Frozen shoulder is the term commonly used to describe persistent shoulder pain and restricted movement. However, shoulder problems are often misdiagnosed and as with any other joint problem, the success of any treatment depends on correct diagnosis and cooperation between patient and practitioner.

The purpose of this information sheet is to clarify some common misconceptions of shoulder problems.

What is a frozen shoulder?

Frozen shoulder refers to loss of arm movement at the shoulder joint combined with inflammation of the tissues within the joint capsule that surrounds the shoulder. These tissues become thickened and shortened and eventually “stick” together, hence the medical term, adhesive capulitis.

What are the symptoms?

Initially, there is progressive limitation of all movements of the shoulder. This may follow a recent minor trauma, dislocation, prolonged immobilisation, heart attack (myocardial infarction) and sometimes neck problems (cervical radicultis). Pain may or may not accompany this, although pain will be felt if you try to exceed the limited movement. This stage is sometimes referred to as the “freezing” stage.

Eventually, the condition progresses until all movement is greatly restricted “frozen” stage. Usually, no pain is felt at this stage. The reverse of this process occurs during the recovery, when pain is again experienced but once movement is restored, the pain diminishes.

Early diagnosis is vital because the condition is reversible. Once it has progressed into the adhesive/frozen stage, some persistent restriction may remain. The recovery period varies depending on how long the problem has been there and the severity of it.

Rotator cuff tendonitis/ Tear

The rotator cuff muscles play an important role in the movement of the shoulder. They consist of the supraspinatus, infraspinatus and teres minor muscles. The rotator cuff tendon is a major source of pain and disability. If it becomes inflamed (tendonitis) or torn, voluntary abduction, elevation and rotation of the shoulder is lost.

However, the practitioner will be able to move the shoulder noting only a slight loss in movement due to pain. Whereas with frozen shoulder, the practitioner will not be able to move the joint. Rotator cuff muscle pain is usually due to trauma of overuse movements

Bursitis

Bursas are fluid filled sacs that surround certain joints of the body and act to prevent excess friction between tissues and/or bony surfaces.

In the shoulder, you will find the sub deltoid bursa that lies underneath the deltoid muscles (these muscles make the rounded shape of the shoulder/arm). The bursa can become inflamed or pinched which in turn will produce pain in some limited and heat production may be felt.

Cervical Referral

When joints become fixated and irritated in the lower part of the neck, pressure may occur on the surrounding nerve fibres. These nerves supply information to the muscles of the shoulder and if these nerves become spasmed and weakened and movement will become limited. There is no actual damage to the shoulder joint itself and no voluntary decrease in movement will be experienced.

Other causes of shoulder pain…

Obviously, fractures and dislocation will cause pain but, due to the severity of these problems, they are treated at the A&E departments in hospitals.

Arthritis of the shoulder joint, natural wear and tear will produce shoulder pain but usually you will have experienced previous problems.

Gall bladder inflammation (cholecystitis) can refer pain into the right shoulder joint but with no loss in actual movement of the shoulder joint.

Heart attacks can refer pain into the left shoulder and arm.  

Treatment

When the cause of the shoulder problem has been established, the appropriate treatment can be initiated. This can range from chiropractic adjustments and mobilisation, icing, rest, modality use (ultra sound and interferential machines) and eventually exercise to improve movement and strength.

How long you decide to benefit from chiropractic care is, of course, always up to you, but for effective long term results, always follow the chiropractor’s recommendations.