Shoulder

What is a frozen shoulder?

Frozen shoulder (adhesive capsulitis) is a common disorder affecting the ball-and-socket (glenohumeral) joint of the shoulder. It is characterised by pain, stiffness, and loss of normal range of motion of the shoulder.

What causes a frozen shoulder?

Frozen shoulder is a progressive inflammatory process that causes the flexible connective tissue of the shoulder joint capsule to thicken and contract losing its normal ability to stretch. The trigger for this process is unclear and can be as trivial as getting a knock to the shoulder or playing a racket sport. In most cases, you may not recall what triggered the episode in the first instance.

Who is at risk of getting a frozen shoulder?

• People aged between 40 and 60, particularly women, are more likely to develop a frozen shoulder.
• Individuals with diabetes mellitus have a much higher risk (between 10-20%) of developing a frozen shoulder. Other medical conditions such as Parkinson's,  thyroid, stroke, or cardiac disease are also associated with developing adhesive capsulitis.
• Individuals who have had to immobilise their shoulder in a sling or a brace, such as after shoulder surgery or an upper limb fracture are at risk of developing post-surgical adhesive capsulitis.

What are the symptoms of a frozen shoulder?

There are two main symptoms of a frozen shoulder: Pain and Stiffness.

• The pain may begin as discomfort that gradually worsens to a constant dull or aching pain. This may be felt spreading down the arm.  A more acute, severe pain may be felt if you move the shoulder to the end of its range in any direction, or if you make a sudden movement.
• There is a gradual reduction of the shoulder range of motion in all directions. Actions like brushing your hair, and putting on a bra or a shirt may become increasingly difficult.

How is a frozen shoulder diagnosed?

The diagnosis of a frozen shoulder is made by taking a medical history, carrying out a clinical examination, and performing a number of imaging investigations, like x-ray and ultrasound scans, to rule out other causes of shoulder pain.

There are a number of conditions that can present like a frozen shoulder so it is important to confirm the diagnosis before deciding on a treatment strategy.

Early diagnosis and treatment of frozen shoulders can help prevent long-term pain and stiffness.

How long will a frozen shoulder last?

If left untreated a frozen shoulder will get better on its own but recovery can be slow taking anywhere between 18 to 36 months! The slow rate of recovery from this sometimes disabling condition can be frustrating for you and your healthcare professional.

Early interventions will often reduce pain and restore function within a year or less.

How do you treat a frozen shoulder?

Treatments are focused on relieving pain and restoring the shoulder's normal range of motion.

• Simple measures such as using hot and cold compresses, oral analgesia, and range-of-motion exercises are the first line of treatment.
• Corticosteroid/"cortisone" injected into the joint to address the pain associated with shoulder inflammation.
• Hydrodistention/hydrodilatation procedure - injecting corticosteroid/"cortisone" directly into the shoulder joint along with a moderate volume of saline fluid to expand the joint capsule to address the shoulder pain and capsule stiffness respectively. Complimented with physical therapy this has been proven to reduce pain and a faster recovery.
• Surgery -  Using key-hole surgery a shoulder surgeon can perform precise cuts to release the joint capsule from the inside. This is reserved for cases with the most severe movement limitation or those that don't improve despite all efforts.

If you are struggling with shoulder pain that is not improving make an appointment to see Dr. Ade.

The shoulder is a highly dynamic joint capable of a large range of movement. The result of this is that there are several elements inside and around the shoulder joint that can cause you pain if injured, impinged, inflamed, or worn over time.

A common cause of shoulder pain is through performing repetitive actions like swimming, doing tennis serves or any overhead head activities like painting a ceiling. You can also develop shoulder pain from holding your body and shoulder in a provocative position for extended periods. One example is sitting at a desk working or playing video games.

To complicate matters, pain around the shoulder can be referred from other areas, such as the neck, or can refer along the arm towards your elbow. This is why you may find it difficult to localise your pain. This may also be the reason why the strategies you may have adopted might not have relieved your symptoms, targeting the wrong cause. 

The good thing though is that the majority of causes of shoulder pain can be managed non-operatively, as long as the correct diagnosis is made and an appropriate plan is put into place.

If you are struggling with shoulder pain that has not improved despite your best efforts click here to make an appointment with Dr. Ade.

The shoulder is a highly dynamic joint capable of a large range of movement. The result of this is that there are several elements inside and around the shoulder joint that can cause you pain if injured, impinged, inflamed, or worn over time. 

To complicate matters, pain around the shoulder can be referred from other areas, such as the neck, or can refer along the arm towards your elbow. This is why you may find it difficult to localise your pain. This may also be the reason why the strategies you may have adopted might not have relieved your symptoms (targeting the wrong cause). 

The good thing though is that the majority of causes of shoulder pain can be managed non-operatively, as long as the correct diagnosis is made and an appropriate plan is put into place.

If you are struggling with shoulder pain that has not improved despite your best efforts click here to make an appointment with Dr. Ade.

What is the acromioclavicular joint?

The acromioclavicular joint (ACJ) along with coracoclavicular ligaments connects your collarbone (clavicle) and your shoulder blade. You may recognise this area as a raised bump at the tip of your shoulder.

What causes shoulder separation?

An ACJ injury, or shoulder separation, often happens if you fall onto an outstretched arm or take a hit to the tip of your shoulder, such as when falling off a bicycle or landing on your shoulder when making or getting tackled in a sport like rugby.

What are the symptoms of shoulder separation?

Symptoms of acute shoulder separation include:

Pain - for acute injuries the pain is usually localised to a specific point of the shoulder. You may find it is worse with your arm hanging down by the side. If the injury is longstanding you can still get pain in the area when you try to lift your arm above shoulder height or bring your arm across your body - as if to scratch the back of the other shoulder.

Limited shoulder range of motion - mostly due to pain, particularly if the injury is recent.

Swelling, bruising and tenderness at the tip of the shoulder. 

Depending on the severity of the injury you may also notice the collarbone sticking up at the tip of the shoulder.

When to seek medical advice regarding ACJ injuries

ACJ separation injuries are common in sports that involve body-to-body collision (rugby league/union), and body to surface impact (martial arts or cycling). They can be described/classified by how badly you tear the joint capsule, the surrounding ligaments and the final position of the collarbone and this classification determines how the injury is treated.

The most common types of ACJ injuries (Types I-II) do not require surgery. A Type III injury may require surgery depending on your individual case and higher-grade injuries will usually require surgical repair. 

Although the majority of ACJ separations do not need surgery, frequently, a fracture at the tip of the collarbone (distal clavicle fracture) can occur along with the injury or present like an ACJ injury. This can affect how the injury is managed and affect your recovery time. For these reasons, it is important you seek medical advice to confirm the diagnosis and assess the severity if you get a shoulder separation injury.

If you have injured your shoulder playing sport and would like advice on how to recover and safely return to sport Click here to schedule an appointment with Dr Ade.

What is shoulder osteoarthritis?

Shoulder osteoarthritis (OA) is when the cartilage covering the surface of the bones (the articular cartilage) of the shoulder joint degenerates or wears down. The shoulder joint is not a weight-bearing joint, that is unless you have a tendency to walk on your hands, so the incidence of OA is considerably less compared to the hip, knee and ankle joints.

What are the symptoms of shoulder arthritis?

As with other joints, the most common symptom of shoulder arthritis is pain which can occur with activity or at rest. A common phenomenon is to experience pain in the upper arm even though it is arising from the shoulder joint. This is known as referred pain. You may find the shoulder to be more painful at night disturbing sleep as a result.

Another common symptom of shoulder arthritis is stiffness. It is important to differentiate this from a diagnosis of frozen shoulder as the outcome for both is different.

What are the treatment options for shoulder arthritis?

The initial treatment of shoulder arthritis is non-surgical through the use of:

• Physiotherapy to improve the strength and flexibility in your shoulder.
• Prescription anti-inflammatories and pain medication.
• Shoulder joint injection of corticosteroid to reduce swelling and pain in the joint. When combined with physiotherapy can help you improve shoulder strength and slow the progression of joint degeneration.
• There is the option of non-steroid based orthobiologic injections like hyaluronic acid and Platelet-Rich-Plasma (PRP) into the joint.
• Surgical reconstruction - For cases that have exhausted conservative treatment, a shoulder replacement may be necessary to replace the damaged bone surfaces. If indicated Dr Ade has a trusted network of renowned shoulder surgeons he regularly works with that he can refer you to.