Frozen shoulder: Why does my shoulder feel stuck?

One of the common shoulder disorders that present in the clinic is frozen shoulder (also known as adhesive capsulitis) which causes stiffness, pain and reduced range of movement in the shoulder, which gradually becomes worse. If you facing frozen shoulder symptoms you will require read on. You might need a Shoulder Pain Treatment in Guildford.

Patients may report not being able to lift their arm up to do the simplest of tasks, such as combing their hair, doing up a bra strap or even putting on a jacket, which is frustrating debilitating. The pain is constant and especially during the night can prevent sleep. This condition can affect both males and females, though it is four times more prevalent in females and more commonly in their 40-60’s +. (Murakami et al., 2018) (Kingston et al., 2018)

A lot of the time patients report just an insidious onset of the frozen shoulder symptoms becoming gradually painful and stiffening up. Others may report an associated incident linked to their frozen shoulder which may be from physical trauma or injury, or overuse injury.  Frozen shoulder is also associated to patients with diabetes, which may have links to glycosylation (bonding of blood glucose to the red blood cells).  This can affect the shoulder joint due to it being triggered by the presence of high blood sugars. (Goldin et al., 2006) (Hsu et al., 2016). Another cause of Frozen shoulder onset it thought to be linked with emotional trauma or stresses, though there is little evidence to confirm this.

So, what’s causing the shoulder to feel stuck?

The shoulder joint (also known as the glenohumeral joint) is covered by a capsule, which holds synovial fluid. The fluid helps protect, nourish the joint, allowing it to move smoothly.

At the bottom of the capsule is a small recess (axillary recess) of the capsule that allows the shoulder capsule to raise the arm above the head.  As the shoulder becomes less mobile the synovial fluid and the capsule becomes thick causing sticking of the capsule.

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Due to the reduced movement of the shoulder, the muscles are moving less and becoming more fibrotic.  This leads to muscle wasting and weakness of the shoulder.

Stages of frozen shoulder

There are three stages to this condition.

  1. Freezing stage – The shoulder becomes more painful and less movement and stiffness occurring.  This can occur from approximately 6-9 weeks
  2. Frozen stage – There is usually less pain but noticeable difference n the range of movement and limitations and difficulty carrying out daily tasks. The arm is usually limited to less than 90 degrees abduction. This can last from 4-6 months
  3. Thawing stage – This stage is where the shoulder slowly improves it range of movement, either completely or improved. This can take up to 18 months + to recover from.

Shoulder Pain Treatment in Guildford.

An initially conservative approach in the form of manual therapy is advised to help with restoring joint mobility and well helping manage pain. Shoulder Pain Treatment in Guildford can include exercise to help with building strength through the shoulder joint. Joint mobilisation has been shown to be an effective way to encourage movement and assist in restoring movement (Vermeulen et al., 2006) (Johnson et al., 2007), In addition, Low Level Laser therapy (LLLT) has also been shown to be effective in treating shoulder disorders including frozen shoulder. (Awotidebe et al., 2015) (Ip et al., 2015) and Graston Technique (instrument assisted soft tissue therapy)

Exercises

Exercises can be given to help improve shoulder movement, as well as help to rebuild some of the muscles that may have wasted due to the lack of movement.

Pendulum exercises can help with mobility of the joint capsule.  This exercise can also be carried out with a light weight, which encourages traction of the capsule as well as the arm allowing muscles to work under low resistance. This can be carried out with or without a weight. Using a weight will help to create more traction through the shoulder stretching encouraging movement.

Using a ball placed either against a wall or on a table acts as a fulcrum to glide the arm as far as possible to encourage mobility of the shoulder. Using resistance band can also be used to strengthen the shoulder.

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Conclusion

Research suggests manual treatment along with exercises are effective for treating Frozen shoulder and are a preferred option in the first instance. If treatment fails, patients may require a corticosteroid injection in the shoulder. The shoulder will still benefit from the continuation of treatment and exercises after to encourage and restore movement.

If you are suffering with a Frozen shoulder or need Shoulder Pain Treatment in Guildford, make an appointment to see our associate Osteopath Jason Bianchi here at Kinesis Clinic, Guildford

Supraspinatus shoulder pain (A pain in the arc)

What is the supraspinatus?

The supraspinatus is a muscle which sits within the top of the shoulder blade (Supraspinous fossa). It is one of the rotator cuff muscles (supporting muscles of the shoulder) which carries out movement of the arm to the side (known as abduction) The supraspinatus is responsible for providing stability by securing the head of the humerus against the glenoid fossa (shoulder joint). Along with the deltoid muscle, supraspinatus abducts the arm and initiates movement for the first 20° before the deltoid muscle assists the movement to 90°.

So why is this muscle involved with shoulder pain?

The supraspinatus runs across the shoulder blade (scapula) and inserts in the top, outside region of the arm (humerus) The supraspinatus tendon runs in between two bony regions, the acromion (edge of the scapula) and the head of the glenoid (head of the humerus). When the arm is abducted, the space between these bones compress, reducing the amount of space the supraspinatus muscle tendon has to move. When there is an injury or a positional compromise of the shoulder, this can reduce the space even further causing further stress on the tendon.

Pain in the arc

When the arm is lifted out to the side of the body (abduction). Initially the patient may not experience any discomfort before 45°. As the arm is raised between 45°–120°, the supraspinatus tendon is under more compression between the acromion and the humerus. As the arm is raised to 180°, the arm will feel more comfortable, as the palm of the hand turns inwards (External rotation of the humerus). This is due to the bony landmark that sticks out of the humerus the (greater tuberosity) moving away from the supraspinatus tendon and allowing more space for the tendon to move through the subacromial space.

Testing for shoulder impingement

The ‘painful arc’ is one of the tests carried out to assess whether there is pain as the arm is raised into abduction. The test is positive if pain is experienced between 45°-120°. There are a number of additional tests that can be carried out to investigate the shoulder pain, which may include the Hawkins, Neer and Jobe test.

Other contributing factors to shoulder pain

Within the subacromial space, there are a number of surrounding structures, that can be contributing to shoulder pain. This may include involvement of the bursae. Bursae are fluid filled sacs that are responsible for reducing frictions between moving parts in your body., There are six bursae around the shoulder. One of the bursae above the supraspinatus is called the subacromial bursa. The bursa sits under the acromion and above the supraspinatus tendon. As the tendon is pressed between the bone landmarks the tendon also squashes the bursa. Repeated movement of raising the arm can further irritate both the tendon and bursa It can lead to secondary conditions, such as a sub acromial bursitis (Inflammation of the burse sac). At this stage, pain can then be further increased and movement then limited. The supraspinatus is also responsible for maintaining position of the glenohumeral joint. If the supraspinatus is injured, the other rotator cuff muscles will have to take the slack of maintain joint stability. This can lead to the rotator cuff muscle being worked harder, causing fatigue and long term could cause problems for the other rotator cuff muscles.

What’s posture got to do with it?

Sedentary lifestyle such as desk work can be a contributing factor to poor posture. Given the amount of time sitting at a desk in front of a computer can be anything up to eight hours. Throughout the day our posture can gradually become slumped in our lower back, which in turn drops the shoulders forwards to counter balance our body weight. This causes the shoulder blades to draw forwards (protraction). Over time this affects the muscles, both in the front of the chest and around the shoulders and neck. With the shoulders maintaining more of a protracted position, this can lead to the misalignment of the shoulders. This means that each time the arm is abducted, it’s more likely to cause irritation and over time cause increased wear and tear and even inflammation.

Treatment:

As well as considering the Supraspinatus itself, it is important to also consider associated structures and tissues, including mobility of the thoracic spine and neck. These areas can also be contributing to shoulder problems. If the thoracic spine is forward positioned (kyphosis) this can change the position of your shoulders blades which can lead to further compromise of the supraspinatus muscle. Improving movement through the thoracic spine can help to maintain better posture allowing the chest to push forwards and shoulder blades to retract. This can help the supraspinatus tendon to run freely between the acromion and glenoid head.

Osteopathy can help with shoulder pain by improving the quality of the supraspinatus muscle through soft tissue manipulation, as well as looking at improve joint mobility or the shoulder complex and surrounding areas, such as the thoracic spine. This can include gentle articulations of the thoracic spine and or spinal manipulation to encourage movement of the thoracic joints. Other treatment modalities may include Laser Therapy treatment, which is an effective way to treat the inflammation of the tendon and the bursa. Other treatments that are effective include the Graston Technique, which is an instrument assisted soft tissue technique (IAST) that works by breaking down restrictions and scar tissue that can form. The Graston Technique can help to improve and restore movement and soft tissue quality.

Exercise

As well as treatment, strengthening the muscles in the back and shoulders can help with pulling back the scapulae. As well as strengthening muscles, stretching the chest muscles (pectorals) and improving mobility in the thoracic spine can further help with aligning the shoulders.

If you are suffering with shoulder pain, contact Kinesis clinic to arrange an appointment with our OSTEOPATH JASON BIANCHI.

Gardening & Back Pain

With summer here and the sun shining. What better time to start some of those gardening chores? You can spend hours clearing the shed, mowing the lawn and digging up weeds before enjoying the hard work over a glass of wine

One of the main presentations in clinic this time of year is down to overdoing it in the garden over the weekend. People spend hours in the gardening, lifting and bending over, with little breaks. Considering people set aside one hour for the gym, the garden is an endless physical workout.

The importance is to understand, with gardening your likely to be using your back in a much more physical way than you would be on a daily basis, so it’s important to highlight some of the key things to consider;

Exercises – Take five minutes to do some stretches for he hamstrings and lower back. This will help to get the blood flow to the muscles before heading out to the garden.

Taking regular breaks – Taking regular breaks, allows for the body to recover in between tasks. If the body fatigues, it’s likely leave the back venerable to injuries.

Lifting objects correctly – Lifting object in a correct way can save you loads of energy and avoids back injury. Make sure you bend from the knees and keep the objects close to the body. Even better, invest in a wheel barrow or garden trolley to reduce the amount of lifting to do. Working smart is the key when it comes to those heavy tasks.

Keep hydrated – It is so important to keep hydrated, especially in the warm weather. This helps to replenish the body nutrients and helps with recovery from activities. Water helps to maintain temperature, remove waste and lubricate the joints.

Amongst the various list of never ending jobs of mowing the lawn, sawing branches and digging flower beds to pot the lovely plants that were calling out to you in the hardware store. Some of the main injuries that were caused included;

With all that hard work, most importantly, make sure you sit back, relax and enjoy the garden and breathe…

For more advice on low back pain call Kinesis Clinic 01483 504314 and ask to chat with one of our Osteopaths.