Symptoms and Causes of Frozen Shoulder and Shoulder Instability

In this issue on sports injuries, physiotherapist Gerda de Jong shares more on the symptoms and causes of a Frozen Shoulder and Shoulder Instability.

Physiotherapist Gerda de Jong provided some tips on how to prevent shoulder impingement syndrome in the previous article on sports injury. In this issue, she will share about frozen shoulder and shoulder instability.

What is a Frozen Shoulder?

A frozen shoulder (or adhesive capsulitis) is characterised by progressively worsening of pain and stiffness in the shoulder. Pain is felt in the shoulder and often also in the upper arm and the muscles surrounding the shoulder joint. Pain may be worse at night, making it difficult to sleep.

It is not clear what causes a frozen shoulder, although certain factors may put you more at risk. For example, if you have had a recent injury that made it difficult to move your shoulder, such as a broken arm or a stroke, you have a higher risk of getting a frozen shoulder. Also, certain illnesses, like diabetes or Parkinson’s disease, may put you at greater risk.

(Image: Mayoclinic) Frozen shoulder occurs when the capsule of connective tissues at the shoulder joint becomes inflamed, restricting its movement.
(Image: Mayo Clinic) Frozen shoulder occurs when the capsule of connective tissues at the shoulder joint becomes inflamed, restricting its movement.

The disease process for frozen shoulder consists of three phases:

  1. the “freezing” phase – where the pain and stiffness get progressively worse and limit your movements;
  2. the “frozen” phase – where the pain slowly subsides but the limitation in movement remains. It may be hard to perform activities of daily living, such as dressing and bathing.
  3. the final phase is the “thawing” phase – where the range of movement slowly improves.

It can take several years to recover from a frozen shoulder and not everyone regains the full range of movement. Your doctor may prescribe you medication to ease the pain and inflammation. A physiotherapist can help you with exercises that will improve your range of motion and regain full use of your shoulder faster. In later stages, as the pain subsides, exercises intended to re-build strength will be added.

Injuries that prevent you from moving your shoulder are the most common cause of frozen shoulder. Ask a physiotherapist to show you exercises that can mobilise your shoulder and thus help prevent this condition to occur.

What is Shoulder Instability?

The shoulder is the most movable joint in the body. It helps to lift the arm and rotate it in almost any direction. This makes it a very complex joint, and frequently the site of pain or injury. If you regularly feel looseness within the shoulder joint, and that your shoulder slips partially out of place and then back into place, you may have what is known as shoulder instability.

Shoulder instability can happen suddenly, for instance, when the shoulder is dislocated after a fall. It can also happen slowly as the ligaments surrounding the joints are overstretched repeatedly. This is often the case for athletes who perform certain overhead shoulder movements, like baseball players. In this case, the instability is caused by loose ligaments.

(Image: Orthogate) Shoulder instability happens when the shoulder joint is loose and is able to slide around or out of the socket.
(Image: Orthogate) Shoulder instability happens when the shoulder joint is loose and is able to slide around or out of the socket.

If brought on by a fall or other trauma, you may need to avoid lifting your shoulder for the first 3-6 weeks. See your doctor. Strengthening the muscles surrounding your shoulder is an important part of the recovery that will help prevent further (partial) dislocations and alleviate pain. A physiotherapist or occupational therapist can help to teach you the appropriate exercises.

Shoulder pain can be extremely uncomfortable. Help prevent dislocations and other injuries by wearing protective gear when playing sports and exercise regularly to keep the muscles and joints of your shoulder strong and flexible. Don’t allow the pain to keep you from doing the activities you enjoy!

 

References:

  1.  What Is a Frozen Shoulder?, WebMD
  2. Frozen shoulder, Mayo Clinic
  3. Physiotherapy treatment for atraumatic recurrent shoulder instability: Updated results of the Derby Shoulder Instability Rehabilitation Programme, Marcus Bateman, Sally E. Osborne, Benjamin E. Smith, Journal of Arthroscopy and Joint Surgery, 2019
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