Do you have stiffness in your shoulder that has started for no apparent reason? Do you have severe pain in your shoulder, which is particularly painful at night? Are you finding it difficult to move your arm and reach as far as you used to be able to? This could be a frozen shoulder.

What is frozen shoulder?

Frozen shoulder is a common term used to describe the condition “adhesive capsulitis”, which involves a thickening and contracture of the capsule and connective tissues surrounding the shoulder joint. 

The common three phases of a frozen shoulder are:
 
“Freezing” (becoming painful)
– Pain becomes increasingly severe, often worse at night
– Shoulder begins to become stiff, often first losing the ability to fully reach overhead or rotate the arm backwards.
– This period typically lasts 2-9 months

“Frozen” (stiffness)
– Pain is less severe
– There is considerable shoulder stiffness, affecting activities of daily life
– This period typically lasts 4-12 months

“Thawing” (resolving)
– Pain resolves
– Shoulder range of motion is gradually restored
– This period typically lasts 5-26 months

 
What causes it?

It is still unknown what exactly causes frozen shoulder.
It can sometimes start after a shoulder injury or surgery but more often there is no underlying cause. Some conditions such as diabetes and connective tissue disorders may increase the likelihood of developing frozen shoulder.
It most commonly occurs in the 40-60 year old age group and is more likely to affect women than men. 
 

Osteopathy and Frozen Shoulder
In the early stages of frozen shoulder it can be difficult to differentiate the symptoms from a number of other shoulder conditions so our osteopaths will perform a careful assessment to determine a diagnosis of your pain.
Each phase of frozen shoulder requires a different approach and form of treatment so our osteopaths will tailor a treatment and management plan to suit you. The symptoms of frozen shoulder can be flared up by inappropriate treatment and management so it is important to seek advice early on.

Our Approach

• Osteopathic techniques including soft tissue massage, joint articulation, muscle stretching and mobilisation may be used to help relieve pain and reduce muscle tension around the shoulder.
• A program of appropriate gentle stretching and strengthening exercises may help to improve shoulder movement and maintain muscle strength.
• Our osteopaths will also chat to you about some small modifications you can make to your daily routine to avoid aggravating the symptoms.

References

Itoi E et al: Shoulder stiffness: current concepts and concerns. Arthroscopy. 32(7):1402-14, 2016

Le HV et al: Adhesive capsulitis of the shoulder: review of pathophysiology and current clinical treatments. Shoulder Elbow. 9(2):75-84, 2017

Georgiannos D et al: Adhesive capsulitis of the shoulder: is there consensus regarding the treatment? A comprehensive review. Open Orthop J. 11:65-76, 2017

Hsu JE et al: Current review of adhesive capsulitis. J Shoulder Elbow Surg. 20(3):502-14, 2011

Ewald A: Adhesive capsulitis: a review. Am Fam Physician. 83(4):417-22, 2011

Page MJ et al: Manual therapy and exercise for adhesive capsulitis (frozen shoulder). Cochrane Database Syst Rev. CD011275, 2014

Learn more about what can be causing your shoulder pain and how our Osteopaths can help

The rotator cuff is a group of 4 muscles that are responsible for…rotating the shoulder. They are also very important in shoulder stabilization, by helping depress the shoulder to allow for greater movement. Given the large amount of movement allowed through the shoulder joint it is not uncommon for people to develop pain in this area. 

Rotator cuff injuries/weakness are a significant cause of shoulder pain. They occur mainly in patients between 40 and 60 years of age and may be from trauma, but many do not involve an injury. They can slowly evolve from deconditioning, weakness and or overuse. 

Patients might find that the pain can move around their shoulder. Given the close proximity of all the structures, they may experience pain at the front, back or side of the shoulder. Actions like hanging out the washing or movements like putting on a jacket may flare it up.

Below we will discuss some different types of rotator cuff pain but first a very brief shoulder anatomy lesson – The shoulder is made up of 3 bones – the humerus (upper arm bone), clavicle (collar bone) and the scapula (shoulder blade).  These 3 bones makes a ‘little tunnel’ for all the rotator cuff tendons to run through and they attach directly onto the Humerus bone. To help reduce friction and absorb some shock in this space there is a little sac of fluid called a bursa.

Types of Rotator Cuff injuries:

Shoulder Impingement or Shoulder Tip Pain: When you lift you arm above your head, the space where the rotator cuff tendons run narrows, this can lead to compression of the tenson and can cause pain and irritation.

Bursitis: Just like the tendons, this can become irritated. Inflammatory cells infiltrate the sac and can become a shoulder irritant, ‘generally’ bursitis is a secondary finding to another issues in the shoulder 

Rotator cuff tears: Rotator cuff tears can occur in people from direct trauma, like a fall or accident (less likely) or due to repetitive actions over time (more likely). A study has recently found that  54% of asymptomatic (i.e. not having pain or problems) patients aged 60 years or over, were found to have partial or complete tears of the rotator cuff on MRI. This shows us that tissue damage doesn’t always equal pain.

Tendinopathies: This is a general term used to describe cellular changes to the tendons of the rotator cuff over time, due to overload.

OSTEOPATHY AND SHOULDER PAIN

• Our osteopaths will perform a complete assessment and determine a diagnosis of your pain. 
• Osteopathic techniques including soft tissues, joint articulation, muscle stretching and mobilization may be used to help reduce muscle tension of the shoulder, thoracic spine, neck and arm. 
• May help promote blood and lymphatic flow, helping reduce pain and inflammation. 
• Education re exercise program/modification 
• Chat about some small modifications you can make to your daily routine to avoid aggravating the symptoms

Book an appointment to chat with one of our osteopaths about your shoulder pain HERE