FROZEN SHOULDER

This ill understood condition of frozen shoulder, is characterized by pain and stiffness on all movements, increasing over a period of months, .

The pathology is adhesive capsulitis - inflammation of the envelope which contains the gristle covered bone ends.

It involves the shoulder joint proper. This is different to tendinitis in the rotator cuff or the long head of biceps.

All shoulder movements are restricted, and painful when pushed to their limit.
One cannot raise one's arm fully above one's head, nor reach up behind one's back. Reaching behind the neck and over the other shoulder, are restricted.

A medical check including blood tests for inflammation, is important. This is to rule out such conditions as polymyalgia rheumatica which need very different treatment.

I have yet to break anyone's arm doing the stretches described, but it could be prudent to check for osteoporosis as well.

If frozen shoulder is suspected, it is really urgent to start stretching exercises. One can definitely stop the process this way, and avoid the prolonged disability usually experienced.

Lay flat on your back with your arms close by your sides. Lift your affected arm as far as you can. If you can lift it past vertical, relax it and just let the weight of the arm do the stretching.

You are aiming to get it right back, in line with your body (fully elevated.)

Usually you will need help with the stretching, however.

This particular stretch is painful and a fair amount of force is needed, compared to other stretches.

It needs to be done every 2 to 3 days, ideally as soon as any reaction to the last stretch wears off.

In addition to visits to your therapist, stretches at home are needed.

Steady, moderate force is applied to push your arm up, while preventing your shoulder blade from moving.

The gains may be small and the stretching needs to be done frequently.

It does work, however. Frozen shoulder definitely does not need to progress if it is treated early.

A lot of times it resolves within 2 or 3 treatments and one is left not knowing whether it would have progressed to frozen shoulder.

A cortisone injection into the joint can be useful in the early stages. It may give partial relief of pain, and allow stretching to be done.

Hydrodilatation treatment can be given by a radiologist, where the joint is stretched up by injecting saline solution.

POLYMYALGIA RHEUMATICA

People with pmr may complain of aches, but on questioning the other striking feature is marked stiffness in the mornings. (It is an inflammatory condition.)

The aches are usually around the shoulders and arms, but can be around hips and thighs.

Your doctor will also be feeling around your temples, looking for thickened and tender temporal arteries. Temporal arteritis is a giant cell arteritis, which can look similar to polymyalgia rheumatica.

It is vitally important to pick this up as it can lead to blindness, unless it is quickly treated with large doses of cortisone.

There is a specific test for this condition. A length of the thickened artery is removed surgically, and the histology examined by a pathologist.

There is no specific test for pmr, but inflammatory markers in the blood are likely to be increased.

Probably the best test for it is to administer a small dose of cortisone and watch for a dramatic overnight improvement.

The treatment is long term cortisone, but fortunately usually in small doses.

To read more on this see arthritisinsight.com

SHOULDER INFLAMMATION

It is quite difficult to see swelling when your shoulder joint is inflamed, because of the large deltoid muscle covering it.

You are probably the best judge, as you know what it normally looks like.

If your shoulder is painful and stiff, you will obviously be seeing your health professional anyway.

Be sure to tell them if you've had any other joints painful lately,or any skin rash, as this may be part of a general arthritic condition, such as that of psoriasis.

FRACTURED NECK OF HUMERUS

This is a common result of osteoporosis.

The bones may have been jammed together as they broke, so that it may look as though it is arthritis of the shoulder joint rather than a fracture.

A plain X-ray is going to sort this out.

More on treatment of rotator cuff problems - your rhomboids

Return from frozen shoulder page to shoulder anatomy page.