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.

Treatment

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 (24 Hour) to make an appointment to see our doctor regarding rotator cuff tendinitis today.

You don’t have to live with it. Most shoulder injuries can be easily treated by medication, physiotherapy and surgery.

Do you feel a twinge in your shoulder when you lift up your arm? Or find that you are having trouble stretching your arms backwards? You may be suffering from a shoulder joint injury.

The shoulder joint is made up of three bones – the upper arm bone, shoulder blade and collarbone – along with a combination of muscles and tendons called the rotator cuff.

Rotator Cuff Tear

The joint is one of the most mobile in the human body and prone to injury because of the heavy use of the arm and shoulder.

There are three main causes of shoulder pain:

  • Rotator Cuff Injuries
  • Dislocated Shoulder
  • Frozen Shoulder

Rotator Cuff Injuries

Rotator cuff injuries can range from less severe inflammation or partial tears of the cuff, to a complete tear. This can be caused by wear and tear, which is why the Chinese call this type of injury the “50-year shoulder”. People most affected are those who have to constantly life their arms over 90 degrees. Larger tears are also caused by trauma, such as in sports accidents or when you use your arms to break a fall.

Inflammation and smaller tears sometimes heal by themselves without surgery, and treatment for such conditions include non-steroidal anti-inflammatory drugs to bring down the swelling and ease the pain, combines with physiotherapy to strengthen the other rotator cuff muscles. Another option is an injection of anaesthetic into the area, which gives pain relief and brings down inflammation for up to six months. Activity modification is also important in treatment and prevention. This may include physical exercise to strengthen the rotator cuff, and changing the patient’s posture during everyday activities. A cycle of non-operative treatment usually lasts about three to six months.

In more serious tears, or when non-operative treatment is ineffective, surgeries are usually performed using the keyhole procedure, and will attempt to repair any damage to the rotator cuff. “Results are usually very good and most of our patients are able to return their sport in six to seven months.”

Dislocated Shoulder

Dislocated Shoulder

A dislocated shoulder happens when your upper arm bone pops out of the socket in the shoulder that it should fit in. Patients with dislocated shoulder will be in a lot of pain and unable to move the arm. The shoulder joint will also look deformed. After reducing the dislocation, one of the first steps of diagnosis is to undergo X-rays and a scan to find out why the dislocation happened, because in young patients, the chance of it happening again is very high. “We also conduct tests to find out how ‘loose’ the joint is as that will tell us how likely another dislocation is, even if the patient undergoes surgery.”

Not getting proper treatment could lead to more serious consequences. If a dislocated shoulder is not treated properly, the bone that is left out of the joint could damage the surrounding cartilage. Bone loss can occur because of the friction between the joint and the surrounding bone. Once that happens, it will be difficult to fix the problem with just keyhole surgery. Because of this, our orthopaedic specialist, Dr. Kevin Yip encourages seeking treatment from an orthopaedic specialist for all dislocations.

Frozen Shoulder

Just like its description, a frozen shoulder occurs when a patient cannot move his shoulder in any direction. This is caused by the thickening of the capsule of connective tissue that surrounds the shoulder joint.

Frozen Shoulder

 

There are three phases:

  1. Freezing
  2. Frozen
  3. Thawing

The first phase is when the range of motion of your shoulder becomes limited and pain arises when you try to move it. In the frozen stage, the shoulder becomes stiffer but the pain decreases, while the thawing stage is when the patient slowly regains the range of motion. The thawing process can take over a year, which is when it becomes disruptive to daily life. Treatment options include physiotherapy, injections and moving the shoulder joint to the full range of motion while you are in anaesthesia to break up the scar tissue and speed up recovery, and keyhole surgery to release the thickened capsule.

Keep Your Shoulders Safe

Shoulder conditions can have a considerable impact on your everyday life, and it is possible to lessen your risk of developing them. Our best piece of advice for protecting your shoulders would be to know your limits. If you know that a certain action is causing damage to your shoulders or making them hurt, stop doing it – activity modification is very important. And for sports enthusiasts, our advice is something we tell the guys we work out with – keep your ego at home when you exercise.

And more importantly, if you are already having shoulder pain, do not ignore it. See a doctor if you have any pain in the shoulder that persists beyond two weeks. There is treatment that can help relieve the pain and prevent it from coming back again. Remember – you don’t have to live with shoulder pain!

Call (+65) 6471 2674 (24 Hour) to make an appointment to see our doctor for your shoulder pain treatment 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.