Frozen Shoulder:Over View

Frozen shoulder, also known as adhesive capsulitis, is a common, painful condition that affects the ability to move the shoulder.
Frozen shoulder reduces normal movement in the joint and, in some cases, it can prevent movement in the shoulder altogether.
Pain and stiffness in the shoulder are the most common symptoms of a frozen shoulder. See Frozen shoulder - symptoms for more details.

How Common Is Frozen Shoulder?

Most cases of frozen shoulder occur in people between the ages of 40 and 60. The condition is more common in women than men. It is estimated that a frozen shoulder could affect up to 1 in 20 people.
The exact cause of frozen shoulder is not fully understood, although it appears to be more common in people with certain health conditions, such as diabetes (a long-term condition that is caused by too much glucose in the blood).

Outlook

There are several different forms of treatment for frozen shoulder, including:

• Painkillers
• Physiotherapy, where physical methods are used to promote healing
• Surgery

Recovery from a frozen shoulder can be slow and the symptoms can last for several years. However, most people with the condition eventually regain full movement in their shoulder.
If you have frozen shoulder, only one shoulder will usually be affected, although the condition can sometimes spread to the other shoulder. A frozen shoulder is not related to arthritis and other joints are not affected.

Neck Pain Or A Stiff Neck

Usually, the pain or stiffness gets better after a few days 

While this site is mainly concerned with dealing with backache I thought it a good idea to include some info on Neck Pain,Shoulder Pain,what causes it,and how to treat it.





Neck pain or a stiff neck is a common complaint and generally nothing to worry about.
Usually, the pain or stiffness gets better after a few days and is not a sign of any neck problem or serious underlying condition.
Neck pain or a stiff neck can result from a sprain after bending your neck into an abnormal position (for example, by sleeping on too many pillows), from poor posture, or even from sitting in a draught for too long.
But often, there is no obvious cause and doctors will refer to it as 'non-specific'.

This Page Covers:

• Managing your neck pain or neck stiffness at home
• When to see your GP
• A twisted or locked neck
• Problems with the nerves or bones in your neck

Back pain, shoulder pain and whiplash (neck injury) are covered in separate topics.

Managing Neck Pain Or A Stiff Neck At Home

Whatever the cause of neck pain or a stiff neck, the advice is generally the same:

• Carry on with your normal lifestyle, 
• keep active and take painkillers to relieve the symptoms.

See More Specific Advice Below. 

• Take regular doses of paracetamol, ibuprofen or a combination of the two to control pain. Ibuprofen gel can be rubbed onto the neck as an alternative to tablets. Always follow the dosage instructions on the packet.
• Try holding a hot water bottle or heat pack to your neck to reduce any pain and muscle spasms.
• Sleep on a low, firm pillow at night. Avoid using two pillows as this may force your neck to bend unnaturally.
• Check your posture, as this can aggravate the pain and may have caused it in the first place – see How to sit correctly.
• Avoid wearing a neck collar – there is no evidence that this will help to heal your neck, and it is better to keep the neck mobile. If you must wear one to make your neck more comfortable, do not wear it for more than 48 hours.
• Avoid driving until the pain and stiffness have gone, as you will not be able to turn your head to view traffic.
• If your neck is stiff or twisted, try some simple exercises within your comfort zone – gently tense your neck muscles as you tilt your head down and up and from side to side, and as you carefully twist your neck from left to right. These exercises will help to strengthen your neck muscles and improve your range of movement.

When To See Your GP

See your GP if the pain or stiffness does not seem to be getting better after a few days and you are worried, or if you cannot control the pain with ordinary painkillers. Your GP will examine your neck and ask questions to rule out any serious underlying condition, and may prescribe you a stronger painkiller, such as codeine, to take along with your usual over-the-counter painkillers.

If the pain or stiffness has persisted for a few weeks, ask your GP to refer you to a physiotherapist. There is no agreed scientific evidence that chiropractic or acupuncture are effective treatments for neck pain or a stiff neck.

If your symptoms do not improve, you should ask your GP to consider referring you to a specialist or pain clinic for painkilling injections. For more information and advice on persistent pain, see:Ten Self Help Tips For Pain management

A Twisted Or Locked Neck

Some people suddenly wake up one morning to find their neck twisted to one side and stuck in that position. This is known as acute torticollis. Any attempts to move the neck will cause sharp pain.

Torticollis can occur after long exposure to a cold draught, or after your neck has been in an unusual position. See your GP for treatment, and to rule out any serious underlying cause. Acute torticollis can take up to a week to get better, but usually only lasts 24-48 hours. Manage your pain at home by following the advice above.

Nerve Or Bone Problems In The Neck

Sometimes, neck pain may be caused by the general ‘wear and tear’ that occurs on the joints and bones in your neck. This is called cervical spondylosis, and is a type of arthritis.

It is important to note that cervical spondylosis happens naturally as people get older, and it often causes no symptoms. But for an unfortunate few people, the bone changes can cause stiffness in the neck and can sometimes squash the nearby nerves, leading to pain that radiates from the arms, pins and needles and numbness in the hands and legs. 

Neck pain caused by a squashed nerve is known as cervical radiculopathy. It is not always the result of cervical spondylosis – it may sometimes occur after your neck has been held in an awkward position or twisted, if you have twisted or bent your body abnormally, or after your hand and arm has been vibrating (e.g. after using power tools).

Pain can be controlled by following the advice above, but if your pain has lasted for more than four weeks you may be referred for an MRI scan to investigate the problem with your neck. Talk to your GP about being referred for pain management (see When to see your GP, above).

Treating Shoulder Pain Part 2

 Treating Shoulder Pain:Part 2

Corticosteroid Injections

If your shoulder pain is very severe, such as in certain cases of frozen shoulder, painkillers may not be enough to control the pain. In this case, you may have corticosteroids injected into and around your shoulder joint.
Corticosteroid injections can help to relieve the pain that is caused by frozen shoulder and increase your range of movement for several weeks at a time, particularly during the first stage of symptoms. However, the injections cannot cure your condition completely, and your symptoms will gradually return.
Research also suggests that corticosteroid injections can provide pain relief for up to eight weeks for tendonitis (inflammation of a tendon). They may also improve your ability to use your shoulder, although they may not be as effective as some other treatments, such as NSAIDs.
One study found that corticosteroid injections may be most effective if they are used within 12 weeks of tendonitis symptoms starting. However, some experts believe that the use of corticosteroid injections should be delayed for as long as possible.

Cautions

After having a corticosteroid injection, you may experience a number of side effects at the site of the injection.
Possible side effects can include:

• Temporary pain
• Depigmentation – when your skin becomes lighter 
• Skin atrophy – when your skin becomes thinner as some of the skin cells waste away

Having too many corticosteroid injections can damage your shoulder. Therefore, you may only be able to have this treatment up to three times in the same shoulder in one year.


Hyaluronate Injections

Hyaluronate is another medicine that can be injected into your shoulder to treat shoulder pain. One review of a number of studies found that hyaluronate was effective at reducing pain.
However, the National Institute for Health and Clinical Excellence (NICE) does not recommend hyaluronate to treat osteoarthritis (a condition that affects the joints). It found that hyaluronate only had small benefit and that corticosteroid injections were a better treatment choice. Therefore, hyaluronate may not be used.

Physiotherapy

Physiotherapy, often referred to as physio, uses a number of different physical methods to promote healing. If you are referred to a physiotherapist, they should explain to you what treatment they will use and how it will work. Possible treatments include:

• Massage – where the physiotherapist uses their hands to manipulate your shoulder
• Laser therapy – where the energy from lasers (narrow beams of light) are used to stimulate your nervous system and reduce pain  
• Transcutaneous electrical nerve stimulation (TENS)

TENS is a type of physiotherapy where small electrical pads (electrodes) are applied to the skin over your shoulder. The TENS machines delivers small pulses of electricity through the electrodes, which numb the nerve endings and control your pain.
As well as these treatment methods, your physiotherapist may also recommend shoulder exercises. These will be specific for your needs. For example, if you have shoulder instability, you may be given exercises that will strengthen your shoulder.

Shoulder Exercises

If you have shoulder pain, it is important to keep your shoulder joint mobile by doing gentle, regular exercise. Not using your shoulder can cause your muscles to waste away and may make any stiffness worse. Therefore, if possible, you should continue using your shoulder as normal.
If your shoulder is very stiff, exercise may be painful. Your GP or physiotherapist can give you some exercises that you can do without further damaging your shoulder.
You may be given exercises to carry out on your own or you may complete the exercises with supervision from your GP or physiotherapist. You may also have manual therapy, which is when the healthcare professional moves your arm for you. Manual therapy uses special techniques to move the joints and soft tissues in your shoulder.
One review of a number of studies found that long-term physiotherapy was equally as effective as surgery for impingement syndrome (any type of damage to the tendons in the rotator cuff).

Surgery For Frozen Shoulder

If other treatments for frozen shoulder have not worked, you may be referred for surgery. There are two possible surgical procedures, which are explained in more detail below.

Manipulation

Manipulation involves having your shoulder moved while you are under general anaesthetic. General anaesthetic is a painkilling medication that makes you unconscious. During the procedure, your shoulder will be gently moved and stretched while you are asleep.
Afterwards, you will usually need to have physiotherapy to help maintain mobility in your shoulder. Manipulation may be used if you are finding the pain and disability from your shoulder difficult to cope with.

Arthroscopic Capsular Release

An alternative procedure to manipulation is arthroscopic capsular release. This is a type of keyhole, or non-invasive, surgery. The surgeon will carry out the procedure after making an incision (cut) that is less than 1cm (0.4in) long.
During arthroscopic capsular release surgery, your surgeon will use a special probe to open up your contracted shoulder capsule. They will then remove any bands of scar tissue that have formed in your shoulder capsule, which should greatly improve your symptoms.
As with manipulation, you will need to have physiotherapy after arthroscopic capsular release surgery. This will help you regain a full range of movement in your shoulder joint.

Surgery For A Rotator Cuff Tear

Surgery may be used to treat rotator cuff tears if the tear is very large or if other treatment options have not worked after three to six months. It is possible that having surgery earlier will lead to a quicker recovery, although at the moment there is not enough research into whether early surgery is beneficial or not.
During the procedure, a small amount of bone may be shaved off the bones in your shoulder. Damaged tendons and bursae (fluid-filled sacs that are found over joints and between tendons and bones) may also be removed. This creates more space within the joint to allow your rotator cuff to move freely.

The Operation Can Be Performed As:

• Open surgery – a large incision is made in your shoulder
• Mini-open surgery – a small incision is made in your shoulder 
• Arthroscopic surgery – a type of keyhole surgery that uses a camera to look inside your shoulder joint

Evidence suggests that people return to work about a month earlier if they have mini-open surgery rather than open surgery.
As with frozen shoulder surgery, you will need to have physiotherapy after your operation to help you regain a full range of movement in your shoulder joint.

Surgery For Shoulder Instability

If your shoulder dislocates (the ball comes out of the socket) regularly or severely, you may need to have surgery to prevent it happening again and to prevent the surrounding tissues and nerves from becoming damaged. Depending on the type of instability that you have, surgery may involve:

• Tightening stretched ligaments or reattaching them if they have torn – ligaments are tough bands of connective tissue that link two bones together at a joint
• Tightening the shoulder capsule by using heat to shrink it or tightening it with sutures (stitches)

Surgery for shoulder instability can either be done using keyhole or open surgery. After the operation, your shoulder will need to be immobilised (prevented from moving) using a special sling for several weeks. You will also need to have physiotherapy to improve your strength. Full recovery may take a number of months.

Read Part 1 Here

Frozen Shoulder:Symptoms

A frozen shoulder is a painful, persistent stiffness of the shoulder joint, which makes it very difficult to carry out the full range of normal shoulder movements.





You May Find It Difficult To Carry Out Everyday Tasks, Such As:

• Dressing
• Driving
• Sleeping comfortably

Some people find they are unable to move their shoulder at all, which is why the condition is known as a frozen shoulder.

Stages Of Frozen Shoulder

The symptoms of a frozen shoulder advance slowly and are usually experienced in three separate stages that are spread over a number of months or years. However, the symptoms of frozen shoulder can vary greatly from person to person.
The three stages of frozen shoulder are described below.

Stage One

During stage one, your shoulder will start to ache and will feel stiff before becoming very painful. The pain is often worse at night and when you lie on the affected side. This stage lasts two to nine months.

Stage Two

Stage two is known as the adhesive stage. Your shoulder may become increasingly stiff, but the pain will not usually get worse. Your shoulder muscles may start to waste slightly because they are not being used. This stage lasts four to twelve months.

Stage Three

Stage three is the recovery stage. During this stage, you will gradually regain movement in your shoulder. The pain will begin to fade, although it may recur from time to time as the stiffness eases.
Although you may not regain full movement of your shoulder, you will be able to do many more tasks. Stage three can last five months to three or four years.

Shoulder Pain:Over View

Shoulder pain is a symptom rather than a condition in itself

Shoulder pain is a symptom rather than a condition in itself. Shoulder disorders are the most common causes of shoulder pain.


Examples Of Shoulder Disorders Include:

• Frozen shoulder – a painful condition that reduces normal movement in the joint and can sometimes prevent movement in the shoulder altogether 
• Rotator cuff disorders – the rotator cuff is a group of muscles and tendons that surround the shoulder joint and help to keep it stable 
• Shoulder instability – where the shoulder is unstable and has an unusually large range of movement (hypermobility) 
• Acromioclavicular joint disorders – conditions that affect the acromioclavicular joint, which is the joint at the top of the shoulder

How Common Are Shoulder Disorders?

• Shoulder disorders are fairly common. About 3 in 10 adults are affected by these types of conditions at any one time.
• Frozen shoulder and rotator cuff disorders are most common in middle-aged and older people. 
• Shoulder instability and acromioclavicular joint disorders tend to affect younger people, particularly men who play certain sports.

For Example:

Sports that involve repetitive shoulder movements, such as overarm bowling or throwing
contact sports, such as rugby, where you may injure or fall on your shoulder

Outlook

Shoulder pain can be a long-term problem. Up to half of people still have symptoms after 18 months. It is therefore important to obtain the correct diagnosis so that you can receive effective treatment for your symptoms.
Several treatment options are available for shoulder pain. They include:
painkillers – such a paracetamol
physiotherapy – where physical methods, such as massage and manipulation, are used to promote healing
injections of corticosteroids – corticosteroids are a type of medication that contain hormones
surgery (in some cases)