Shoulder Problems
Frozen shoulder (adhesive capsulitis)
Chronic Problems
This condition occurs in phases of pain and stiffness and can last for up to three years. It is the process in which the shoulder capsule fibers get thicker than normal and stiff
Risk factors
This shoulder condition occurs between ages 40-60 and can develop without injury. Those with diabetes or thyroid disease are also at higher risk for developing this debilitating condition.
Symptoms
Adhesive capsulitis makes it hard to move the shoulder joint on your own (active range of motion) or with help (passive range of motion).
Diagnosis
This is fairly easy to diagnose on physical exam. Depending on the phase, the person is experiencing pain that is sometimes severe when moving the shoulder, even with help. The phases of adhesive capsulitis are:
Freezing pain is slowly starting to set in and the motion of the shoulder is close to normal. This phase is about 6 to 9 months long.
Frozen pain is minimal; however, shoulder motion is severely limited, making normal daily activities very challenging. This phase may last up to 6 months.
Thawing pain improves, and shoulder motion improves as well. This stage takes the longest, lasting between 6 months and 2 years.
No specific imaging is necessary to diagnose Frozen Shoulder.
Treatment
Physical Therapy is the mainstay of Frozen Shoulder. Daily stretching and range-of-motion work are crucial for improvement. Anti-inflammatory medications like ibuprofen can also help. Steroid injections may also be recommended if medications and physical therapy have not helped the person to make enough progress.
Arthroscopic surgery is reserved for the most severe cases that are not improving after years of conservative treatment. Because the condition can take 2-3 years to improve, it is appropriate to wait that long before deciding whether to proceed with surgery. Surgery would involve cutting down tight portions of the shoulder capsule and manipulating the shoulder while under anesthesia. Physical therapy after surgery is crucial to maintain the motion achieved during surgery.
Scapular Dyskinesia
Several muscles support the shoulder joint and shoulder blade and must work together. When an injury occurs, muscle imbalance can cause the shoulder blade to move or rest in an abnormal position. Dyskinesia translates to deviation (dys-) of motion (-kinesia).
Risk factors
Other soft tissue injuries or shoulder fractures can weaken the shoulder blade or cause abnormal movement. Nerve injury to the muscles that control the shoulder can cause scapular dyskinesia.
Symptoms
Pain, popping and weakness are common symptoms.
Diagnosis
A physical exam in which the examiner watches the shoulder blades move while standing behind the person. With your arms at your sides or in front of you, your shoulder blades may look different at rest or in motion. The shoulder blade might wing or make loud noises known as snapping scapula.
Treatment
Retraining the muscles that aren't working properly is the top priority in treating scapular dysrhythmia. Weight training, heat therapy and better posture can also help improve shoulder blade movement.
Subacromial bursitis and impingement syndrome
Bursae are located throughout the body to reduce friction between bones and tendons. These bursae are small, fluid-filled sacs that can become irritated when the space they occupy becomes smaller or they are injured. The shoulder bursa is located under the acromion and above some rotator cuff tendons.
Risk factors
Anyone who performs repetitive overhead activities is at risk of developing subacromial bursitis. Other contributing risk factors include:
- AC joint arthritis
- Rotator cuff tears
- Scapular dyskinesia
- Repetitive overhead motion
Symptoms
A pinching feeling at the top of the shoulder occurs when you reach across your body or overhead. Other symptoms include popping or cracking with shoulder movements.
Diagnosis
A few physical exam tests help pinpoint this diagnosis, such as pain when reaching across the body or overhead. If you hear popping under the roof of the shoulder when you move, the diagnosis is clearer.
Treatment
Non-surgical treatment is the first approach and mirrors the treatment for AC joint arthritis, which includes:
- Anti-inflammatory medications like ibuprofen
- Corticosteroid injections into the AC joint
- Physical therapy to improve the range of motion
- Ice the joint
- Modify activity
Surgery is reserved for the worst cases that don't respond to non-surgical treatment. This would entail an arthroscopic surgery with a small camera and instrument that can help clean around the subacromial space and ultimately take down the bursa that is causing the pain. Recovery from this type of surgery is fairly fast and is best supported by physical therapy to help regain muscle strength and range of motion.
AC joint arthritis
The joint space between the end of the clavicle and the acromion can be injured from repetitive trauma or sudden impact to the side of the shoulder. The cartilage at the ends of these bones can become injured, as in any joint, where arthritis can form. Although there is no cure for arthritis, many treatment options can help manage the pain it may cause.
Risk factors
Football players are most at risk for developing AC joint arthritis after repetitive tackling. However, anyone who might perform repetitive overhead activity is also at risk.
Symptoms
Pain with reaching across the body or overhead activity is common. The top of the shoulder may also be tender to pressure.
Diagnosis
The joint space may look narrower than usual on a shoulder X-ray. You may also see visible bone spurs around the joint. No other imaging is usually needed to diagnose it.
Treatment
Treatment for AC joint arthritis mainly focuses on managing symptoms.
Non-surgical treatment includes:
- Anti-inflammatory medications like ibuprofen
- Corticosteroid injections into the AC joint
- Physical therapy to improve the range of motion
- Ice the joint
- Modify activity
Surgery is reserved for the most severe cases that don't respond to non-surgical treatment. The surgeon may discuss a distal clavicle resection, or Mumford procedure, which involves making a small incision over the joint and removing a small piece of the end of the clavicle to widen the joint space.