Frozen Shoulder

Have you ever been working out at the gym, pushing a heavy weight and heard a popping sound in your shoulder. Or what about skiing down the slopes, and landing shoulder first in the snow at the bottom. Or maybe just having a friendly game of tennis, when all of a sudden there's a sharp pain in your shoulder.

These are all signs of the same thing; a shoulder injury. Whether you want to call it a frozen shoulder, a rotator cuff tear or tendinitis shoulder, it's really all the same. A tear or strain in the rotator cuff muscles and tendons.

The shoulder joint is a truly remarkable creation. It's quite a complex formation of bones, muscles and tendons and provides a great range of motion for your arm. The only downside to this extensive range of motion is a lack of stability, which can make the shoulder joint vulnerable to injury.

Lets have a quick look at the shoulder joint in a little more detail. The shoulder is made up of three bones, and the tendons of four muscles. (Remember, tendons attach muscle to bone.) The bones are called the "Scapula," the "Humerus" and the "Clavicle." Or, in layman's terms, the shoulder blade, the upper arm bone and the collarbone, respectively.

The four muscles which make up the shoulder joint are called, the "Supraspinatus," the "Infraspinatus," the "Teres Minor" and the "Subscapularis." It is the tendons of these muscles, which connect to the bones, that help to move your arm.

In the picture to the right, three of the four muscles are visible, the supraspinatus, the infraspinatus and the teres minor. These are the muscles which are viewed from the rear, or posterior. The subscapularis is not visible because it can only be viewed from the front, or anterior and this particular view only shows the muscles from the rear, is if looking at someone's back. Anyway, enough of the technical stuff.

Causes

There are two major causes of most shoulder injuries. The first being degeneration, or general wear and tear. Unfortunately, the shoulder is a tendinous area that receives very little blood supply. The tendons of the rotator cuff muscles receive very little oxygen and nutrients from blood supply, and as a result are especially vulnerable to degeneration with aging. This is why shoulder problems in the elderly are common. This lack of blood supply is also the reason why a shoulder injury can take quite a lot of time to heal.

The second cause of most shoulder injuries is due to excessive force, or simply putting too much strain on the tendons of the shoulder muscles. This usually occurs when you try to lift something that is too heavy or when a force is applied to the arm while it's in an unusual or awkward position.

Symptoms

There are two common symptoms of a shoulder injury, pain and weakness. Pain is not always felt when a shoulder injury occurs, however most people who do feel pain, report that it's a very vague pain which can be hard to pinpoint.

Weakness, on the other hand, seems to be the most reliable symptom of a shoulder injury. Common complaints include an inability to raise your arm above your head or to extend your arm directly to the side or in front. In most cases, the larger the tear or damage to the tendons, the harder it is to move your arm and the injured area.

Treatment

The earlier a shoulder injury is treated, the better. The first 48 to 72 hours are crucial to a complete and speedy recovery. The first and most important course of action is the R.I.C.E.R. regime. Rest, Ice, Compression, Elevation and Referral. For the time-being, I'm not going to go into the specifics of the R.I.C.E.R. regime. It's a very important topic and I've decided to dedicate the entire next months issue to it.

After the initial injury has been treated with the R.I.C.E.R. regime, (for at least 48 to 72 hours) it's time to move onto the next stage of treatment. As mentioned before, the shoulder joint receives very little blood supply. So, what can you do to increase blood flow, and oxygen and nutrients to the injured area?

Firstly, heat! Heat is extremely good for increasing blood flow to a particular area. Heat lamps are the most effective way to increase blood flow, while heat based creams are probably a distant second choice.

Secondly, massage! Massage is one of the best ways to increase blood flow to an injured area, and of course the oxygen and nutrients that go with it. The other benefit of massage is that it helps to reduce the amount of scar tissue which is associated with all muscle and tendon, strains and tears. (I'll also discuss scar tissue in next months issue along with the R.I.C.E.R. regime.)

Lastly, don't stop moving. Some doctors will often tell patients to keep the injured area still, and this is not always the best advice. Gentle movement will help to keep the blood flowing to the injured area. Of course, if pain is present, limit the amount of moving you do, but don't stop moving all together.

Prevention

Mark my words, "Prevention is much better than Cure." Anything you can do to prevent an injury from occurring is worth it. The prevention of shoulder injuries comes down the conditioning of the shoulder muscles and tendons, which ultimately involves both stretching and strengthening of the shoulder joint.

Also, don't forget the common injury prevention techniques like, warming up properly and using a bit of old-fashioned common-sense. However, for the most part, stretching and strengthening are going to be your best defence against shoulder problems. Even if you don't have a shoulder problem now, the following stretching and strengthening exercises could save you from a major headache in the future.

Firstly, below you'll find two good stretches for the shoulder area. The first is quite a basic stretch, while the second is a more advanced stretch, specifically for the rotator cuff muscles and tendons. Please be careful, if you haven't been stretching your shoulder joint, the second stretch will put quite a lot of stress on the rotator cuff tendons. Warm-up first, then gently and slowly is the best way to proceed.

In the stretch to the left, simply stand upright and clasp you hands behind your back. Keep your arms straight and slowly lift your hands upwards. Hold this stretch for about 15 to 20 seconds, then repeat it 3 to 4 times.

In the stretch to the right, stand with your arm out and your forearm pointing upwards at 90 degrees. Place a broom stick or pole in your hand and let it fall behind your elbow. With your other hand, pull the bottom of the stick forward. Be especially careful with this stretch, it will put a large strain on the rotator cuff muscles and tendons. As above hold this stretch for about 15 to 20 seconds, then repeat it 3 to 4 times.

Secondly, the strengthening exercises. Instead of me trying to explain these, I simply found a great web site that has clear pictures and a good description of the four most common shoulder exercises. These four exercises help to strengthen all of the muscles and tendons located in the shoulder joint. You can find these exercises at http://familydoctor.org/handouts/265.html

© 2003, Walkerbout Health. All rights reserved.
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Article by Brad Walker. Brad is a leading stretching and
sports injury consultant with over 15 years experience
in the health and fitness industry. For more articles
on the prevention & treatment of sports injury,
subscribe to The Stretching & Sports Injury Newsletter
by visiting http://www.thestretchinghandbook.com
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