Saturday, March 26, 2011

Shoulder: arthritic or frozen?

There are three common conditions of the shoulder that are often confused: rotator cuff tear, shoulder arthritis and frozen shoulder. Shoulder stiffness is a common symptom of each of them. Shoulder stiffness is diagnosed as shown here.

A detailed discussion of rotator cuff problems can be found here.

A detailed discussion of shoulder arthritis can be found here. The reasons for stiffness in arthritis are shown here. The photo below shows an arthritic humeral head as seen at surgery.

A frozen shoulder is, like shoulder arthritis, one of the conditions that can result in a stiff shoulder. The difference is that in a frozen shoulder, the joint surfaces are normal and the shoulder motion is limited because the tissue around the joint - the joint capsule - has tightened down. Frozen shoulders are thought to arise from inflammation within the joint. Frozen shoulders can be particularly problematic in individuals with diabetes. It was once believed that frozen shoulder was associated with personality disorders, but recent evidence does not support this contention. We diagnose a frozen shoulder when the shoulder has limited motion, without a history of prior injury or surgery and with AP and Axillary x-rays showing a normal joint space as diagrammed below.

Frozen shoulders usually respond to home exercises.

Our basic approach to rehabilitation of a frozen shoulder is shown in the post on stretching (see this link) and in the post on strengthening (see this link)

If this is not successful, consideration can be given to a gentle manipulation under full muscle relaxation and anesthesia. If this is not successful an arthroscopic or open surgical release of the tight capsule can be considered.

You can support cutting edge shoulder research that is leading to better care for patients with shoulder problems, click on this link.

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Here are some videos that are of shoulder interest
Shoulder arthritis - what you need to know (see this link).
How to x-ray the shoulder (see this link).
The ream and run procedure (see this link).
The total shoulder arthroplasty (see this link).
The cuff tear arthropathy arthroplasty (see this link).
The reverse total shoulder arthroplasty (see this link).
The smooth and move procedure for irreparable rotator cuff tears (see this link).
Shoulder rehabilitation exercises (see this link).