Frozen shoulder: the symptoms and solutions

It is estimated that one in 20 adults in the UK will suffer a painful shoulder condition at some point in their lifetime. One problem that people can develop is frozen shoulder, which is medically known as adhesive capsulitis. The condition can be confused with arthritis or other shoulder problems such as bursitis. Below, you’ll discover how to spot the signs of frozen shoulder and what solutions are available.

What is frozen shoulder?

Frozen shoulder occurs when the articular shoulder capsule – the lining that surrounds the shoulder joint – shrinks and stiffens. It’s a very painful condition that can affect sleep, reduces mobility and makes everyday tasks extremely difficult such as reaching for something or even just getting dressed. It usually affects just one shoulder at a time, but in some cases, both shoulder joints can be affected. If one shoulder does develop the problem, then there is a 20% chance that at some time point the other shoulder will develop the same problem.

The good news is that for most patients the condition is self-limiting and it will get better. The bad news is that it can take 18 to 24 months to completely resolve, and, in some cases, it can persist for even longer.

The exact nature of the problem is till under investigation.

Who is at risk of developing frozen shoulder?

Frozen shoulder most commonly affects those between the ages of 40 and 60 and women are more likely to suffer than men. Whilst in many cases there is no obvious cause,  some people are more susceptible to the condition, such as those with diabetes, Dupytrens disease, Parkinson’s or possibly thyroid problems. Additionally, patients who have had a stroke or immobility caused by an injury or previous surgery can be at increased risk.

Studies suggest frozen shoulder in diabetics is brought on by collagen glycosylation in the shoulder joint caused by high blood sugar. Those who are insulin dependent have also shown to be six times more likely to develop shoulder issues than others.

What are the signs of frozen shoulder?

Most cases of frozen shoulder follow a pattern, with symptoms worsening and then resolving within an 18 to 24 month period. Typically, the stages of frozen shoulder are classified as freezing, frozen and thawing.

Stage 1: Freezing

This is the painful stage and the sufferer starts to notice discomfort and the shoulder gradually tightening, limiting mobility. This can occur over a period of weeks but the pain is such that there will be significant night pain causing sleep disturbance. Discomfort and pain may also be experienced simply at rest. When the limits of movement are reached, again the shoulder is very painful. This period can last for six months or more.

Stage 2: Frozen

In this stage, whilst there is still some pain, this generally improves. However, the shoulder remains very stiff. making it difficult to carry out everyday tasks. Again this period can last for over six months.

Stage 3: Thawing

In this final stage, the movement in the shoulder gradually returns and any residual pain dissipates. It is unusual but not impossible to develop the same problem again in the same shoulder.

How is frozen shoulder diagnosed?

London Shoulder Specialists diagnose frozen shoulder by assessing the level of pain experienced and the range of motion present within the joint. An X-ray is likely to be requested to check whether there are any other issues in the shoulder which could be causing the pain and stiffness. Occasionally we may carry out an MRI to establish the full extent of the damage caused to the soft tissue surrounding the joint. An alternative might be to perform an Ultrasound scan.

What are the treatment options for frozen shoulder?

Once diagnosed with frozen shoulder, there are numerous treatment options available aimed at relieving pain and increasing or preserving mobility and flexibility in the shoulder. A recent web survey carried out in the Netherlands and Belgium, revealed shoulder specialists most commonly opt for non-steroid anti-inflammatory drugs along with intra-articular corticosteroid injections to treat the first stage of the condition. This can be very helpful in reducing the significantly debilitating pain symptoms, particularly those experienced at night. Usually, injections are limited to 1 – 2 episodes and sometimes the cortisone is combined with water (saline) to try to expand the capsule (hydrodilatation).

If the pain persists or if stiffness remains significant following injection, then an arthroscopy (keyhole surgery) can be considered, whereby a camera is put into the shoulder and the tight, thickened capsule is released. This technique has largely superseded manipulation of the shoulder under a general anaesthetic.

The role of physiotherapy in the first stage of the condition is slightly controversial, but there seems to be no question that it is beneficial in the second and third stages of the disease.

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Tuning your tennis shoulder

The temperatures have plummeted and rain is predicted so we must be nearing one of the highlights of the British summer: Wimbledon. As the oldest and most prestigious of the Grand Slams looms, it’s that time of year when even amateur tennis enthusiasts dust off their rackets and a great opportunity to highlight one of the most common injuries suffered in the sport and how you can prevent it.

Tennis shoulder is a common, painful injury, which largely occurs due to repetitive overuse of the shoulder. Just like cricket, tennis players use a lot of overhead arm movements; causing the joint and underlying muscles to eventually loosen, tear or – in more severe cases – come away from the socket completely.

Understanding tennis shoulder

The shoulder is by far the most flexible joint within the body. It’s designed to allow a wide range of different movements, while maintaining good stability. However, if you push the joint too far in any direction, it has the possibility to irritate any of the surrounding muscles and tendons.

Out of the entire structure of the shoulder, the rotator cuff tends to be the most susceptible to injury. Some experts argue this is because the rotator cuff isn’t able to adapt quickly enough to any sudden changes. So, with this theory, if you’re just starting out in the world of tennis, you’re at a higher risk of developing shoulder-related injuries.

Even seasoned tennis players are at a high risk of injury. Many take time off during the winter months then, as the weather warms up, returns to their favourite sport. As the shoulder hasn’t been used for months, it’s simply unprepared for the pressure that it’s about to be placed under and injury becomes a high possibility.

Is tennis shoulder preventable?

If you’re looking to return to tennis or take it up for the first time, one of the best pieces of advice is to make sure you’re properly warmed up. This doesn’t just mean doing a series of stretches before playing, it means starting to prepare for the game before the season actually commences.

Proper training will help you expose the shoulder to the movements required within a tennis game, over a gradual period. This alone will make a massive difference to your tennis shoulder risk level. The longer you can prepare the shoulder before you start playing properly, the lower your risk will be.

Right before you play, a proper warm-up will also help. This should ultimately include some of the movements you’ll be performing, such as an overhead serve. You’ll also want to focus on flexibility training of the legs, spine, arms and shoulders.
Similarly, a cool down is just as important as the warm-up. This will also greatly reduce the amount of aching you experience the day after.

Building up your back and shoulder muscles will also help to lower your risk of injury. The more stable and strong you can make the shoulder, the less prone it will be to injury.

Overall, due to how repetitive tennis shoulder movements can be, it’s impossible to completely prevent the risk of injury. However, the above advice will help you minimise your chances of developing tennis shoulder. If you do experience any pain in the shoulder, it’s imperative you get it looked at right away. The earlier you get the problem treated, the easier it will be to rectify.

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Age is not a factor in shoulder replacement success

A recent study has shown that age may not necessarily be a factor in determining shoulder replacement success. shoulder-replacement-successThis result has surprised researchers, as up until now, age has always been associated with a decreased chance of success.

What’s more, older patients tend to experience far less complications and gain an increased level of shoulder function after the procedure compared to younger patients.

Understanding the study

The recent study was conducted by the Henry Ford Hospital in Detroit and it followed two different aged patient groups. The first included 262 patients under the age of 65, while the second followed 103 patients who were over 75. Each patient had undergone surgery due to osteoarthritis.

The older group were found to have less function in the shoulder than the younger group before they had surgery. However, once the replacement surgery had been performed, the older group experienced more improvement than the younger group.

While the study determined there was no real link between age and the outcome of shoulder replacement surgery, it was quite a small study. Therefore, more in-depth research would need to be done in order to determine just how factual these results are.

What causes a patient to require shoulder replacement?

Shoulder replacement surgery may not be performed as much as knee and hip replacement surgery, but it’s still surprisingly common. There are numerous things that can lead to a patient requiring this type of surgery including:

Osteoarthritis and rheumatoid arthritisArthritis in the shoulder joint is by far one of the most common causes of shoulder pain; particularly osteoarthritis. This occurs over time and largely affects patients aged 50 or over. The pain results from the cartilage being worn away and the bones then begin to rub against each other. Eventually the joint becomes painful and stiff.

Rotator cuff tear arthropathy – If you have a large rotator cuff tear that’s been there a while, it can lead to rotator cuff arthropathy. Because of the tear, changes can start to appear within the joint, which in turn can lead to damage to the cartilage and arthritis.

Serious fractures – If the bone in the upper arm becomes shattered, it could prove very difficult to have them placed back together. Therefore, a shoulder replacement may be recommended.

Understanding shoulder replacement surgery

Shoulder replacement surgery has proven really successful at eliminating shoulder joint pain. It’s one of the few surgical procedures that has been carried out since the 1950s. However, the techniques and equipment used have certainly improved over time.

While it is an effective treatment option, surgery is only ever considered as a last resort. The first thing patients are usually given to ease the pain is medication and recommended changes in activity. If these initial treatments don’t work, that’s when surgery could be more effective.

The procedure involves removing any damaged sections of the shoulder joint and replacing them with artificial components. The head of the joint alone could simply be removed, or the ball and socket may need to be replaced depending upon the severity of the problem.

Overall, shoulder replacement surgery is common and it does have a high success rate. In the past, patients have been put off due to their age, but this new study proves surgery could actually be more effective in older pat

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Mr Andrew Wallace of Fortius Clinic operates on Atletico Madrid’s Jan Oblak

dislocation of the left shoulder while making a save during a game against Villarreal in December. Surgery to repair the labrum was successful but Oblak, who also plays for his national team of Slovenia, will now spend up to four months recovering.

Oblak suffered a Bankart tear to the shoulder

Twenty-three-year-old Oblak suffered a Bankart tear which is more common in younger patients. It is an injury to the labrum which occurs after a shoulder dislocation; to provide stability to the shoulder, particularly with its wide range of movement, the shoulder is supported by a cuff of cartilage called the labrum.

When the shoulder is dislocated, the shoulder pops out of its joint and the inferior glenohumeral ligament that composes part of the labrum can become torn. Oblak would have felt sensations of instability, catching and aching in the shoulder and would have likely experienced repeated dislocations in the future.

The club made the following statement after the surgery: “Jan Oblak has undergone a successful operation of the injury he suffered last Monday in the game against Villarreal. The player underwent arthroscopic surgery to the left shoulder to repair the labrum — with a positive result and stabilisation of the shoulder joint.”

Treatment was provided by Mr Andrew Wallace of the Fortius Clinic, a leading sports orthopaedic centre in London.

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London Shoulder Specialist to speak at ‘The Future of Football Medicine’ conference in Barcelona

This week, London Shoulder Specialist Mr Andrew Wallace will be attending one of the big events in the international sports medicine calendar. This year’s International Conference on Sports Rehabilitation and Traumatology will focus on ‘The Future of Football Medicine’ and will take place between 13 and 15 May at Camp Nou, the home of FC Barcelona.Future-of-Football-Medicine-300x76

With over 2,500 attendees from 90 countries expected, Mr Wallace has been invited to give a lecture on shoulder injuries in footballers. On Sunday, he will be joining other leading sport medicine specialists on a panel focusing on the ‘Future of Sport Surgery: Sparing the Scalpel?’ and reviewing conservative versus surgical options for footballers’ shoulders.

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Could stem cells be used to regrow rotator cuff tendons in the future?

A new discovery made by Uconn Health researchers, could revolutionise the way rotator cuff tears are treated stem-cell-rotator-cuff-repairforever. Using stem cells, the researchers found that they could regenerate the tendons, completely repairing the tear without surgery. This exciting discovery provides hope, particularly for athletes, that this common shoulder issue could be treated quickly and almost painlessly.

How would stem cell rotator cuff repair work?

In order to regenerate the tendons, it requires a nano-textured fabric seed complete with stem cells. It is the introduction of the nano-textured fabric along with the stem cells that’s important in the effectiveness of the stem cell rotator cuff repair treatment. Surgeons have already used stem cells occasionally in the past, injecting them in the tear of the rotator cuff. However, on their own, they haven’t proven to be very successful.

The nano-textured fabric seed appears to significantly increase the success of the treatment. With the seeds help, the stem cells found it much easier to attach to the bone. This resulted in regrown tendons that weren’t just repaired, but they were stronger afterwards too. The cell structure appeared to look just like undamaged and natural tissue. This contrasts to current surgical treatment which often leaves an unorganised cell structure, causing the tendons to grow back weaker.

It’s worth noting that this stem cell rotator cuff repair treatment has only been tested on animals. So, human trials would need to be conducted in order to establish whether it presents the same benefits.

Understanding rotator cuff tears

Rotator cuff tears are extremely common, and they’re typically caused by repetitive micro-trauma. That means, they develop over time, whether it be weeks or even years. Once the tendon becomes torn, it causes the shoulder to weaken, which ultimately leads to pain when you try to carry out normal, everyday activities such as brushing your hair.

A lot of the time, torn tendons actually start out by fraying. Then, often after lifting a heavy object, and after a period of time where the damage becomes worse, the tendon finally tears.

Rotator cuff tears are categorised as partial and full-thickness tears. With the partial tear, the tendon becomes damaged, but it doesn’t completely tear. A full-thickness tear on the other hand, occurs when the tendon comes completely away from the bone.

These tears often result in extreme pain, even when the patient is resting, or lying in bed at night. So, the fact these common tears could soon be repaired by stem cells is definitely welcome news for patients. However, until these stem cells can be used as a mainstream treatment, what options do patients have in the meantime?

Current rotator cuff treatment options

There are numerous treatment options available right now, including injections, surgery and physical therapy. The treatment that’s right for you will depend upon the severity of the tear. Surgery tends to be used for the most severe, painful rotator cuff tears, and there’s many different methods that can be used.

If you suspect you have a rotator cuff tear, it’s best to get it diagnosed as soon as possible. The earlier it is detected, the less invasive the treatment will be. For example, a minor tear could repair itself with physiotherapy. So, if you want to avoid surgery, always get your shoulder pain checked out as quickly as possible.

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London Shoulder Specialist to speak at Sport and Exercise Medicine Symposium

London Shoulder Specialist Ms Susan Alexander is to speak at this month’s One Day International Sport and Exercise Medicine Symposium held in London. Entitled ‘From Pain to Performance’, the conference is widely recognised as one of the leading sport and exercise medicine conferences in the UK and is facilitated by the Society of Sports Therapists.

The Society of Sports Therapists was established in 1990 by Professor Graham Smith to address the increasing demands made on everyone involved in the management and treatment of sports injuries. For the symposium, Professor Smith brings together internationally renowned speakers who work at the cutting edge of musculoskeletal and orthopaedic medicine.

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Alongside colleagues discussing topics such as the management of groin injuries in professional sport to the effects of cryotherapy on muscle reaction time in ankle sprains, Ms Alexander will be speaking on ‘The Problem Shoulder – Referral or Rehab?’.

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Chris Robshaw to miss Six Nations: Rugby and the shoulder injury

England’s defence of their Six Nations title has got off to a shaky start against France and Wales; as head coach Eddie Jones described it, England have now used up all of their “get-out-of-jail-free cards”. The loss of Chris Robshaw due to a significant shoulder injury requiring surgery meant the England team entered the tournament with over half of the starting pack missing from action.

However, it’s more of a blow for Robshaw who has fought hard to make it into the starting team. He suffered the injury on New Year’s Day in the Aviva Premiership Harlequins’ 24-17 match.

This will be the first Six Nations he has missed for five years. Other players in the team have also been plagued with injury. Joe Marler is recovering from a calf injury, while James Haskell recently returned after a six-month absence caused by a toe injury, only to get knocked out within 35 seconds of being back.

Rugby is renowned for its high-injury risk and shoulder issues account for 20% of all injuries in the sport.

Understanding rugby-related shoulder injuries

Out of all sports, ruby is known to have the highest risk of injury both per player and per hour. Shoulder injuries make up 20% of all rugby-related injuries coming second to knee injuries.

Approximately 35% of rugby shoulder injuries are recurrent, meaning if a player does injure their shoulder they are more than likely to suffer another. These injuries most commonly occur during the tackle manoeuvre.

The risk of developing shoulder injuries in rugby can never be fully eliminated due to the high-contact and rough nature of the sport. However, players can reduce the risk by ensuring the surrounding musculature is well-built up.

The most common rugby-related shoulder injuries include:

  • Labral tears
  • Rotator cuff tears
  • AC joint sprain

Out of the above, labral tears are significantly more common than any other type of shoulder injury in the sport. Surprisingly, the number of full shoulder dislocations are rare in rugby. This is thought to be because of the additional support provided by the built-up muscles around the joint.

Treatment and prevention of rugby shoulder injuries

The majority of rugby shoulder injuries tend to occur at the beginning of each rugby season. This suggests that adequate pre-season training could help to reduce the risk. A proper training program should work on building up the shoulder gradually, intensifying in duration and strength as the season draws nearer.

It’s also important for players to ensure they are using proper technique, particularly when it comes to tackles and defensive skills. However, even with adequate preparation, it may not be possible to prevent injury completely.

Most players who develop what is commonly referred to as rugby shoulder, end up requiring surgery. They are also unable to return to their performance prior to the injury. This shows just how significant a shoulder injury can be to a player’s career.

The key is to seek treatment as soon as a shoulder injury is identified. Pain is typically the main symptom to watch out for. Early detection and treatment can make all of the difference to a player’s career.

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Jan Oblak returns to Atletico Madrid after shoulder surgery

London Shoulder Specialist Mr Andrew Wallace was in Madrid at the weekend to watch Jan Oblak play his first game back as goalkeeper for Atletico Madrid only ten weeks after Mr Wallace performed shoulder surgery to repair Oblak’s labrum after a dislocation.

Sadly, they lost against Barcelona 2-1 but Oblak played the full game with no problems and it was fantastic to watch his superb one-handed save against a Messi free-kick, before stopping a goal-bound header from Gerard Piqué just before half-time.

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Why your shoulder pain could be linked to an increased risk of heart disease

shoulder pain and heart diseaseA new study carried out by the Utah School of Medicine has established a link between shoulder pain and heart disease.
According to the study, those suffering with shoulder pain may be at an increased risk of heart disease. In particular, rotator cuff issues can indicate a much more serious problem and patients may need more than simple shoulder treatment to address their health.

Study intensifies heart-disease connection

Shoulder pain has already been suspected to be linked to heart disease and this latest study further strengthens the connection. It appears patients who have an increased risk of heart disease are also susceptible to musculoskeletal disorders such as tennis elbow and carpal tunnel syndrome.

Results of the study, published within the Journal of Occupational and Environmental Medicine, showed the more heart disease risks participants had, the more likely they were to suffer problems with the shoulder. This includes conditions such as high cholesterol, high blood pressure and diabetes.

A total of 36 participants experiencing the highest heart disease risk factors were shown to have a 4.6 times increased risk of developing shoulder pain. Interestingly, they were also six times more probable to suffer from a second shoulder problem known as rotator cuff tendinopathy.

Heart disease more likely than physical strain to cause shoulder issues

There are a lot of contributing factors which can lead to the development of shoulder pain. Most commonly reported is physical strain. However, the study included 1226 labourers and results showed a shoulder-straining job did not increase the risk of shoulder injuries in comparison to those with heart disease risk factors.

Of course, that isn’t to say straining jobs don’t accelerate rotator cuff injuries, but what it does show mean is they aren’t the primary cause. In patients who do present with shoulder pain, particularly rotator cuff injuries, cardiovascular health is more likely to play a role in its development.

The data collected by the study now needs to be properly analysed, which lead researcher, Dr Kurt Hegmann estimates will take around five years.

How can heart disease contribute towards shoulder pain?

Currently researchers don’t know for certainty why heart disease links to shoulder pain. However, there is a theory that it could be caused by a decreased blood supply to the shoulder, leading to weakened tendons. This would therefore increase the chances of injury.

Shoulder pain is also associated as a warning sign for a heart attack, most commonly if intense pain is felt suddenly down the left arm. This is caused by a blockage in the arteries, typically brought on by high cholesterol.

Overall, this new study is one of the most in-depth carried out to establish the link between heart disease and shoulder pain. It followed participants for a total of nine years and covered a wide range of risk factors. While it is important to note that it purely points out a link and not a cause and effect between heart disease and shoulder pain, it’s still a factor to be aware of when seeking treatment.

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