The shoulder is the most complex joint in the body, and it allows for a great range of movement. It is composed of the shoulder blade, or scapula, which is found in the back, and the clavicle, or collarbone, in the front. The upper arm bone has a round head that fits into a depression in the scapula which creates a ball and socket joint. There are also seventeen muscles and their attendant ligaments and tendons that allow the joint to move. Because of this, the shoulder is at higher risk of injury than any other joint in the body, and the clavicle is the most frequently fractured bone in the body. This is because it lies right beneath the skin and lacks the protective fat and muscle that protect other bones.
The following lists the three most common causes of shoulder pain and how to fix them:
Frozen shoulder is also called adhesive capsulitis. It is fairly common among middle aged people and most often affects women and diabetics. Adhesive capsulitis happens when the connective tissue that supports the shoulder joint and its tendons tightens, thickens, and forms adhesions. This makes the shoulder painful to move. Over time, the person may not be able to move their shoulder at all. Doctors don’t know what causes frozen shoulder, though a person who has conditions such as heart or thyroid disease may be more at risk. People who needed their shoulder to be immobilized because of an injury are also more susceptible to frozen shoulder.
There are three stages to frozen shoulder. First, the shoulder freezes, and the person feels more and more shoulder pain. This stage lasts for about a month, and a half to as long as nine months. After the freezing stage, the shoulder is frozen. Ironically, the person may not feel as much pain during this phase, which lasts from about four to six months. After this, there’s the thawing phase where the shoulder slowly returns to normal. This can take as long as two years.
As can be seen, frozen shoulder goes away over time, but this can take years, in which the person has limited movement. Doctors prescribe NSAIDs or give corticosteroid injections to ease the pain and inflammation. The shoulder can also be helped by hydrodilatation. This is when the doctor floods the shoulder joint with fluid to stretch the capsule. The injection of the fluid is guided by imaging technology.
The doctor can send the patient to a physical therapist for rehabilitation. Physiotherapy to help frozen shoulder includes gentle stretching exercises.
Rotator Cuff Injury
The rotator cuff is a complex of muscles and tendons in the shoulder joint that help stabilize it. Problems occur when the one of the tendons is injured or inflamed. Unlike frozen shoulder, the person knows immediately that their shoulder has been injured. The pain they feel is severe and immediate, and they may actually feel something tear in their shoulder. If the tendon is inflamed, the shoulder may make a crackling sound. The shoulder is weak, and the arm cannot be lifted out to the side. Rotator cuff injuries are very common. Every year, four million people see their doctor because of this injury.
If the injury is minor, the rotary cuff can repair itself if the patient rests their shoulder. As with frozen shoulder, the doctor can prescribe corticosteroid injections to hasten the healing process and recommend a physiotherapist to help the patient regain their full range of motion. If the injury is severe, the doctor may need to perform arthroscopic surgery then have the patient wear a sling or about a month to a month and a half while the shoulder heals.
Shoulder, or Subacromial Bursitis
Bursae are little sacs full of synovial fluid that help lubricate the area between the bones and muscles in the shoulder. The symptom of shoulder bursitis is pain when a person tries to attempt an overhead maneuver such as lobbing a tennis ball, or if they put weight on their shoulder. The injured shoulder has a restricted range of movement, the arm feels weakened, and the pain can be worse at night. Sometimes shoulder bursitis can be healed with rest and the application of cold compresses to the shoulder. Again, the doctor may prescribe NSAIDs, give the patient corticosteroid injections to treat the inflammation in the bursae, and refer them to a physiotherapist. The patient can also get relief from topical analgesics in the form of creams that actually cause an irritation that distracts the brain from the shoulder pain. The doctor may also prescribe a lidocaine patch to be placed on the shoulder. Physiotherapy may include pec stretches, posterior capsule stretches, and the use of lower and upper limb weights.
If the bursitis doesn’t respond to these treatments, the doctor may aspirate the inflamed bursa. Even though the subacromial bursa doesn’t swell very much even when it is inflamed, drawing the fluid out of it brings relief to the patient.
Shoulder bursitis that is left untreated can lead to infection, which may necessitate surgery. However, in most cases the infection can be cleared up with a course of antibiotics.
To learn more, call Focus Physiotherapy today at (256) 883-0636 or request an appointment here.