The Stiff Shoulder

There are many causes for stiffness in the shoulder - ranging from the common frozen shoulder or adhesive capsulitis to the rare disorders of collagen metabolism that tend to affect multiple joints at once

Frozen shoulder is a condition of no clearly identified cause that tends to affect the movements of the shoulder in a global way - with reductions of all the directions and ranges of movement.

Studies estimate that frozen shoulder or adhesive capsulitis can affect about one person in every forty at some point in their lives - and women make up about seventy percent of the frozen shoulder patient group.

The other interesting aspect (and very annoying if it's you who has the problem) is that about one in five people with frozen shoulder get it again later in the opposite shoulder.

 Several diseases and conditions have been found to be related to frozen shoulder or adhesive capsulitis. They include:

• female gender
• diabetes - particularly insulin dependent diabetes
• underactive thyroid
• auto-immune disease like SLE or Rheumatoid Arthritis
• Prolonged immobilisation - for example after injury or illness
• trauma to the shoulder or the chest wall
• age more than forty
• recent heart attack
• recent stroke
• recent head injury

Patients with insulin dependent diabetes sometimes get adhesive capsulitis in both shoulders at the same time - and they find that normal treatments are less likely to work. They often take much longer than others to get fully better.

Until recent times the underlying cause for a frozen shoulder was not understood - and to be truthful there are still several different theories around.

What follows seem like the most likely causes - but it may well be that we realise later that more than one aspect is going on at the same time.

Even with current advanced techniques, research scientists have failed to find good evidence to back up some of the theories listed.

Some believe that the condition is due to an auto-immune reaction but the evidence against that is that blood tests have failed to show signs of autoimmune disease in those who have a frozen shoulder. And also - why should it only be the shoulder that is affected if their is a whole body autoimmune reaction going on?

Others suggest that the problem is triggered by transient infection or by crystals like gout - on the down side of this theory is that no evidence for this has ever been found in the shoulder joints.

Other scientists have suggested that the problem is a form of arthritis, related to trauma or to degeneration in the joint or tendons of the rotator cuff, related to problems with collagen or fibrin enzymes, or even, in one study that it is "all in the head" or psychogenic. It's important to emphasise that no supportive evidence has been found for any of these theories.

In truth, we still really don't know what the trigger is for this mysterious condition.

 Not all stiff shoulders are due to adhesive capsulitis or frozen shoulder

Here's a list of other conditions that can result in stiffness of the shoudler

• parkinsons disease
• head or brain injury
• trapped nerves in the neck
• some forms of motor neurone disease
• stroke
• polio
• heart attack
• tuberculosis
• lung cancer
• polymyalgia rheumatica
• some medications
• bursitis of the shoulder
• rotator cuff tear at the shoulder
• calcium in the muscles or tendons
• shoulder joint instability
• and a list of about thirty other possibilities

I hope you'll realise from the list above exactly why it's always important to seek advice from a doctor before a diagnosis is made. You should never attempt to diagnose your own shoulder pain.

It's a general rule in medicine that - whenever there's a long list of possible treatments for any one condition - you can reasonably deduce that none of them are guaranteed to be effective! If one treatment always worked well then the others would fall from common use and would just disappear into history.

The list below includes most of the common treatments for frozen shoulder. There are other options but the ones below make up the treatment plan for nearly all cases.

1. Keep it until it gets better - many frozen shoulder patients simply need an explanation and reassurancet that there is nothing too serious amiss
2. Home physiotherapy with stretches or exercises
3. Supervised physical therapy in a hospital or health centre setting
4. NSAID anti-inflammatory drugs like ibuprofen, diclofenac or naproxen
5. Oral steroid tablets
6. Steroid injection treatments
7. Heat, Ultrasound treatment, Laser Treatment, Infrared treatment, Shockwave treatment, Acupuncture
8. Distension Arthrogram - sometimes called hydrodistension or hydrodilatation
9. Manipulation under anesthesia
10. Open surgical release of adhesions
11. Arthroscopic surgical release of adhesions
12. Combinations of several of the above - either at once or in sequence

Again - the best approach for anyone who has a frozen shoulder is to sit down with a specialist doctor and discuss what would work best for their own particular case. The decision will be based on the actual findings in their shoulder, on the results of scans or blood tests, on their past medical history, on their current medical history including any medications they may be taking - and on a whole range of other important issues.

 The above article was written by Doctor Gordon Cameron - it only really scratches the surface of the available knowledge about Frozen Shoulder.

You can discover much more about the subject on Doctor Cameron's frozen shoulder website - where you can also download an 85 page ebook on the subject.