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 Frozen Shoulder (Adhesive Capsulitis)

Frozen shoulder or adhesive capsulitis causes severe restriction of shoulder movement due to pain. The condition results from abnormal bands of tissue that form between joints, thereby restricting their motion and producing pain. Synovial fluid – which usually serves to lubricate the space between the capsule and ball of the humerus in the shoulder, allowing smooth motion – is often lacking in this condition. It is more common in females.

Frozen Shoulder

 

Anatomy and physiology

Frozen shoulder involves injury and accompanying loss of movement in the shoulder or glenohumeral joint. The joint consists of a ball (formed by the humeral head) and socket (the glenoid cavity). While the glenohumeral joint is normally one of the body’s most mobile joints, it is inherently unstable due to the gleonoid cavity being only approximately one-third the size of the humeral head, (although it is slightly deepened by a rim of fibrocartilage called the glenoid labrum). The joint capsule appears to be a major cause of movement limitation in this condition. Adhesions of scar tissue forming in joint spaces can restrict movement, causing the shoulder to freeze up, with severely limited range of motion.

Frozen Shoulder Range of Movement Limited

 

Cause of Frozen Shoulder

Scar tissue formation following shoulder injury. Formation of adhesions following shoulder surgery. Repeated tearing of soft tissue surrounding the glenohumeral joint.

Signs and symptoms

Dull, aching pain in the shoulder region, often worsening at night. Restricted movement of the shoulder. Pain and ache when lifting the affected arm.

Complication if left unattended

Frozen shoulder has a tendency to worsen over time without adequate treatment and proper recovery period. Attempted athletic activity, involving the affected shoulder, will likely lead to further adhesions of the joint, with further pain and restrictions of movement. Production of scar tissue may eventually require surgical removal.

Treatment

  • Injection
  • Manipulation under anaesthesia to loosen the joint and break up the scar tissue
  • Key-hole surgery to remove the scar tissue

Rehabilitation and prevention

Most heat should be accompanied by stretching exercises to gradually restore mobility. Heat therapy should be combined with doctor-supervised physical therapy. Moving the shoulder through the full range of motion several times daily, as well as strength training exercises, may help avoid frozen shoulder. Injuries to the shoulder should be given prompt medical attention to avoid formation of scar tissue, where possible.

Long-term prognosis

The length recovery time following frozen shoulder varies depending on the underlying cause as well as the age and health of the athlete, and the history of shoulder injury. If the condition fails to improve after 4-6 months, surgery may be required. Some lasting discomfort and impairment of movement is common with this injury.

Call (+65) 64712 674 (24 Hour) to fix an appointment to treat your frozen shoulder today.

Brief Outline of Bicipital Tendinitis

Bicipital tendinitis results from irritation and inflammation to the biceps brachii tendon, which has lies on the front of the shoulder and allows bending of the elbow and supination of the forearm. Overuse can lead to inflammation and is a common affliction in golfers, weight lifters, rowers, and those engaged in throwing sports.

Anatomy and physiology

Tendons are tough, resilient bands of fibrous tissue, connecting muscle to the bone. Irritation of the tendon due to overuse occurs as it passes back and forth in the intertubercular (bicipital) groove of the humerus, and can cause inflammation of the tendons (known as tendinitis) as well as the tendon sheaths or paratenons. The musculo-tendinous junction of the biceps brachii is highly susceptible to injuries brought on by overuse, particularly following repetitive lifting activities.

Cause of Bicipital Tendinitis

Poor technique, particularly in weight lifting. Sudden increase in duration or intensify of training. Impingement syndrome.

Signs and symptoms

Pain over the biceiptal groove where the tendon is passively stretched, and during resisted supination and elbow flexion. Pain and tenderness along the tendon length. Stiffmess following exercise.

Complications if left unattended

Bicipital tendinitis, left without care and treatment, generally worsens as the biceps brachii tendon becomes increasingly irritated and inflamed. Movement and the ability to perform athletically without pain will be furthered hampered. Exercising without adequate healing rehabilitation can lead to tearing of the tendon and tendon degeneration over time.

Treatment

Rehabilitation and prevention

The condition is self-limiting given rest and minimal medical attention. Following full recovery, exercises directed at improving flexibility, propioception, and strength may be undertaken. Thorough warming-up and stretching exercises and a steady athletic regimen that avoids sudden, unprepared increases in activity can help avoid this injury, as can attention to proper sports technique.

Long-term prognosis

A full return to athletic activity may generally be expected,  given adequate time for tendon recovery and reduction of inflammation. However, the injury is frequently recurrent. Surgery is generally not required. Injections of anti-inflammatories are sometimes used to reduce pain and inflammation.

Call (+65) 6471 2674 (24 Hour) to make an appointment to see our doctor to treat bicipital tendinitis today.

Brief Outline of Shoulder Bursitis

Shoulder bursitis is not generally an isolated condition, but is usually associated with a rotator cuff tear, or impingement syndrome, and occurs when the region between the upper arm bone (humerus) and tip of the shoulder (acromionI) becomes inflamed. Tennis, baseball, and weight training are all prone to this injury.

Anatomy and physiology

Tendons of the rotator cuff act to rotate the upper humerus, raising the arm by pulling the humeral head down. At the same time, the deltoid muscle pulls the arm up. This process can lead to irritation due to pressure from the acromion process of the scapula and the coraco-acromial ligament. Such irritation can affect the bursae – fluid-filled sacs providing a cushion between the bones and the tendons – leading to inflammation and accumulation of excess fluid, further limiting the space available for tendon movement. The subacromial bursa is the largest and most commonly injured bursa in the shoulder region.

Shoulder Bursitis

 

Cause of Shoulder Bursitis

Overuse of the shoulder from throwing activites, tennis, swimming or baseball. Falling onto an outstretched arm. Infection of the bursa in the shoulder.

Signs and symptoms

Pain in the shoulder, particularly when raising the arm. Pain when turning over in bed on injured shoulder. Loss of strength and limited motion of the shoulder.

Treatment

Rehabilitation and prevention

The athlete should avoid pressure to the injured shoulder and inflamed bursa(e) during recovery as well as any activities likely to irritate the condition. Begin exercising the shoulder when instructed  by a medical professional in order to restore strength and shoulder mobility. Warming-up and cooling-down exercises, with an emphasis on stretching, strength training and maintaining looseness in the shoulder can help prevent bursitis from developing.

Long-term prognosis

Shoulder bursitis tends to ease with proper healing and minor rehabilitation, and a full recovery to athletic activity can usually be expected, particularly if no infection of the bursa is detected. In some cases, aspiration of bursa fluid by needle is recommended to reduce inflammation and ensure no infection is present.

Call (+65) 6471 2674 (24 Hour) to fix an appointment to see our doctor regarding Shoulder Bursitis 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.