back to list "Frozen Shoulder" and Muscle/Tendon Injuries
The most difficult problems in the shoulder are adhesive capsulitis or the “frozen shoulder” and muscle/tendon injuries. The muscle tear usually occurs suddenly, but may be caused by repeated micro trauma. The frozen shoulder is the development of a stiff shoulder in the absence of significant trauma. Sometimes trivial trauma will trigger an inflammation in the shoulder; frequently, there is no injury at all. The shoulder becomes stiff and, usually, painful in the early stages.
The shoulder consists of the arm bone that is held into a muscular socket. It is a ball and socket joint and looks like a golf ball being held against a tee. The tee is a shallow groove on your shoulder blade that has a thick piece of cartilage over it. A tough joint capsule and three major muscles that form a cuff hold the ball of the arm against this socket, the rotator cuff.
The tendons of the rotator cuff muscles attach to the upper end of the arm bone and help to rotate the arm in the shoulder socket. Tears of the tendons can be caused by injury to the shoulder and/or the gradual degeneration of the tendons from pressure and friction caused by the overlying end of the scapula or shoulder blade. Injuries or weakness in the muscles of the rotator cuff will cause some of the same symptoms. The symptoms of rotator cuff muscle injury, or tears, consist of weakness and pain, particularly with arm elevation and at nighttime while sleeping. Diagnosis of this condition starts with observing how you move your arm. There are characteristic abnormal motions that are used when one of these important muscles is injured. Then gentle testing of the muscle using palpation and actual muscle testing is used to isolate which muscle/ tendon is damaged and what can be done to speed the healing of the injury.
After speeding the healing of the injured muscle, many patients will have to undergo specific exercises to regain strength to the shoulder region. Like a barrel, the shoulder is only as strong as its weakest muscle.
When you have a frozen shoulder, also known as adhesive capsulitis, this capsule becomes inflamed, stiff and “sticky.” It’s similar to what can happen when you have an eye infection. You may wake up in the morning to find your eyelid is stuck shut with mucus.
Likewise, tissue in your shoulder capsule sticks together when it’s inflamed. That can cause pain and loss of movement. You may not even be able to move your shoulder enough to do everyday activities, such as comb your hair or reach for your wallet in your back pocket.
Frozen shoulder can affect anyone, but you’re more likely to develop it if you’re in your 50s or 60s. Typically, a patient will say that he had a fall a few months ago, or just overworked his arm around the house doing something he is not used to doing.
Most patients have favored their shoulder, taken anti-inflammatory drugs, and avoided strenuous activities. But the shoulder has not responded and become so stiff the patient can barely move it. And the pain — an aching, burning feeling — is there even when they sleep. Obviously this is more easily treated at the beginning before the capsule becomes sticky.
The typical medical – physical therapy treatment program for this condition can last for 4 – 6 months, with many patients requiring up to a year to recover. There is a percentage of patients that do not respond and have permanent reduced motion in their shoulder.
As in the rotator cuff problem, treatment begins with a thorough examination of the muscles of the shoulder. There will often be trigger points in the muscles that will need specific treatment. A trigger point is a small area within a muscle that, when pressed, causes local and possibly radiating pain or soreness. Specific treatments are used to allow the muscles to begin to move the shoulder properly and to allow the muscles to regain their normal lengths.
The patient is actively involved in this process by performing daily home exercises and stretching throughout the healing process. The stretching exercises should be done at home at least once or twice daily. In general, a frozen shoulder will resolve almost completely with teamwork, time and consistent compliance with the prescribed treatment program. Working together with the patient, this whole process can be speeded up dramatically. Internal rotation (moving the hand to the back pocket or up the middle of your back) is usually the motion that takes the longest to regain.
The final word, though, is not to allow this condition to set up. Remember that this takes weeks and months to happen. If you injure your shoulder and the ache or restriction is not improving, don’t wait until it freezes up to come in.
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