Other Shoulder Conditions

Frozen Shoulder (Adhesive Capsulitis)

What is Frozen shoulder?

Frozen shoulder, also called Adhesive Capsulitis, it is a condition characterised by pain and loss of motion in the shoulder joint. It is more common from middle age and more common in women than men.

What causes Frozen shoulder?

Frozen shoulder is caused by inflammation of the capsule along with the ligaments of the shoulder. This inflammation causes pain. With the inflammation the capsule and ligaments become thick. These thickened structures are less elastic and hence leads to shoulder stiffness.

Adhesive Capsulitis can be spontaneous or triggered by an injury or surgery. You may me predisposed to developing a Frozen shoulder if you suffer from Diabetes or Thyroid disease.

What are the symptoms of Frozen shoulder?

The initial “Freezing” phase of a Frozen shoulder is highlighted by pain primarily and then stiffness. With the “Frozen” phase the pain improves but the stiffness is still quite bad. Finally, the “Thawing” phase involves the stiffness finally improving.

A Frozen shoulder can be diagnosed primarily by symptoms and radiological investigations such as Ultrasound or MRI scans. 

How do you treat Adhesive Capsulitis?

The good news is that Frozen shoulders will usually get better by themselves. The bad news is that this may take 6-24 months.

Non operative treatment includes:

These primary focus on pain improvement. None of which will alter the course of speed up the recovery.

Surgery in the Frozen phase may be contemplated in severe cases. This involves an arthroscopic release and division of the thickened capsule and ligaments followed by a manipulation. During the surgery you will obtain full movement of your shoulder. Following surgery you will need to undergo Physiotherapy to ensure you keep this range of motion. Within 2-4 weeks most of your movement would have returned.

Shoulder Impingement

What is Shoulder impingement?

Shoulder impingement is the condition of inflammation of the tendons of the shoulder joint. It is one of the most common causes of pain in the adult shoulder. The shoulder is a ‘ball-and-socket’ joint. A ‘ball’ at the top of the upper arm bone, and the humerus fits neatly into the ‘socket’, called the glenoid, which is part of the shoulder blade or “scapula”. Shoulder impingement is also called a swimmer’s shoulder, tennis shoulder, or rotator cuff tendinitis.

What causes Shoulder impingement?

Shoulder Impingement results from pressure on the rotator cuff from part of the shoulder blade (scapula) as the arm is lifted. It is more likely to occur in young and middle-aged people who engage in physical activities that require repeated overhead arm movements. The pain may be due to a “bursitis” or inflammation of the bursa overlying the rotator cuff or a “tendonitis” of the cuff itself. In some circumstances, a partial tear of the rotator cuff may cause impingement pain.

What are the symptoms of Shoulder impingement?

Individuals with shoulder impingement may experience severe pain at rest and during activities, weakness of the arm and difficulty in raising the hand overhead.

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How do you diagnose Shoulder impingement?

Diagnosis involves physical examination where we check for the possible range of movements with the affected shoulder. X-rays and MRI scans may be ordered to see the injury and inflammation.

How do you treat Shoulder impingement?

Shoulder impingement can be treated mostly without an operation. Primarily with rest, ice packs, anti-inflammatory drugs, and avoiding the activities involving the shoulder. Physical therapy may be advised to strengthen the muscles and steroid injections may be given if pain persists.

Arthroscopic surgery is recommended if the rotator cuff tendons are torn and to remove the bony spurs along with the inflamed bursa.

Acromio-clavicular Joint Arthritis

What is Acromio-clavicular joint arthritis?

ACromio-clavicular joint or AC joint arthritis is damage to the joint which is formed by your clavicle and part of your scapular (shoulder blade). It is a small joint with little movement and contains a small fibro-cartilagenous disc. AC joint arthritis is very common but not commonly symptomatic.

What are the symptoms of AC joint arthritis?

AC joint arthritis causes pain. This pain is localised usually over the AC joint, it can be constant, worse at night and worsened with movement over shoulder height. There may be crepitus or instability associated being experienced as “pops” or “cracks”.

What causes AC joint arthritis?

Like most arthritis’s, acromio-clavicular arthritis is primarily caused by wear and tear. It can be cause by trauma or injury, instability and infections.

How do you treat AC joint arthritis?

AC joint arthritis can be treated non operatively quite well with:

For cases in which non operative treatment has failed, surgery may be warranted. This involves an arthroscopic (keyhole) procedure in which the end of the clavicle bone is excised, approximately 5-10mm. This takes a joint which is “bone on bone” and creates a space or buffer so the pain is eliminated. It is a small day procedure which take less than 30 minutes. Post operatively you can use your arm immediately. The pain will settle over the first few weeks.

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