Category: Shoulder

 

 

The rotator cuff plays a key part in shoulder stability and movement, allowing everyday actions such as lifting, reaching, and rotating the arm. When injured, it can lead to pain, weakness, and restricted mobility, making routine tasks more difficult. This article explores the symptoms, causes, diagnosis, and treatment options available for managing rotator cuff injuries.

Recognising the Symptoms of a Rotator Cuff Injury

Identifying the symptoms early can assist in managing the condition before it worsens. Some common indicators include:

Shoulder Pain

Pain can vary from mild to intense and often worsens with specific movements or positions, such as raising the arm or lying on the affected side. In more persistent cases, discomfort may continue even at rest.

Weakness in the Shoulder

Individuals with a rotator cuff injury may experience difficulty lifting objects or performing overhead movements. This reduction in strength can make routine tasks, such as reaching for items or carrying bags, more challenging.

Restricted Shoulder Movement

Stiffness in the shoulder can limit the ability to reach behind the back or extend the arm overhead. This can interfere with activities such as dressing, hair grooming, or retrieving objects from high shelves.

Clicking or Popping Sensations

Some individuals may notice clicking, popping, or grinding sounds during shoulder movement. These sensations may indicate irritation of the tendons or structural changes within the joint.

What Leads to Rotator Cuff Injuries?

Rotator cuff injuries can develop suddenly due to an accident or gradually from ongoing strain. Common causes include:

Sudden Trauma

A fall onto an outstretched arm, lifting a heavy object incorrectly, or experiencing a direct blow to the shoulder can strain or tear the rotator cuff tendons. Such incidents typically result in immediate pain and a noticeable loss of function.

Repetitive Strain

Activities that involve frequent overhead movements, such as certain sports, manual labour, or repetitive lifting, can gradually weaken the tendons over time. This ongoing stress increases the likelihood of injury.

Age-Related Changes

Tendons naturally lose strength with age, particularly after 40. This makes the rotator cuff more susceptible to damage, even during everyday activities that previously posed no issue.

Common Types of Rotator Cuff Injuries

Rotator cuff injuries vary in nature and severity. The most frequently encountered types include:

Tendinitis

Tendinitis occurs when the rotator cuff tendons become inflamed, usually due to repetitive overhead movements, prolonged strain, or excessive use of the shoulder. This inflammation can cause pain, stiffness, and discomfort, particularly when lifting or rotating the arm. If left unaddressed, the condition may lead to persistent weakness and a gradual decline in shoulder function.

Bursitis

Bursitis refers to inflammation of the bursa, a small fluid-filled sac that reduces friction between the tendons and surrounding structures in the shoulder joint. When the bursa becomes irritated or swollen, often due to repetitive movements, pressure, or direct impact, it can cause pain, tenderness, and limited range of motion. Increased friction within the joint may further aggravate shoulder discomfort, making movements such as reaching or lifting more difficult.

Rotator Cuff Tears

Rotator cuff tears occur when the tendons become damaged, either partially or completely. A partial tear affects only a portion of the tendon, leading to pain, mild to moderate weakness, and discomfort with specific movements. A complete tear (full-thickness tear) involves a full rupture of the tendon, often causing significant loss of strength and stability in the shoulder. This can make it difficult or impossible to lift the arm, particularly in overhead positions.

Diagnosing a Rotator Cuff Injury

Clinical Assessment

Evaluation of shoulder function typically involves assessing range of motion, muscle strength, and areas of tenderness. Observing movement patterns can help identify structural concerns or instability that may be contributing to discomfort.

Imaging Tests

• X-rays: While X-rays do not capture tendon injuries, they can reveal bone-related issues such as fractures, spurs, or arthritis that may be affecting shoulder function.
• Ultrasound: This imaging technique provides a real-time view of the shoulder, allowing assessment of the tendons during movement. It can help detect inflammation, fluid build-up, or structural irregularities.
• MRI: MRI scans produce detailed images of soft tissues, making them particularly useful for identifying tendon tears, degeneration, or swelling. This information can help guide treatment planning.

Treatment Options for Rotator Cuff Injuries

The approach to treatment depends on the extent of the injury, with options ranging from non-surgical methods to surgical procedures aimed at restoring shoulder function.

Non-Surgical Treatment

Rest and Activity Modification

Reducing activities that place strain on the shoulder can aid recovery. This may involve temporary adjustments to work duties, exercise routines, or daily movements to prevent aggravation. A gradual return to normal activity under professional guidance can help restore function safely.

Pain Relief Medication

Anti-inflammatory medications such as ibuprofen can help manage pain and reduce swelling. In cases where symptoms are more persistent, a doctor may recommend prescription alternatives.

Corticosteroid Injections

These injections deliver anti-inflammatory medication directly into the affected area to provide temporary relief from pain and swelling. However, repeated use is generally avoided to prevent tendon weakening.

Surgical Treatment

Surgery may be considered if non-surgical measures do not provide sufficient relief, particularly for more severe injuries.

Arthroscopic Surgery

This minimally invasive technique involves inserting a small camera (arthroscope) and specialised surgical instruments through tiny incisions to assess and repair damaged tendons. The arthroscope provides a clear view inside the shoulder joint, allowing precise repairs with minimal disruption to surrounding tissues. As this approach reduces trauma to the area, recovery is generally quicker compared to open procedures, with less post-operative discomfort and a lower risk of complications.

Mini-Open Repair

Mini-open repair combines arthroscopy with a small incision to directly access and repair the damaged tendons. The arthroscopic phase allows for a thorough evaluation of the joint, while the open portion of the procedure provides better access for intricate stitching or tendon reattachment. This method balances the benefits of a minimally invasive approach with the ability to perform more complex repairs, limiting tissue disruption while ensuring a secure and durable repair.

Open Repair and Shoulder Replacement Surgery

For larger or more complex tears, an open procedure may be required. A wider incision provides direct access to the affected tendons and surrounding structures, enabling a more extensive repair. This approach is often used for longstanding or severe injuries where the tendon has significantly retracted or when previous repairs have not been successful. In longstanding cases of massive rotator cuff tears which has resulted in severe shoulder joint degeneration, shoulder replacement surgery may be the surgery of choice. While recovery may take longer compared to less invasive techniques, these methods allow for a thorough reconstruction of the shoulder’s stability and function.

Preventive Measures for Rotator Cuff Injuries

Taking steps to maintain shoulder mobility and strength can help reduce the likelihood of injury.

• Stretching and flexibility exercises support movement and help prevent stiffness.
• Strength training reinforces the muscles around the shoulder, improving joint stability.
• Modifying repetitive tasks, such as reducing frequent overhead lifting, can minimise strain.
• Maintaining good posture while sitting, standing, or lifting reduces unnecessary pressure on the shoulder.
• Warming up before physical activity prepares the muscles and tendons, reducing the risk of injury.

Conclusion

Rotator cuff injuries can affect shoulder function and interfere with daily activities. Early diagnosis and appropriate management can help restore mobility and reduce discomfort. Incorporating preventive strategies, such as strengthening exercises and posture adjustments, can also lower the chances of future injuries.

If you have ongoing shoulder discomfort or difficulty with movement, schedule a consultation today for professional guidance on treatment options.

Here’s What You Need To Know

Shoulder injuries can be caused by a myriad of reasons, ranging from athletic activities to everyday tasks. This may include overhead movements that involve repetitive motions found in sports such as weightlifting, swimming, and a host of racquet sports. Everyday tasks such as household chores, plumbing, or gardening can similarly expose you to the risk of overuse shoulder injuries.

Additionally, shoulder injuries can arise from accidents that inflict trauma upon your shoulder joint. You may experience broken bones or soft tissue damage, and in some cases, a combination of both.

But this doesn’t mean you should avoid sporting or outdoor activities. In fact, you should seek out injury prevention strategies that can help minimise your risk of injury.

Types Of Shoulder Injuries

To understand the different types of shoulder injuries, we first have to examine the shoulder joint to understand how injuries can occur. You should know that the shoulder is the most mobile joint in the human body, consisting of numerous muscles and tendons which hold the shoulder bones in place. These ligaments are also responsible for stabilising arm movement.

To obtain a better picture, let’s take a closer look at the shoulder.

Firstly, the bursa is a gel-filled sac that sits across the shoulder joint, providing protection for the surrounding tendons and muscles. When the bursa in the shoulder becomes inflamed, it can cause a great deal of pain. Shoulder impingement syndrome or rotator cuff problems may also arise from bursitis.

Secondly, the shoulder is a ball and socket joint whose wide surface area predisposes itself to the possibility of injury. Prolonged trauma exerted on the shoulder can lead to the formation of scar tissue. Other various dysfunctions in movement patterns may also develop over time. There are also degenerative conditions, such as arthritis, which arise due to wear and tear of the joint.

Thirdly, the shoulder joint itself contains a piece of cartilage known as the labrum. The labrum can become torn or strained during impact injuries, which affects the shoulder’s full range of motion. Shoulder dislocations, for example, can result in labral tears that require reconstructive surgery.

Fourthly, the tendons connecting the bicep and deltoid can also experience tendonitis, leading to joint pain.

Lastly, ligament tears or strains may also occur within the acromioclavicular joint (AC joint) due to traumatic injuries.

One thing to note is that most sports place physical demands on the shoulder joint, which is susceptible to injury owing to its remarkable mobility. The shoulder structure itself is not as stable as joints in the legs and hips, making the shoulder much more vulnerable to injury. As mentioned earlier, this shouldn’t scare you away from your favourite sporting activities.

Nevertheless, it is important to understand how these injuries come about. Read on to find out more…

Shoulder Dislocation

A dislocated shoulder occurs when the upper arm bone is displaced from the cup-shaped socket of your shoulder joint. This injury is common given that the shoulder is the most mobile joint in the body. Unlike other joints, it is more susceptible to dislocation.

Note that a shoulder subluxation, which happens when the shoulder dislocates partially but immediately goes back into the socket, is a type of dislocation.

Causes

Shoulder dislocations can either be anterior or posterior. For the vast majority of cases, dislocated shoulders arise due to trauma from direct force or impact on the shoulder. In some cases, patients may also experience a sudden forceful movement that destabilises and overwhelms the joint, leading to dislocation.

This can occur in contact sports such as American football, rugby, basketball, soccer, and water polo due to trauma inflicted from a collision. It can also happen from an accident where there is a forceful and direct impact on the shoulder, such as tripping and falling from a ladder.

Anterior dislocations make up 97% of shoulder dislocations. However, the shoulder may not always fully dislocate. In some cases, you may experience a partial dislocation, known as a shoulder subluxation. This occurs when the head of the upper arm bone only partly disconnects and pops back into the socket by itself.

Symptoms

The symptoms for a dislocated shoulder include:

• Visibly displaced or out-of-position shoulder
• Bruising of the shoulder
• Inflammation and swelling
• Intense pain
• Limited movement of the arm

Rotator Cuff Injuries

The rotator cuff is made up of a group of muscles and tendons which help to stabilise the shoulder joint, supporting regular movement function. Pressing and pulling movements, for example, involve the use of the rotator cuff to stabilise and move the joint.

The common types of rotator cuff injuries include tendinitis, bursitis, rotator cuff strains, and rotator cuff tears.

Causes

Not all rotator cuff injuries are equal, as some may be more severe than others. They generally fall into one of three categories.

Rotator cuff strains (less severe) or rotator cuff tears (more severe) can be caused by two reasons: overuse injury over time or the sudden onset of acute injury. When this happens, the tendons connecting the shoulder muscles to the shoulder blade can overstretch and become strained or torn, resulting in sharp pain.

Tendinitis is a type of rotator cuff injury caused by overuse of the rotator cuff, leading to inflammation and pain in the shoulder. Racquet sports and activities such as weightlifting which require overhead movements can cause this injury.

Another common type of rotator cuff injury is bursitis, which is caused by repetitive motions such as a pitcher throwing a baseball over and over. Spending an extended period of time in uncomfortable positions that put pressure on your shoulder can also cause bursitis.

Symptoms

Common rotator cuff injury symptoms include:

• Inability to achieve full range of shoulder motion
• Pain when sleeping on the affected shoulder
• Pain when attempting to reach overhead
• Weakness of the affected shoulder
• Difficulty in reaching around the back

It is important to note that not all rotator cuff injuries cause pain, as some are the result of long-term degenerative conditions that may not be apparent until years later.

Shoulder Impingement Syndrome

Unlike other shoulder injuries that occur from an immediate traumatic sports accident, shoulder impingement syndrome usually develops over a period of time. It is also commonly referred to as shoulder tendinitis.

Shoulder impingement syndrome is one of the most common culprits of persistent shoulder pain, and can greatly affect everyday activities. Even simple tasks such as reaching to scratch your back or reaching overhead to close the curtains can be a cause of pain.

Over time, if left untreated, the shoulder joint may slowly worsen and the tendons may begin to thin or even tear.

Causes

Most cases of shoulder impingement are caused by overuse. This is common among sports athletes and powerlifters, as repeated use of the shoulder in the gym can result in the shoulder tendons swelling. Other sports which require heavy lifting or repetitive overhead arm movement can similarly cause shoulder impingement over time.

Occupations such as construction work, warehouse packing, and painting can also predispose workers to shoulder impingement. Initially, the pain you experience may not be significant enough to warrant attention. However, it will gradually worsen over time if left unchecked.

Symptoms

The symptoms include:

• Slight albeit persistent pain in your shoulder
• Pain that runs from the anterior shoulder to the side of your upper arm
• Pain that worsens at night
• Weakness in the affected shoulder or arm

Frozen Shoulder Injuries

Frozen shoulder is a condition characterised by stiffness and pain in your shoulder joint, resulting in a reduced range of motion. In some extreme cases, the shoulder becomes increasingly difficult to move, almost as if it has become ‘frozen’. It is also known as adhesive capsulitis.

The good news is that frozen shoulder is one condition that tends to heal by itself over a long period of time. However, physical therapy and rehabilitation exercises will help to speed up the recovery process and improve overall shoulder health.

Causes

Doctors and medical researchers do not fully understand the causes of frozen shoulder. More accurately, there has been no established connection between overuse of a dominant arm or a specific occupation which predisposes you towards developing a frozen shoulder. However, there are a few factors that may increase your risk of developing the condition.

For one, frozen shoulder occurs more frequently in patients diagnosed with diabetes. The exact reason for this is unknown, but diabetic patients who develop frozen shoulder usually tend to experience greater stiffness that persists for a longer period of time. Several other diseases have also been associated with the increased likelihood of developing frozen shoulder. They include hyperthyroidism, hypothyroidism, cardiovascular disease, Tuberculosis, and Parkinson’s disease.

Another cause is long-term immobilisation of the shoulder due to recovery from surgery, fracture, or soft tissue injury. If you have experienced prolonged immobility, such as having your arm kept in a cast, you will be at a higher risk of developing a frozen shoulder.

Symptoms

The symptoms include:

• Pain and stiffness in the shoulder
• Difficulty in moving the affected arm
• Dull ache in the affected shoulder
• The sensation of the pain in your shoulder muscles wrapping around the top of your arm bone

Frozen shoulder typically develops in three stages, with each lasting as long as a couple of months. The first is the freezing stage, where the pain is first experienced. The second is the frozen stage, where your shoulder becomes stiffer. The third is the thawing stage when your shoulder joint’s range of motion slowly becomes restored.

Shoulder Fractures

Fractures are essentially broken bones. Shoulder fractures occur as a result of trauma to the shoulder joint.

The types of shoulder fractures include:

• Clavicle fractures
• Humerus fractures
• Scapula fractures

In cases such as traumatic accidents from contact sports, a shoulder can suffer both broken bones and soft-tissue damage. For example, a fracture on top of a torn ligament.

Causes

The most common cause of a shoulder fracture is a fall which results in trauma being inflicted directly onto the shoulder. Collisions from contact sports or road accidents can also cause shoulder fractures.

Symptoms

The symptoms include:

• Intense shoulder pain
• Swelling or bruising in the shoulder area
• Tenderness or redness
• Shoulder instability
• Tingling sensation in the hand or arm
• Your shoulder looks visibly out of place or has a bump

Shoulder Contusions

A shoulder contusion, also known as a shoulder bruise, is a mild shoulder injury that can arise due to a direct blow to the shoulder joint.

Although a shoulder contusion can be the cause of temporary discomfort, it’s an injury that usually goes away by itself. As long as you don’t have any broken bones, this injury will take anywhere from a few days to a few weeks to heal. In more severe cases, shoulder contusions might be treated with a sling to immobilise the arm.

Causes

Shoulder contusions happen when a direct blow or repeated blows strike the shoulder area, damaging the muscle fibres and connective tissue under the surface of the skin. Contusions are most typically the result of sports-related injuries, especially in sports such as American football, rugby, basketball, lacrosse, basketball, and baseball.

Symptoms

The symptoms include:

• Pain around the shoulder joint
• Ecchymoses (‘blue-black’ bruising) at the affected area
• Inflammation and swelling around the shoulder

Injury Prevention Strategies

Given the prevalence of shoulder injuries, it can be incredibly frustrating for athletes and those who lead a physically active lifestyle. Unfortunately, shoulders that have been injured before are more likely to become injured again.

For this reason, it is important to identify small pains and aches instead of ignoring them until they become a problem. You have to recognise that pain is your body’s indication that something is wrong, possibly due to bad form, muscle tightness, strength imbalance, amongst other problems.

Beyond that, it is also paramount to preemptively lower your risk of injury through certain injury prevention techniques. The emphasis here is to take proactive steps to prevent injury before it can happen, focusing on prehab rather than just rehab work.

If done right, you should be able to improve your overall shoulder health, thereby minimising the likelihood of injury.

Targeted Strength Training

The targeted shoulder strength training referred to in this section is not your regular full-body strength training. Rather, it is specifically targeted at the muscles which are responsible for keeping your shoulder joint stable.

The important muscle groups that you should target include:

• Deltoids (anterior and posterior shoulder)
• Trapezius muscles (below neck area)
• Rhomboid muscles (upper back)
• Teres muscles (supports the shoulder joint)
• Supraspinatus (supports the shoulder joint)
• Infraspinatus (supports the shoulder joint)
• Subscapularis (front of shoulder)
• Biceps (front of the upper arm)
• Triceps (back of the upper arm)

Most of the shoulder joint’s stability and movement is dependent on the small rotator cuff muscles which surround the shoulder joint. While compound exercises in the gym provide many strength benefits, they fail to provide adequate activation of the smaller stabiliser muscles. In other words, exercises like the barbell row will work the trapezius and rhomboids significantly but do not do a good job of activating the supraspinatus and infraspinatus muscles.

It is important not to neglect the small stabiliser muscles in the shoulder joint, as they are essential in preventing injuries. Exercises that target these areas have been incorporated into physical therapy programs, which are also often used for rehabilitation after injuries. This is because the key to keeping your shoulder strong and flexible is with exercises that target these small yet important muscles.

Examples of exercises that target the stabiliser muscles include:

• Lateral Arm Raise: isolates the supraspinatus muscle
• Banded External Rotation: targets the infraspinatus and teres minor
• Banded External Rotation with Arm Abducted at 90 degrees: targets the infraspinatus and teres minor
• Banded Internal Rotation: targets the subscapularis
• Bent-Over Horizontal Abduction with Dumbbell: works the infraspinatus, teres minor, and posterior deltoid

Correct Poor Posture And Muscular Imbalances

Having poor posture may seem harmless, but did you know that poor posture can lead to shoulder instability? In fact, poor posture can lead to many shoulder problems such as shoulder impingement.

For athletes and gym-goers, in particular, poor posture is often exacerbated by muscle imbalances due to a greater emphasis placed on pressing movements such as the bench press and overhead press. When back development is neglected, this can become problematic.

Fitness enthusiasts should therefore aim to have a balanced push/pull training program, thus preventing muscular imbalances from developing. What we often see in most athletes is the over-emphasis on pressing movements while neglecting pulling movements, which commonly results in internally rotated shoulders, also known as rounded shoulders.

Rounded shoulders are one of the most common postural alignment problems that people suffer from. Not only do they look unsightly, but they also put our shoulder joints at risk. Rounded shoulders, if left untreated, can also get worse over time. Consequently, bad postural habits will also influence your movement, which in turn poses a higher risk of a shoulder injury.

For that reason, it is crucial to resolve the imbalance of tension between the muscles which pull your shoulder blades forward and the muscles that pull your shoulder blades backwards. Having good posture will go a long way when it comes to shoulder injury prevention.

Mobility And Flexibility Work

Most people underestimate the importance of good flexibility and mobility without realising how greatly they can reduce the risk of experiencing shoulder injuries. But first, you should know that they are two different things; flexibility is the ability of a muscle to lengthen passively while mobility is the ability of a joint to move through a range of motion.

When it comes to shoulder injury prevention, optimising your shoulder joint’s flexibility can help the ball of the shoulder joint stay centred throughout the entire range of motion for an arm swing. If the shoulder capsule is tight and lacks mobility, a sudden movement that sends your arm reaching overhead could result in injury. Although tightness in the tendons surrounding the shoulder joint may seem harmless, they ultimately contribute to the micro-instability of the joint.

In particular, there are two areas of the shoulder joint in which reduced flexibility and mobility can be particularly problematic. The first is the humerus, which is meant to freely move about the shoulder socket. If you suffer from shoulder mobility issues, this will impede the range of flexion, extension, internal rotation, and external rotation movement. The second is the rotator cuff, which requires flexibility of the rotator cuff muscles for freedom of movement.

In essence, having good flexibility and mobility are important for achieving a healthy range of motion at the shoulder joint. Beyond just preventing injuries, having good shoulder mobility will also carry over to greater performance in the gym or out in the field.

Myofascial Release

Strengthening your stabiliser muscles and improving your postural alignment can provide a good foundation for avoiding shoulder injuries, but mobility exercises and static stretches can sometimes be insufficient for releasing tightness in the shoulder.

Here is where self-myofascial release (SMR) techniques come in. Myofascial release can help to effectively release tension in the muscles surrounding the shoulder joint. For the longest time, it was thought that static stretching of each individual muscle group post-exercise was the best strategy. But recent medical research has identified new techniques and approaches to physiotherapy, rebuilding the whole concept of mobility training.

When it comes to SMR or soft tissue work, your goal is simply to relax or “wind-down” certain muscle groups that are overactive or unnecessarily restrictive. This involves the use of foam rollers as well as lacrosse balls and applying deep, slow, and consistent pressure. These techniques can be immensely helpful for resolving shoulder mobility issues and impaired movements. Furthermore, they also help to alleviate pain due to tight muscles and fascia.

Overall, SMR techniques are designed to relieve knots, stiffness, and pain. This not only helps to prevent tightness but also restores your full range of motion, thereby reducing the risk of injury when playing sports. This is particularly useful to athletes who are experiencing slight pain or discomfort, as soft tissue work will help to clear up mobility problems in their shoulders which may otherwise lead to impaired movement and eventual injury.

In Conclusion

The first step towards shoulder injury prevention is to simply get started. Now that you’re aware of the different strategies which can help lower your risk of injury, you should make improving your overall shoulder health a priority. Even small habits such as practising good posture or stretching daily can go a long way.

Do not be discouraged if you take some time to see progress because good mobility and flexibility do not happen overnight. In all likelihood, it took you many years of poor posture for your shoulder health to deteriorate to where it is now. Similarly, it will take some degree of effort to restore your natural postural alignment and a full range of motion.

Until then, enjoy the process of bulletproofing your shoulders.

Best Ways To Safely And Effectively Improve Shoulder Mobility

The shoulder is one of the most important joints in our body, thanks to its unique and complex anatomy structure. With its extensive range of motion, the shoulder joint is also the most mobile joint in the entire body. 

However, despite possessing the amazing gift of mobility, the stability of the shoulder is often compromised. As such, the shoulder is also the most vulnerable to injuries. Fortunately, shoulder mobility can be improved with the correct methods, which can significantly reduce shoulder damages such as dislocations.

Read on further to find out more!

Here’s What You Need To Know…

You may often hear the words flexibility and mobility being tossed around interchangeably. True enough, even the dictionary thinks that these two words are synonymous with each other. However, flexibility and mobility are actually two different things, albeit being slightly related.

Flexibility is the ability of a muscle to lengthen passively, whereas mobility is the ability of a joint to move actively through a controlled range of motion. Still confused? To put it simply, flexibility is a ‘component’ of mobility; mobility requires flexibility. However, just being flexible is not enough. You will also need muscular strength, coordination and stability to actively manipulate your joints.

Without proper control of your muscles and joints, you may still be able to pull off specific movements successfully. However, you may sustain injuries due to the lack of proper control of your muscles and joints.

Furthermore, it is common for our shoulder mobility and flexibility to decrease as we age. You will likely realise this decline around the middle age mark, which will become more and more apparent as you grow even older. In fact, according to a 2013 study from the Journal of Aging Research, adults between the ages of 55 to 86 will likely experience a decrease in flexibility of the shoulder by an estimated 6 degrees every 10 years. This is primarily due to your bones solidifying and muscles tightening with age. 

Prolonged and poor sitting postures can also lead to shoulder damage such as shoulder impingement. When you slouch or hunch your shoulders, the space at the top of your shoulder bone (subacromial area) narrows, leading to less space for the muscle tendons. This may result in the muscle tendons becoming pinched.

Shoulder mobility issues also commonly occur amongst athletes and weightlifters, who often undergo repeated overhead, swinging and pressing movements. These movements place significant strain on a shoulder joint called the acromioclavicular (AC) joint, resulting in significant shoulder injuries.

Introducing The Shoulder Joint

To deal with shoulder mobility issues, you must first understand how these problems develop. As the shoulder has a complex anatomy structure, it helps to recognise the different components and functions of the shoulder.

Anatomy Of The Shoulder

The shoulder consists primarily of three bones—the upper arm bone (humerus), shoulder blade (scapula) and the collarbone (clavicle). These bones provide the fundamental support and structure for the various joints and ligaments that form the shoulder.

The shoulder is also made up of four main joints: the glenohumeral, sternoclavicular, scapulothoracic, and acromioclavicular joints. Out of these four joints, the glenohumeral joint, more commonly known as the shoulder joint, is the most vital part of the shoulder.

The shoulder joint is a ball-and-socket joint that attaches the head of the humerus to the rounded shallow socket (glenoid) of the scapula. It is the most mobile joint in the shoulder.

Apart from the various shoulder joints, the shoulder is also surrounded by many muscles and tendons, mainly the deltoids, biceps and rotator cuff. These muscles are in charge of supporting and controlling regular shoulder movements by allowing your arms to extend and rotate in multiple directions and angles. Additionally, the rotator cuff, which is a group of muscles and tendons surrounding the shoulder joint, helps secure the humerus to the socket of the scapula. This complex anatomy structure of the shoulder provides both mobility and stability.

However, even though the shoulder joint is highly flexible, it can also develop poor mobility due to various circumstances.

What Causes Our Limited Mobility

There are many causes of limited shoulder mobility, including the following:

• Inactivity. A sedentary lifestyle is one of the most common causes of limited shoulder mobility. This is because a lack of activity will cause the shoulder muscles to tighten, reduce the stability of the joints and significantly restrict movement.
• Poor posture. Poor standing or sitting postures can lead to internal rotation of the shoulders. As a result, the humerus bone will shift slightly and will be in a displaced position in the shoulder socket. This can contribute to shoulder damage such as impingement, resulting in potential swelling and inflammation.
• Instability. Instability of the shoulder is often a result of muscle imbalances due to unequal forces acting on both sides of the shoulder. This is common in athletes involved in sports that require more movement on one side of the body, such as baseball or cricket.

Alternatively, improper techniques performed during strenuous exercises can also promote internal rotation of the shoulders and hence create muscle imbalances. This may place significant strain on muscles such as the rotator cuff, resulting in shoulder mobility issues and injuries.

Why You Should Be Concerned About Poor Shoulder Mobility

Now you know what leads to poor shoulder mobility, the question is, why should you be concerned about it?

The reason is simple. Poor shoulder mobility can result in:

Higher Risks Of Injury

When your shoulders lack mobility, they will also lack muscular strength, coordination and stability. As such, you may not appropriately activate the intended muscle groups or attain the optimal range of motion when performing certain exercises. This leads to dysfunctional movement patterns as other assistance and stabiliser muscles have to overcompensate, forcing them to be activated more. 

When this occurs, it may place unnecessary stress on other muscles and joints, drastically increasing your susceptibility to injuries.

Potentially A Sign Of Muscular Imbalance

Poor shoulder mobility is also usually symptomatic of other hidden problems such as muscular imbalances or poor postural alignment. These issues may not be apparent from the start, but they are causes of concern.

Muscular imbalance arises when a group of muscles are stronger than the other due to improper techniques or repetitive movements when performing specific exercises. For example, your form may be incorrect when exercising, resulting in you training unintended muscle groups instead of the primarily targeted group. Alternatively, when you hold a specific posture for prolonged periods, you may also cause a muscle group to work harder than the rest. All these may result in limited mobility and range of motion.

How To Improve Shoulder Mobility

After knowing the causes and effects of poor shoulder mobility, the next step is to understand how to improve shoulder mobility. 

Here are some ways:

Perform Diagnostic Tests

To improve shoulder mobility, you will first need to understand your shoulder limitations to determine which areas you should work on.

A diagnostic test is the most common and direct method to identify mobility issues. Most of these tests are performed in conjunction with imaging tests such as an x-ray or ultrasound to detect and clarify the results of a physical examination.

Some of these tests may include:

• Neer Test. For this test, a physical therapist will stand behind you and press down on the top of your shoulder. They will then rotate your arm towards your chest and raise your arm as high as possible.
• Hawkins-Kennedy Test. Your physical therapist will position your elbow to a 90-degree angle and raise it to your shoulder level while you are seated down. They will then place their arm below your elbow before pressing down on your wrist to rotate your shoulder.
• Yocum Test. You will be instructed to place one hand on your opposite shoulder and attempt to raise your elbow without moving your shoulder.

These tests are designed to detect any signs of pain and determine the exact location of the pain. A painful reaction when carrying out the exercises is usually a positive indication of a shoulder mobility issue.

Self Myofascial Release Techniques

Self-myofascial release techniques involve applying pressure to target tight muscles and fascia (a protective membrane that protects your muscles and other organs in your body) to reduce pain. These techniques, when applied correctly, can effectively resolve shoulder mobility issues. However, the reverse is also true. If done improperly, it can also aggravate the problem, causing greater pain.

Some of these techniques may include:

• Deltoid rolls. This involves placing a foam roller between your shoulder and a wall. Position your hips to align with the wall and slowly move until you feel tightness. Proceed to move up and down using your body weight until the pain dissipates slightly. Repeat with your other shoulder.
• Neck rolls. Lie down on your back with the foam roller under your neck. Next, tilt your chin to one side and gently move up and down. Repeat this process with the other side of your neck.
• Lats roll. Lie on the floor with the foam roller placed under the back of your armpit. Gently rotate your body until your chest faces the floor and then slowly rotate back up. Repeat this process several times before changing sides.

Stick To A Shoulder Mobility Routine

A structured shoulder mobility routine can also considerably improve your shoulder mobility by fixing tight shoulders and correcting improper body posture. The routine should also be comprehensive and involve all related components of the shoulder, including the area from your mid-back to neck (thoracic spine) and lower back.

As everyone may experience issues in different areas, there isn’t a one-size-fits-all training programme. 

However, there are various effective exercises you can include in your routine, including the following:

• Quadrupled shoulder overhead reach. This exercise will enable you to control your lower back (lumbar spine). Start with both hands and knees on the floor, with the hands beneath your shoulders and knees beneath your hips. Push into the ground to spread your shoulder blades (scapula). Next, put your lower back into a neutral position by arching and tucking. With this neutral position and scapula still extended, stretch one arm outwards and slowly reach overhead, rotating your thumb towards the ceiling. Perform a few repetitions before changing sides. Ensure that your scapula does not sag throughout the exercise, and you do not rotate your body (remain in a neutral position)
• L-arm stretch. This exercise stretches your rotator cuffs and the back of your shoulder. Begin by lying on your stomach and place one arm by your side. Extend your other arm across your chest with your palms facing upwards. Ensure that you do not shrug your shoulders towards your ear as much as possible. Using your shoulder muscles, pull your chest towards the floor to stretch the shoulder capsule and hold for several seconds. Perform a few repetitions before changing sides.
• Open book. Your thoracic spine will be actively stretched with this exercise. To start, lie on a side and extend both arms in front of you. Next, bring your top hand towards the ceiling and stretch it all the way to the floor on your other side. Your head should follow the motion of the hand. Perform a few repetitions before switching to the other side. Ensure that your hips remain still throughout this motion.

However, to improve shoulder mobility, it is insufficient to do these exercises only once. You have to perform them consistently to see progress.

Best Practices For Staying Injury Free

Improving your shoulder health and staying injury-free will help with shoulder mobility and vice versa. If you sustain an injury due to poor shoulder mobility, you may become sidelined for months at best. This may also result in inactivity and a possible further reduction in mobility.

As such, following the best practices below can go a long way towards an injury-free body.

Prehab Exercises

Performing physical therapy exercises even if you are not injured may seem counterintuitive to many people. However, prehab or preventive rehabilitation exercises are vital even if your shoulder is in good health, as they can dramatically reduce the risks of injuries and pain.

As such, do not wait until you are injured before you have to do rehabilitation work, as the damage would have already been done.

However, keep in mind that prehab exercises are not warm-ups you do before an exercise. Prehab exercises are designed to be performed regularly and consistently about 2 to 3 times per week. These exercises need to be individualised and tailor to your specific weakness.

Perform Dynamic Warm-Ups Before Exercising

One of the best ways to reduce the risk of injury is to perform warm-ups before a workout. There are generally two types of warm-ups: Static stretching and dynamic stretching. 

For a long time, static stretching has been regarded as a vital pre-workout warm-up. However, warmups have since evolved as people are now more equipped with the knowledge of what our body requires to perform an action optimally and safely. As such, an even more appropriate warm-up now is the dynamic warm-up.

A good warm-up routine should include dynamic exercises (cardio) such as squats, burpees or push-ups as it increases your heart rate and loosens up your muscles. These warm-up exercises will allow your muscles and joints to become activated to tolerate the intensity required during the workout. Furthermore, dynamic warmups should also be tailored specifically to the type of exercise or sport you will be performing, as well as focus on engaging several muscle groups together. 

However, that does not mean that static stretching is not essential. It is still paramount to stretch, but only after the workout as it is the most effective. Stretching reduces muscle tension and loosens up your muscles after an exercise, which helps to prevent the risk of injuries.

Conclusion

Poor shoulder mobility may not be an urgent cause for concern initially, as the red flags may not be apparent (it may start as a simple case of difficulty raising the arms above your head). You may even ignore this signal and pass it off as a one-time or temporary occurrence.

However, poor shoulder mobility may result in more severe repercussions if not improved. It is thus vital to understand the cause of your shoulder mobility and learn how to improve it to reduce the risks of injuries.

What Is A Rotator Cuff Repair?

A rotator cuff injury occurs when the tendons that comprise the rotator cuff experience a strain or a tear. It can either stem from repetitive stress to the tendon tissue in the shoulder, resulting in wear and tear, or a sudden shock to the shoulder joint, resulting in an injury. Rotator cuff injuries predominantly affect middle-aged and older individuals. 

A rotator cuff repair is a surgery to repair an acute rotator cuff injury caused by a torn tendon in the shoulder. The most common surgical procedure is arthroscopic tendon repair. Other procedures that are usually performed on more severe injuries include open tendon repair, tendon transfer and shoulder replacement. 

When Should You Do A Rotator Cuff Repair?

Certain groups of individuals are more prone to rotator cuff injuries due to the type of sports they play, the nature of their work and a multitude of other factors, even the way that they sleep, according to rotator cuff specialist Dr K.L. Ong. 

Sports that demand large and repetitive movements of the shoulder joint include swimming, baseball, tennis and golf. 

Jobs that require repetitive overhead motions such as a painter or a carpenter also place substantial stress on the shoulder joints, increasing the risk of a rotator cuff injury.

The optimal treatment depends on the severity of your injury, among other factors. Minor rotator cuff injuries are often characterised by a dull ache in the shoulder. These can be treated with rest, ice and therapy. 

As your body naturally heals, the pain gradually recedes and eventually goes away altogether. During therapy, your physiotherapist will tailor exercises to target your specific area of injury. These exercises help to strengthen the muscles surrounding the tendon tissue and build flexibility. 

Over-the-counter (OTC) pain relievers such as ibuprofen and acetaminophen could also be useful in reducing discomfort. In slightly more serious cases, you could take steroid injections to ease the pain. However, they may exacerbate the tendon’s weakness and reduce the success rate of a potential surgery. Persistent use of steroids is not encouraged and caution should be exercised.

However, these remedies do not suffice for severe rotator cuff injuries. If you have been experiencing severe or prolonged pain for more than six months, your orthopaedic shoulder specialist would advise you to go for surgery. This is especially so if you require the active use of your shoulder for daily activities, such as sports and work.

You should consult your physician for a rotator cuff repair if you experience one or more of the following symptoms:

• Reluctance or difficulty in exercising your shoulder due to discomfort. 
• Pain in the shoulder that interferes with daily activities such as cooking and jogging.
• Pain in the shoulder when performing overhead motions and heavy lifting.
• Reduced range of motion in your shoulder joint, accompanied by severe pain for extreme movements.

How To Prepare For Rotator Cuff Repair

Before your surgery, the doctor will first obtain a thorough diagnosis of your condition. The primary tests are done by applying pressure on different parts of your shoulder, gently moving it into different positions and rotating it. This is to determine the degree of pain and the exact site of pain, which will then determine the surgical location and size of the incision. 

You should, if possible, pinpoint the specific area of pain to your doctor, its severity, the movements that induce and relieve pain, as well as numbness in your arm, if any. 

X-ray tests will also be administered to provide a comprehensive and clear view of your shoulder joint. It also tests for indicators for other possible causes of pain. For instance, a bone spur suggests arthritis. Other tests include ultrasound, an electrocardiogram (EKG), and a complete blood count (CBC), each for a different purpose. 

Meanwhile, you should also avoid movements that further strains the injured area, such as heavy lifting and overhead ball sports. It is paramount to visit a doctor immediately after a severe injury, as surgery has the greatest effectiveness on fresh injuries (and less so for chronic illnesses).

On The Day Of Surgery

Basic pre-operative tests will be performed on the day of the surgery to ensure fitness for the procedure. These include a temperature check, a pulse check, a blood pressure test and an oxygen level test. 

You will either receive general anaesthesia, usually through an IV drip attached to your arm, or regional anaesthesia. General anaesthesia induces unconsciousness during the length of the procedure, while regional anaesthesia only numbs your arm and shoulder. 

The most common form of surgery, also known as an arthroscopic tendon repair, involves the surgeon making a few tiny incisions at the site of the injury. One is used to insert a camera, while others are used for the insertion of medical instruments to reposition and connect your tendon to your bone from where it was torn. Then, sutures are attached to the tendon, which are fastened to suture anchors that are in turn attached to the bone. As such, the tendon is rejoined to the bone.

Open tendon repairs are performed when your surgeon has to remove calcium deposits or a bone spur. A bone spur is a bony projection that might exert pressure on surrounding nerves or tendons, thus causing pain. 

After the surgery, your vitals will be monitored for a couple of hours. If there are no abnormalities, you will be briefed on post-surgical care and discharged, all within the span of a few hours.

Recovery and Rehab For Rotator Cuff Repair

Usually, your surgeon will instruct you to wear a sling or a shoulder immobilizer for four to six weeks post-surgery. This is to prevent excessive movement and to keep your arm stable and close to your body. 

Physical therapy is a beneficial and paramount post-surgical activity. It strengthens the muscles in your shoulder through specific exercises tailored to your injury. Proper therapy, coupled with ample rest, catalyzes the recovery process. A full recovery takes anywhere from three to six months, depending on the severity of your injury, your age, whether you are a smoker, your body’s healing capacity and a multitude of other factors.

Long Term Outlook For Rotator Cuff Repair

Studies have shown that surgery is very effective at reducing pain induced by rotator cuff injuries and improving shoulder mobility. Although recurrent tears might grow in size, they are usually painless and do not compromise shoulder function. However, the site of injury might experience protracted soreness or a lack of strength. This improves with time and therapy. 

Meanwhile, you should provide your shoulder with a sufficient amount of rest and refrain from engaging in strenuous sports that require a wide range of motion from the rotator cuff. In addition, extra precaution should be taken in exercising your shoulder joint if you have already injured your rotator cuffs in the past.

Shoulder pain that doesn’t go away with a few days’ rest or pain that requires a significant amount of painkillers to bring relief should raise alarm bells. In my clinic, patients who suffer from shoulder pain with seemingly unknown causes typically have one of three common conditions: injury to the rotator cuff (the main group of muscles that mobilise the shoulder), injury to the labrum (a rubber band-like structure that keeps the shoulder in its socket) or “frozen shoulder”.

Believe it or not, a rotator cuff injury doesn’t just happen to athletes. In fact, a large number of patients with a bothersome shoulder ache have no recollection of how it occurred. It could easily have been due to a forgettable action such as grabbing a bag from the back seat of a car while sitting in the front seat. 

Labrum injuries, too, don’t just happen to athletes, though this type of injury does commonly occur in throwing sports or activities with repetitive overhead movement – volleyball and tennis, for example. And, it happens gradually over time. So, a frustrated gym enthusiast will lament that he is no longer able to bench-press his usual loads because of a sharp pain; or a tennis player might no longer be able to serve overhead without pain; yet, both will deny any earth-shattering injury.

A frozen shoulder may be triggered by a known injury, including a labrum or rotator cuff injury. However, often the patient doesn’t recall any injury at all. Without proper counsel and care, a condition that could have been resolved in two months may drag on for two years with serious complications. Therefore, it’s important not to brush off that shoulder pain! Getting a diagnosis early and receiving proper treatment will stave off long-lasting disability.

What is a rotator cuff injury?

The rotator cuff is a group of muscles and tendons that surround the shoulder joint, keeping the head of your upper arm bone firmly within the shallow socket of the shoulder.

A rotator cuff injury can result in a painful shoulder which may even disturb sleep.

Who may get a rotator cuff injury?

Rotator cuff injuries may occur to both the young and older patients.

They may be associated with a single traumatic incident or multiple frequent overhead motion.

In many cases, degeneration without significant injury can also lead to a rotator cuff tear.

What are the symptoms of a rotator cuff injury?

Patients with rotator cuff injuries usually report one or more of the following symptoms:

• Painful motion of the shoulder, especially overhead movements
• A painful shoulder that may distribute towards the elbow and neck
• A stiff shoulder
•  A “weak” shoulder
• Inability to lift the arm
• Painful sleeping on the shoulder

When to see a doctor for shoulder pain?

Shoulder pain that is of short duration can be evaluated by your family doctor.

If the pain is prolonged or weakness is experienced, you should see an orthopaedic specialist in Singapore who has a special interest in shoulder conditions at the earliest possible time.

What is done to diagnose a shoulder rotator cuff injury?

The diagnosis is made initially with a thorough history taking and physical examination.

Xrays are done to evaluate the shoulder for other possible shoulder conditions which can also present with pain.

The diagnosis of rotator cuff injury is subsequently confirmed with an ultrasound scan or a Magnetic Resonance Imaging (MRI) scan. Your orthopaedic doctor will help recommend the type of scan needed.

How can rotator cuff injuries be treated?

Many people recover from rotator cuff disease with physical therapy exercises that improve flexibility and strength of the muscles surrounding the shoulder joint.

However, extensive rotator cuff tears may require surgical rotator cuff repair, transfer of alternative tendons or joint replacement. In certain cases, a specialized procedure known as superior capsule reconstruction may benefit patients.

What are the possible complications if I do not seek treatment for a rotator cuff injury?

Without treatment, rotator cuff problems may lead to permanent loss of motion and function of the affected arm. 

This may lead to progressive degeneration of the shoulder joint which can be a source of long term pain and discomfort.

Although it is possible to relieve a painful shoulder by resting the shoulder, immobilization of the shoulder for a prolonged time may cause the connective tissue surrounding the shoulder joint to become thickened, painful and tight. This is also known as a “Frozen Shoulder”

What if physical therapy and injections fail?

In patients that have severe rotator cuff injuries, physiotherapy or injections may not be helpful.

In such patients, the rotator cuff specialist may suggest the option of surgery.

What is Arthroscopic “Key-hole” Surgery?

Most rotator cuff tear repairs involve “key-hole”, minimally invasive surgery.

This will allow the orthopaedic surgeon to access the shoulder joint easily and repair the rotator cuff tear with special implants that reattach the rotator cuff tendon. During this procedure, any excessive bone prominence will also be removed to aid in tendon healing.

A patient who undergoes this surgery often returns home the next day after surgery.

What is Superior Capsular Reconstruction?

Superior capsular reconstruction (SCR) is a surgical procedure that has a niche role in patients with severe rotator cuff tears. It is usually indicated in patients who are deemed too young for shoulder replacement surgery.

This procedure involves the reconstruction of an important stabilizing soft tissue structure in the shoulder joint. It requires the transfer of a substitute soft tissue graft from either the patient (autograft) or another person (allograft).

A patient who undergoes this procedure will likely be able to return home the next day after surgery.

What is a Shoulder Replacement Surgery?

There will be some patients who have excessively severe rotator cuff tears that cannot be repaired effectively.

In such cases, the shoulder joint may need to undergo open shoulder replacement to allow for better function and pain relief to the patient. 

This will involve a removal of the diseased shoulder joint and replacing with a metal prosthesis.

A patient undergoing this procedure will likely be able to return home in 3-5 days after the surgery.

What is the rehabilitation like after shoulder surgery?

The duration of rehabilitation with physical therapy will depend on the type of surgery done. 

Patients will be expected to wear an armsling for a few weeks after surgery. This will be determined by the surgeon.

In general, rehabilitation after arthroscopic “key-hole” surgery will last for 6 to 12 months.

Rehabilitation after open shoulder replacement surgery will last for usually 12 months.

It is important to stay compliant to the rehabilitation program and also be compliant to pain relief medications during this time to have the best outcome after surgery.

Frozen Shoulder, medically referred to as Adhesive Capsulitis (AC), is a painful condition that affects 2-5% of the general population.

Women are particularly more at risk, along with diabetics and people in the 40 – 65 year age group.

It is generally not a life-threatening condition but it can cause significant disturbance to a patient’s lifestyle, both at home, work or play.

It is also important to ensure that the patient is not suffering from a more serious condition, that masquerades as a frozen shoulder.

What Is A Frozen Shoulder?

A common disorder characterised by stiffness and pain in the shoulder that limits the range of motion, frozen shoulder is a chronic inflammatory condition that develops gradually over time, making it difficult to detect.

The shoulder’s ball and socket joint slowly loses mobility, until it becomes “frozen”. This is a result of inflammation and scarring of a surrounding shoulder capsule.

It is akin to a thin-walled bubble turning into a leathery basketball, hence “trapping” the shoulder.

This means compromising simple daily activities such as getting dressed or reaching a shelf above, as any movement may cause a great deal of pain.

The Medical Mystery Of Frozen Shoulder

There is a lingering mystery surrounding the condition when it happens to healthy people.

In most cases, a diagnosis of frozen shoulder is deemed “idiopathic”, meaning it happens for no particular reason. Nonetheless, it is sometimes associated with traumatic injuries such as dislocation or a rotator cuff tear.

In other cases, the so-called injury may just be a simple arm movement such as reaching awkwardly underneath a table to switch on a power point, or even putting on a car seat belt. This is sometimes enough to be the initial trigger of a frozen shoulder.

Frozen Shoulder & Diabetes

Frozen shoulder is not an uncommon condition amongst the diabetic community. Although statistics vary, it is estimated that as many as 10 – 20% of individuals with diabetes will suffer from a frozen shoulder in their lifetime. It has also been reported in medical literature that unfortunately, the frozen shoulders of diabetic patients tend to take longer to recover.

Timeline For Developing Frozen Shoulder

The primary symptoms of a frozen shoulder are usually so subtle that you may not notice them. Therefore, it is crucial to be aware of any persistent shoulder pain, according to Dr K L Ong, an orthopaedic surgeon and frozen shoulder specialist in Singapore.

Frozen shoulder progresses in 4 stages: inflammation, freezing, frozen, and thawing.

• Stage 1 (inflammation): The initial stage may last up to 3 months, associated with pain and reduced range of motion.
• Stage 2 (freezing): Pain slowly becomes worse while the range of motion gradually decreases over a period of 6 weeks to 9 months. Certain types of movements may be especially painful.
• Stage 3 (frozen): Over a span of 4 to 6 months, where the shoulder is “stuck”. The pain dwindles down to a dull ache, especially at night.
• Stage 4 (thawing): Slow but gradual recovery of shoulder movement over a 6 to 24 months period.

The duration of each phase above varies with the timing of treatment interventions. Early detection, together with appropriate treatment methods can help you avoid the undesirable consequences of a frozen shoulder.

Frozen Shoulder Treatment Methods

A frozen shoulder is one of the few health conditions that will actually go away on its own if you ignore it. However, the process can take up to 2 years and the pain can be unbearable, affecting your quality of life.

Therefore, the main focus of treatment is to minimise pain while restoring motion and strength in the shoulder.

Non-Surgical Treatment

Most patients have seen remarkable improvements with relatively simple non-surgical treatment methods for frozen shoulder.

Nonsteroidal Anti-Inflammatory Medicines

Drugs like aspirin and ibuprofen have the ability to reduce inflammation and alleviate mild pain. However, not all painkillers are suitable for every patient, so it is crucial to consult your doctor before consuming one

Corticosteroid Injections

This is a powerful anti-inflammatory medicine that will be injected directly into your shoulder joint. Nonetheless, repeated injections are discouraged as they may cause further damage to the shoulder.

Physical Therapy Exercises For Frozen Shoulder

Frequent, gentle exercises could help speed up the process of restoring motion in the shoulder. However, it is important to only do it under the supervision of a physiotherapist. Therapy includes a range of stretching exercises tailored to enhance motion in the shoulder.

It is crucial to warm up the muscles in your shoulder before performing these exercises. And remember to only stretch to the point of tension but not pain. Here are some exercise examples that might be recommended.

Pendulum Stretch

This is a gentle way to increase movement in the shoulder, using the force of gravity. Stand slightly wider than shoulder-width apart and lean forward. Let the affected arm hang down and swing it in small circular motions. Continue for 30 to 60 seconds. As your condition improves, you can try increasing the diameter of the circular swing or try holding a lightweight object in the swinging arm.

Towel Stretch

Grasp a rolled-up towel firmly with both hands behind your back. Use your good arm to slowly lift the affected arm upwards. You will feel a stretch in your shoulder. Do this 10 to 20 times a day.

Finger Walk

Stand three-quarters of an arm’s length away from the wall. Starting from waist level with your elbow slightly bent, slowly “walk” your fingers up the wall till your shoulder level, or as high as you can. Once the maximum height is reached, slowly lower the arm and repeat the process. Do this 10 to 20 times a day.

Cross-Body Reach

Stretch the affected arm out straight and bring it across your body. Hook your good arm under the affected arm and apply gentle pressure to stretch the shoulder. Hold this position for 20 seconds. Do this 10 to 20 times a day.

Remember that these exercises should only be performed after evaluation by a qualified medical professional. Should you experience any pain or discomfort while doing the above exercises, stop immediately.

Surgical Treatment

The surgeon’s knife is always the last option. However, if symptoms do not improve with therapy or other conservative methods, a well-performed surgery can be a function-restoring option. Remember to discuss with your doctor about the risks and benefits involved in surgery and the post-surgery recovery plan. Shoulder Arthroscopic Capsular Release and Manipulation is a common procedure performed for recalcitrant frozen shoulders.

Shoulder Arthroscopy (Key-Hole) Capsular Release and Manipulation

By the time the patient with a frozen shoulder has reached this stage of treatment, the shoulder is likely to have undergone and failed other less invasive treatment methods.

This is often due to the severity of inflammation and scarring that is within the affected shoulder joint.

It is this inflammation and scarring condition that a surgical option addresses.

Under general anaesthesia, a minimally invasive keyhole surgery is performed with small incisions. A small arthroscope camera, in combination with arthroscopic instruments are used to safely and carefully release the scarred tissue trapping the shoulder and to reduce the inflammation.

Having safely released the scarred and inflamed tissue, gentle manipulation of the shoulder through its range of motion is performed.

After surgery, compliance to physical therapy is necessary in order to maintain the motion that was achieved with surgery. This duration will vary, but if done consistently and properly, your shoulder should be able to achieve a normal range of motion again.

In patients who have been suffering from this condition, such a keyhole surgery offers a much needed relief and more predictable return to function.

How Will I Know If I Have A Frozen Shoulder?

If you suspect that you have a frozen shoulder, see a shoulder specialist as soon as possible to get a diagnosis.

A physical examination conducted by a doctor is usually necessary for diagnosing a frozen shoulder. The simple test involves a doctor carefully moving your shoulder in various directions to determine if pain occurs with the motion and thus evaluating the severity of the condition.

This range of motion is known as the “passive range of motion”. When you move your shoulder on your own, you are exhibiting the “active range of motion”. It is normal for people to display a limited range of motion both passively and actively when they have a frozen shoulder.

Other imaging tests such as X-ray or Magnetic Resonance Imaging (MRI) may be required to rule out other possible conditions that are causing stiffness and pain in your shoulder.

What Should I Do If I Have A Frozen Shoulder?

If you are in doubt over whether you have a frozen shoulder or not, contact an orthopaedic surgeon in Singapore who specializes in shoulder conditions to get a thorough assessment and to determine if you are truly suffering from frozen shoulder. Furthermore, consulting a doctor will ease any worries and concerns you may have regarding this condition.

Frequently Asked Questions About Frozen Shoulder

If you are in doubt over whether you have a frozen shoulder or not, contact an orthopaedic shoulder specialist to get a thorough assessment and to determine if you are truly suffering from frozen shoulder. Furthermore, consulting a doctor will ease any worries and concerns you may have regarding this condition.

Can I get a frozen shoulder twice?

Yes, but it rarely occurs in the same shoulder. Once you’ve had it on one side, you have a 50% chance of recurrence in the opposite shoulder.

After a frozen shoulder, is it possible to achieve a full range of motion again?

Most people who have recovered from a frozen shoulder report that they do get their full range of motion back.

How long is the recovery period for a frozen shoulder?

The timeline for recovery varies depending on the treatment approach. Full recovery for this condition may even take up to 3 years. Nonetheless, physical therapy remains the primary treatment method recommended to patients, focusing mainly on shoulder flexibility.

However, if the shoulder inflammation and scarring is severe, a well performed keyhole surgery may offer an option with a more predictable and shorter recovery time.

It is important for patients to understand that the recovery journey may be slow and tedious. Commitment to therapy remains crucial in ensuring complete recovery.

Conclusion

In a nutshell, a frozen shoulder is not as scary as it seems to be. It is a condition that will go away eventually with the right type of treatment. There are usually no hard and fast rules when it comes to treating your frozen shoulder.

Depending on the severity of your condition, a treatment method will be carefully selected by your orthopaedic surgeon.

Most patients gradually find complete relief of pain and experience a normal range of motion in the shoulder joint after going through physiotherapy. Surgery is an available option if medication and physiotherapy does not produce a satisfactory outcome. Don’t let your frozen shoulder hinder your daily activities, and seek medical advice early to avoid complications.