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Frozen Shoulders with pain and stiffness

Causes of painful, stiff, frozen shoulders are of 2 types:

1. Traumatic shoulder pain: bumping against a door or falling to the ground on an arm. Minor trauma results in bruised skin, muscle contusion, tendon, and shoulder sprain. Severe cases may end up with hairline or displaced fractures.
2. Non-traumatic shoulder pain presents with sudden onset and gradual worsening of pain affecting the ability to raise the arm and lift the shoulder. In some cases, the sharp shooting pain can lead to sleep disorders or insomnia.

Shoulder pain because of the injury has a clear-cut cause. Rest, taking painkillers, and massaging in topical analgesic cream can resolve the condition. If doubtful or the symptoms do not improve, consultation with an orthopedic doctor (bone and joint specialists) is called for, especially when the injury and pain are severe; there could be muscle tears, rotator cuff tears, or fractured bone.

Non-traumatic shoulder pain, seemingly arising out of nowhere, worsens slowly over weeks or months to the point you are unable to raise your shoulder or arm. There may be localized pain trigger points or radiating pain over the whole shoulder. Non-traumatic shoulder pain is prevalent in people who exercise regularly but recently raised its duration and intensity and people who just embarked on a new exercise routine. Repetitive activities in factory workers, car washers using to-and-fro wiping motion, or lifting heavy objects on outstretched arms could also cause non-traumatic shoulder pain.

Symptoms

Shoulder pain is frequent in the elderly and can occur without physical exertion or exercise. A minor misalignment of the shoulder and arm can cause shoulder pain because the muscles and ligaments of older people are less flexible than in young people.

Shoulder joints are the most mobile parts of the human body. It consists of 8 muscles and ligaments controlling its movement. Due to its complexity, the shoulder joint can be easily injured or inflamed.

The non-traumatic causes of shoulder pain and stiffness are:

• Common causes of shoulder pain in the elderly are muscle fatigue and micro-tears of muscle fibers from overuse; repetitive activities, or unaccustomed activities such as lifting heavy objects; raising arms to arrange books on a shelf, to-and-fro wiping motion washing a car, and reaching back and stretching shoulder to pick up an object from the car backseat.
• Tendinitis or tenosynovitis of the rotator cuff muscle insertion points on shoulder joint bones.
• The inflammation of the bursa lies between the tendons, muscles, and bones (bursitis); the bursa is a thin synovial fluid-filled sac that reduces friction between adjacent tendons, muscles, and bones. The hyper-repetitive motions of the rotator cuff can cause bursitis, leading to shoulder pain and stiffness.
• Joint inflammations(arthritis) due to diseases such as rheumatism and gout.
• Rotator cuff ligaments tear from excessive strain from carrying something too heavy or age-related degeneration.
• Shoulder joint degeneration is the wear and tear or thinning of its cartilage lining, causing bone-on-bone rubbing. This condition develops sooner in patients with rheumatism or gout or the elderly who repeatedly overtax their shoulders long term.
• Frozen shoulder. The rotator cuff becomes stiff with a limited range of motion due to injury or old age.

Treatment Options

Treatments for non-traumatic shoulder pain

• Rest and avoid using the shoulder.
• Take pain relievers or anti-inflammatory drugs and avoid using the shoulder.
• Steroid injection. In patients with severe shoulder pain and sharp, shooting pain causing sleep disturbance, injecting steroids into muscles, around tendons, inflamed bursa, or joints (in case of degeneration) can relieve inflammation and symptoms effectively. For the patients’ safety, orthopedic doctors should perform the steroid injection. Ultrasound-guided injection is even more accurate and precise and can avoid injection into the tendons.
• Rotator cuff tendon tears: Steroid injection can temporarily relieve the pain. The best treatment is the arthroscopic rotator cuff repair by trained orthopedic doctors.
• The age-related degeneration of the rotator cuff is not curable, but taking anti-inflammatory medicines, injecting steroids into the joint, or total shoulder replacement in some cases are the treatment options.
• Frozen shoulder: Stretching according to the recommendation of orthopedic doctors is the first-line treatment. Patients can do the stretching at home and take pain relievers occasionally. Sometimes this can resolve the problem, but it takes patience and time ranging from 3-6 months to 1-2 years. For people with persistent, severe symptoms without improvement after a lengthy trial of stretching, arthroscopic capsular release can be an option.

If you have shoulder pain or cannot raise your shoulder and arm, please come for a consultation and treatment at Orthopedic Center, 5th Floor, Counter A. Or call 02-090-3116 for an appointment.