OH MY STIFF SHOULDER! (Frozen Shoulder/Adhesive Capsulitis)

Does your shoulder…

hurt or pinch when you reach overhead or lift directly out to your side?

– ache or wake you up when you try sleeping on it?

– make it harder to reach behind your back to give it that good scratch up between your shoulder blades?

– hurt when you try and throw overarm?

– pinch or get sore after you do repetitive overhead activities like swimming, volleyball or tennis?

then these are all early indicators that your shoulder might be stiffening up.


The onset of these symptoms can be traumatic, for example after an acute athletic injury, a fall on an outstretched arm or a direct strain from lifting.  These types of symptoms may also present with a delayed onset, after a relatively simple shoulder strain or repetitive use months before, which you may have thought had nothing to do with the current pain.  Regardless of the onset, if you’re feeling these types of symptoms and pain, your shoulder is telling you: it’s starting to get in trouble.

Shoulder injuries tend to progress in a gradual continuum; starting with painful pinching with overhead movements (impingement) to loss of strength and pain with lifting and increasing pain with repetitive overhead sports (bursitis/tendonitis) to a partial loss of movement to an eventual significant loss of movement or full blown frozen shoulder (adhesive capsulitis).

Once your shoulder starts to freeze up, you will see a progressive loss of motion in all planes of movement.  Initially, you will notice that it’s painful when you reach overhead or out to your side and gradually that you can no longer reach behind your back.  In advanced cases, this stiffness can progress to the point that even doing simple tasks like combing your hair and putting on or taking off your shirt becomes restricted and painful.  By this stage you can forget about sleeping on your sore side because it’s just too painful!  Typically, this continuum of shoulder pain and stiffness can be so gradual that by the time you decide to do something about it your shoulder has become really stiff.

The good news is that the Doctors at IMUA Orthopedics, Sports & Health are experts in helping you fix any painful condition of your ailing shoulder.

As an orthopedic surgeon, Dr. Ignacio has advanced training in diagnosing and treating all painful conditions of the shoulder.  A comprehensive examination to test the stability and integrity of your shoulder will be performed.  X-ray is usually indicated to identify any bony or structural problems.   Imaging studies (MRI) may also be indicated to rule out a tear in the rotator cuff (supporting muscles of the shoulder) or damage to any of the internal structures of your shoulder complex.

A shoulder injection can often prove to be helpful.  If your shoulder is in the impingement or tendonitis phase, a well-placed steroid (cortisone) shot can significantly reduce the inflammation allowing for quicker recovery.  If the shoulder injection is helpful at first, but the pain quickly returns, then this could be diagnostic of a more serious problem.

Although frozen shoulder (adhesive capsulitis) itself is not an indication for surgery, you may have underlying damage to the rotator cuff or internal structures of the shoulder that led to your shoulder stiffness and pain in the first place.  If you do require surgery, don’t worry you are in good hands.  In addition to being board certified in orthopedic surgery, Dr. Ignacio has advanced training in arthroscopic surgery of the shoulder, which is clinically proven to give the best surgical outcomes, with the shortest recovery periods.

If it is determined that conservative treatment is the best choice for a positive outcome, Dr. Ignacio may refer you to her associate Dr. Gesik for further treatment.

Dr. Gesik will utilize hands-on Osteopathic Manipulative Treatment (OMT) techniques to identify painful pressure points that are diagnostic of strained muscles in your shoulder, upper back, rib cage or neck that have also tightened up as your shoulder has become stiffer.  Treatment of these pressure points will shut off the joint protective reflexes that lead to painful muscle spasm.  Because the frozen shoulder (adhesive capsulitis) is not only a painful condition, but also an inflammatory condition, the shoulder develops cobwebs (adhesions) inside the actual shoulder joint that bind down the ball and socket making it hard to move or reach with the arm.

In order to get your shoulder completely better, it’s imperative to restore the normal range of motion.  Dr. Gesik will perform hands-on joint mobilization techniques that will free or break up the cobwebs (adhesions) in your shoulder that are causing the painful restriction of movement.  In the case of severe stiffness, Dr. Ignacio may have to perform a Manipulation under Anesthesia, which is an effective nonsurgical procedure.

Physical therapy may also be recommended for additional hands-on treatment and for instruction in a specific home exercise program.  It is essential that you stretch out your frozen shoulder everyday to expedite and maximize the best results.  As the pain and stiffness resolve, you will be ready for rotator cuff and shoulder blade (scapula) stabilization exercises to restore your normal strength levels.  Taping techniques, used on the shoulder can also be helpful for further support and to assist in postural correction.  Most people find that icing the shoulder at the end of the day is good for pain relief and decreasing inflammation.  The combination of all these remedies will usually lead to the best outcomes.

It is important to determine which phase of the shoulder pain continuum you may be in.  Regardless of which phase you’re in, the Doctors at IMUA can identify and instruct you in a comprehensive program to safely return you to full activities.

You can get better and stay better, to move you forward in your active life!

Mahalo again to Musashi for all the wonderful photos – http://www.musashi671.com/

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