The “50-year-old shoulder”

In Chinese and Japanese, the “50 Shoulder”, or sometimes also called the “40 shoulder” refers to pain and stiffness of the shoulder occurring without any apparent cause. It is not confined to the 50 year old. and may occur typically in the 35-65 age group. This is also known as the Frozen Shoulder (or Adhesive Capsulitis in medical terms). However some of these patients may have Rotator Cuff Disease or even Osteoarthritis, both of which also present as pain and stiffness. In many of these cases, the symptoms overlap with the frozen shoulder and some form of imaging (X-rays, Ultrasound or MRI scans) may be needed to differentiate them.


Frozen Shoulder

The Frozen Shoulder is a problem involving the shoulder capsule. This is basically a balloon that surrounds the joint, the primary function of which is to hold in the joint fluid. This balloon gets thickened and inflamed in a frozen shoulder resulting in the pain and stiffness. The Rotator Cuff is actually a number of muscles which surround the shoulder ball, sitting just outside the capsult. It is commonly inflamed (tendonitis) or even torn in this age group. Arthritis is damage to the joint cartilage itself.

Usually, the pain starts gradually. In some cases, there may some form of mild injury or overuse, but in most case, the patients cannot remember any precipitating event. The shoulder becomes stiffer and more painful over the course of a few weeks to months.

The natural history of a frozen shoulder is that it eventually gets better on its own in most cases, but may take anything from 6 months to even 2-3 years. With treatment however, this period can be shortened dramatically. The primary treatment is that of a stretching programme. The majority of patients will respond to home programme of capsular stretching but there are always a few that do not.

Those who have too much pain to stretch, or do not respond, may need further intervention. This can be in the form of a simple Manipulation, under Anaesthesia or an Arthroscopic Capsular Release. This intervention is merely a way to get over the “hurdle” as the patient still needs to continue stretching for 2-3 months after this.

Rotator cuff disease is a spectrum of disease, ranging  from Tendonitis, to Partial Thickness Tears, known as Cuff Tear Arthropathy. The patient with a rotator cuff problem sometimes in a similar way to a frozen shoulder. In others it is due to an injury such as a fall or overuse injury. The symptoms are slightly different, as the pain is more pain on exertion or they may have a painful arc.

The rotator cuff is a set of muscles, surrounding the shoulder capsule. The most commonly involved muscle is Supraspinatus. The treatment depends very much on the patient symptoms, size of tear etc.

For example if the symptoms are just a painful arc (Impingement Syndrome) and the scans are negative for a tear, then non operative treatment is often successful. This may involve a stretching programme, rest, anti-inflammatory medication or even steroid injections. If surgery is needed, it is relatively simple Day Surgery Arthroscopic Surgery in which some bone may be removed to reduce the friction and rubbing on the rotator cuff from the adjacent bone.

On the other hand if there is full thickness tear, the symptoms may be more of weakness and pain on overhead activity. In this case, a Surgical Repair of the Torn Supraspinatus Tendon may be needed. Steroid injections are not recommended as they mask the symptoms only and also may compromise the results of surgical repair.

In come cases, a patient may have both a Rotator Cuff Tear, as well as a form of Frozen Shoulder which occurs secondarily to the Rotator Cuff Disease. This complicates the treatment and usually results in slower recovery.

Call +65 6471 2674 (24 Hour) to fix an appointment with our doctor to treat Rotator Cuff Tears or Frozen Shoulder today.

Brief Outline of Rotator Cuff Tendinitis

Rotator cuff tendinitis results from the irritation and inflammation of the tendons of the shoulder in the area underlying the acromion. The condition is sometimes known as pitcher’s shoulder though it is a common injury in all sports requiring overhead arm movements, including tennis, volleyball, swimming and weight lifting, in addition to baseball.

Anatomy and physiology

The shoulder (or glenohumeral) joint is a ball-and-socket structure formed by the top portion of the arm bone (humerus) associated with the scapula or shoulder-blade. The rotator cuff aligns the head of the humerus into the scapula. Occasionally, following repetitive use of the rotator cuff, the humerus can ride up to pinch the cuff and irritate the fluid-filled subacromial bursa that acts to cushion the rotator cuff and acromion/humerus.

Cause of Rotator Cuff Tendinitis

Inflammation of the tendons of the shoulder from tennis, baseball, swimming, etc. Irritation of the bursa of the rotator cuff from repetitive overhead arm motion. Pre-existing disposition including anatomical irregularity.

Signs and symptoms

Weakness or pain with overhead activities, brushing hair, reaching, etc. Popping or cracking sensation in the shoulder. Pain in the injured shoulder, particularly when lying on it.

Complications if left unattended

Rotator cuff tendinitis can worsen without attention as the tendons and bursa become increasingly inflamed. Motion becomes more limited and tendon tears can cause further, in some cases, chronic pain. Further, the acromion may react to prolonged irritation with the production of bone spurs, which contribute to further irritation.


Rehabilitation and prevention

Following the rest and healing of the injured shoulder, physical therapy should be undertaken to strengthen the muscles of the rotator cuff. Occasionally, injections are required to reduce pain and inflammation. Moderation of rotator cuff use, adequate recovery time between athletic activities, and strength training can all help avoid the injury.

Long-term prognosis

Given proper rest as well as physical therapy and (where needed) injections, most athletes enjoy a full recovery from this injury. Should a serious tear of the rotator cuff tissue occur, surgery may be required, although a recovery to pre-injury levels of activity is usually expected.

Rotator Cuff Tear

Call (+65) 6471 2674 to make an appointment to see our doctor regarding rotator cuff tendinitis today.

What is Shoulder Pain Due to Rotator Cuff Injury?

Rotator cuff injury is the damage to the rotator cuff. This condition is one of the most common causes of shoulder pain.

Rotator Cuff Tear

How is Shoulder Pain due to Rotator Cuff Injury Diagnosed?

Diagnosis is done through understanding the patient’s history of activities and symptoms of pain in the shoulder. Plain x-rays are also done to exclude bony injuries. The MRI scan is the best to delineate the tissues of the shoulder.

What are the Causes?

The rotator cuff can be injured due to degeneration associated with aging or inflammation of the shoulder. The rotator cuff is also commonly injured by trauma for example falling and injuring the shoulder or overuse during sports activities. Rotator cuff injury is particularly common in people who perform repetitive overhead motions that can stress the rotator cuff. These motions are frequently associated with muscle fatigue.

What are the Treatments?

Treatment of rotator cuff injury depends on the severity of the injury to the tendons of the rotator cuff and the underlying condition of the patient. Mild rotator cuff disease is treated with ice, rest, anti-inflammatory medications and gradual exercise rehabilitation. More severe rotator cuff injuries require surgical repair.