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Shoulder problems can be very painful and debilitating but luckily are rarely serious and in most cases amenable to treatment. They can be roughly split into five categories.
Frozen Shoulder Syndrome (Adhesive Capsulitis)
Sub Acromial Impingement Syndrome (Rotator Cuff)
Biceps Tendonitis
Instability
Other (such as Osteoarthritis)
Frozen Shoulder Syndrome (Adhesive Capsulitis)
Can be a very painful and debilitating condition that presents as stiffness in all directions of movement and pain around the shoulder that can radiate to the upper arm, which can also be present at night. It normally resolves within two to three years without treatment.
The cause is unknown and can appear gradually for no apparent reason but it may also be the result of trauma, immobility or surgery. It mainly affects those over the age of 40 and slightly more women than men. If you have diabetes you are five times more likely to suffer. It most commonly presents in the non-dominant arm.
The early evidence for the use of osteopathy is encouraging. Osteopathic treatment for this condition usually involves deep soft tissue techniques, articulation and exercise prescription. This study compared Osteopathy, Physiotherapy and placebo over a twelve week period and involved 27 participants. It showed a significant increase in range of movement and reported decrease in pain by 80% for the osteopathy group.
Increase in range of movement
Osteopathy 52.6 degrees of improvement
Physiotherapy 24 degrees of improvement
Placebo 0.8 degrees of improvement
Improvement in pain
Osteopathy 38.7 point improvement
Physiotherapy 19.9 point improvement
Placebo 22.8 point improvement
It is normally done over a period of approximately two to three months. This significantly reduces the usual recovery period of two to three years. More work is needed before we can say categorically that osteopathy can cure frozen shoulder but we are encouraged.
A copy of the published results can be found by clicking, Here
There are usually three distinct phases.
1. The Painful Phase The shoulder gradually begins to ache You may develop pain all round the shoulder, often worse at night and when lying on the affected side. This phase can last between 2-9 months without treatment.
2. The Stiffening Phase Your pain will normally stay the same. However, the stiffness starts to really affect your daily life and you may develop difficulty with normal daily activity, such as dressing and working. Muscle wastage may be evident due to lack of use. This phase can last between 4-12 months without treatment.
3. The Thawing Phase You should get a gradual increase in your range of movement and decrease in your pain, although it may change in nature as the range of movement increases. This phase can last between 5-12 months.
Sub Acromial Impingement Syndrome (Rotator Cuff)
This is a condition that is mostly caused by the tendons of four muscles, collectively called the rotator cuff. The tendon gets impinged between the top of the humerus (arm bone) and the bottom of the acromium process (part of the shoulder blade). It normally comes on after an injury but can be from repetitive micro trauma; especially if there is degeneration of the acromio-clavicular joint which is at the end of the collar bone. This can decrease the amount of space for the tendon. Occasionally it can be associated with multidirectional instability (see below). The pain is normally felt around the shoulder and the outside of the arm and is normally worse when lifting your arm above 90 degrees.
Biceps Tendonitis
Is exactly what it says: it is an inflammation of the biceps tendon. Again this is normally associated with an injury and the pain is normally felt at the front of the shoulder. It can be worse on bending the elbow and extending the shoulder when reaching back.
Instability
This is normally due to genetics, where the ligaments in the shoulder are looser than normal. This means you are much more reliant on the muscles to provide stability and if over used it can break down and sometimes cause other conditions such as impingent syndrome. Treatment would be focussed on the impingent syndrome whist giving advice and exercise to strengthen the shoulder muscles. If this fails there is a surgical option.
Other
There are many other conditions that affect the shoulder, such as osteo-arthritis. Although this is very rare in the shoulder itself it is quite common in the joint next to it, at the end on the collar bone, called the acromio-clavicular joint.