Rotator Cuff Problems: Frozen Shoulder

What is frozen shoulder/rotator cuff?

The term rotator cuff is used to refer to the group of muscles and tendons (end portions of the muscles that connect them to the bone) in the shoulder region that helps to stabilize the shoulder joint. This group of muscles and tendons help in the regulation of the wide variety of movements possible at the shoulder joint. It also helps the bones of the shoulder joint to stay in their location enabling it to function smoothly.

Rotator cuff injury refers to any injury or trauma to the muscles and tendons of the rotator cuff as a result of repetitive actions of the shoulders (as in athletes), fall or lifting heavy objects. The rotator cuff injuries can range from simple inflammation that may heal by itself to massive tears that need surgical repair.

Frozen shoulder is a term used to define the condition wherein the normal movements of the shoulder become restricted due to pain in the shoulder joint. This condition is referred to as adhesive capsulitis of the shoulder in medical terminology. The muscles and tendons of the shoulder joint are covered by a layer of soft tissue that is commonly referred to as a joint capsule. Inflammation in this capsule restricts the movement of the joints such as the shoulder joints.

What are the causes of frozen shoulder?

Frozen shoulder generally results from the inflammation or swelling in the capsule that covers the shoulder joint. However, no exact cause of this inflammation has been identified. Nonetheless, disorders of the cervical disks of the neck, diabetes mellitus, injury or surgery of the shoulder joint, open heart surgery and hyperthyroidism are associated with an increased risk of frozen shoulder. In some cases it has also been thought to be caused as a result of autoimmune reaction wherein the body’s defense cells meant to protect begin to affect the cells and tissues of the shoulder joint resulting in inflammation. Previous injuries or long term use of the shoulder joints can also result in scarring and thickening of the joint capsule ultimately leading to restriction of the movements of the shoulder joint.

What are the signs and symptoms of frozen shoulder?

Frozen shoulder may be noted commonly after injury or surgery to the shoulder joint. Some studies suggest that shoulder injury is a condition of adults wherein individuals below the age of 40 years are rarely affected.

Individuals suffering from frozen shoulder or adhesive capsulitis find it difficult to perform day-to-day activities due to the restricted or painful movement of the shoulder joint. Frozen shoulder that occurs due to certain underlying conditions such as diabetes, surgery of the shoulder or other conditions as listed above is not associated with a significant amount of pain in the initial stages and the condition is noticed as the flexibility of the shoulder joint begins to decrease gradually.

In other cases a significant amount of pain or severe pain with restricted movement of the shoulder joint is commonly noted. The restriction in the movement of the shoulder joint or the arm results in stiffness in the joint which further accentuates the restricted movement. As the condition progresses, performing simple movements such as reaching over your head also becomes impossible. Individuals who suffer from frozen shoulder may also find it difficult to sleep due to the pain that worsens at night or due to the restricted movement of the arms.

Significant amount of depression is also noted in individuals who are suffering from frozen shoulder for a long duration of time.

How is frozen shoulder diagnosed?

The diagnosis of frozen shoulder or adhesive capsulitis is based on the history of the condition, signs and symptoms noticed, physical examination, and certain other additional tests such as X-ray imaging or MRI scans.

What is the treatment for frozen shoulder?

The treatment options available for frozen shoulder are quite wide and include medications, physical therapy, correction of the underlying conditions or risk factors, exercises, hydrodistension, surgery, and alternative therapies.

Medications commonly advised belong to the group of drug known as non-steroidal anti-inflammatory drugs (NSAIDs). These medications are aimed at reducing the inflammation and also the pain associated with frozen shoulder. In some cases steroids may be injected into or near the joint to reduce the inflammation.

Physical therapy involves certain specific stretching movements or massage to the shoulder joint performed to relieve the stiffness in these joints. Long term cases are also associated with a significant amount of thickening of the muscles which can be reduced with the use of physiotherapy or massage.

Stretching exercises that are aimed at improving the flexibility of the shoulder joints are also commonly advised. These can include exercises such as keeping the arm straight and trying to lift it upwards while lying on your back, holding the arm straight and then trying to move it sideways (with the other hand supporting) while standing or holding a stick or a cloth behind your back with both the arms and moving it up and down. The method and specific exercises are advised based on the amount of restriction noted in the shoulder joints and must be performed under the supervision of the doctor. Such exercises also need to be performed on a regular basis to maintain the flexibility of these joints.

Hydrodistension is a procedure wherein certain liquids are injected into joint space to expand it and increase the movement of the arms.

Surgery is advised when all the non-surgical treatment options fail to relieve the stiffness and pain noticed in the shoulder joint. The recent most surgeries are referred to as non-invasive surgeries wherein small devices that do not need extensive surgical procedures are used to correct the inflammation or relieve the tight muscles and ligaments of the affected shoulder. Physical therapy is generally advised following such surgical procedures to retain or extend the mobility of the affected shoulder joint.

Alternative therapies such as acupuncture, hydrotherapy, chiropractic treatment have also been tried and are associated with varied amount of success.

How can frozen shoulder be prevented?

Regular exercise may be beneficial in keeping the joints flexible and prevent any associated conditions. Early diagnosis of shoulder pain and prompt treatment can prevent the occurrence of frozen shoulder. Pain in the shoulder region that has been associated with restricted movement of the shoulder joint should be investigated as soon as possible to prevent the stiffening of the joint.