or the osteopath tries to move the arm. With a rotator cuff tear, the patient cannot move the arm. But when someone else lifts the arm it can be moved in a nearly normal range of motion.

What about Biceps Tendonitis?
Patients generally report the feeling of a deep ache directly in the front and top of the shoulder. The ache may spread down into the main part of the biceps muscle. Pain is usually made worse with overhead activities. Resting the shoulder generally eases the intense pain but can cause aching and discomfort. The arm may feel weak with attempts to bend the elbow or when twisting the forearm into supination (palm up). A catching or slipping sensation felt near the top of the biceps muscle may suggest a tear of the transverse humeral ligament. Biceps tendonitis and Rotator Cuff injuries are far more common than Frozen Shoulders and with treatment usually resolve more easily.

How are Shoulder problems treated?
The aim of treatment in all three cases is to decrease inflammation and increase the range of motion of the shoulder. Osteopathic treatment is a critical part of helping you regain the motion and function of your shoulder. Treatments are directed at getting the muscles to relax using techniques to stretch the joint capsule and muscle tissues of the shoulder. You will also be given exercises and stretches to do as part of a home program. With Frozen Shoulder you may need treatment for several months before you get full shoulder motion and function back. Hot and cold therapy as described in previous articles (10mins hot e.g. a wheat bag followed by 10mins cold gel pack/ frozen peas wrapped in a damp tea towel 3 times per day) will help to reduce pain and promote healing.