Just what is wrong with your shoulders?

The winter weather always tends to make our joints ‘feel older’ than they really are - but despite its name ‘Frozen Shoulder’ has nothing to do with the frost and snow!

In fact, you are just as likely to develop the condition while hunched in front of a computer in a warm office than outside in the freezing cold, according to Mr Tony Corner, a Consultant Orthopaedic Surgeon and expert shoulder specialist at Spire Harpenden Hospital.

He explained: “The complex nature of the shoulder means that there is a lot that can go wrong with the joint and surrounding soft tissues leading to pain and loss of function. It is particularly prone to problems through poor posture, wear and tear and also acute injuries either from sport or falls”.

Here we asked Mr Tony Corner to look at five common problems, how they develop and how they can be treated.

Frozen shoulder

What is it: Inflammation, thickening and contracture of the capsule lining that surrounds the shoulder joint.  It usually occurs with no obvious cause but is often wore in patients who are diabetic.

Symptoms: Pain is felt in the upper arm that can often lead to a lack of sleep. Stiffness gradually develops and, together with the pain, can make it difficult to carry out many of the simple tasks of daily living.

Treatments: if left long enough a frozen shoulder will gradually thaw but this can take over 2 years. Painkillers and anti-inflammatory medication will reduce the pain while physiotherapy may help to control symptoms is the shoulder can tolerate exercises despite the pain. A steroid injection into the affected area can help reduce inflammation and pain. Manipulation of the shoulder or keyhole surgery is considered if other treatments fail with the surgeon releasing the thick and inflamed lining to allow the shoulder to function freely.

Rotator cuff damage

What is it: The rotator cuff is a group of tendons, which wrap closely around the shoulder joint to keep it joint in the correct position and control shoulder and arm movements. The tendons are prone to damage through long-term wear-and-tear, after an accident or fall or, in some cases, a combination of both.

Symptoms: The pain is felt over the shoulder and upper arm made worse by reaching away from the body or behind the back. Movements are weak and restricted making it difficult to raise the arm above shoulder height. Patients may often suffer sleep disturbance as well.

Treatments: Non-invasive treatments such as physiotherapy are used to help strengthen the other muscles and tendons to try to compensate for the part which is torn. However, the best option for some patients is a surgical repair is the with the tendon being secured back onto the bone which can often be performed via keyhole technique.

Shoulder arthritis

What is it: Arthritis of the shoulder is a degenerative wear process of the smooth cartilage lining of the ball (humeral head) and socket (glenoid) joint. The worn surfaces can then grind on each other causing pain.

Symptoms: Deep-seated pain that develops over months to years, worse with activity and often felt at night. Joint stiffness may make it difficult to carry out simple activities of daily living. Painful clicking and grinding is often experienced by the patient.

Treatments: Cortisone injections into the shoulder joint may provide some temporary relief but it is also sensible to modify or limit the actual use of the shoulder.

A shoulder replacement removes the arthritic joint surfaces and replaces them with artificial components. The typical total shoulder replacement involves replacing the arthritic joint surfaces with a combination of highly polished metal and plastic. Shoulder replacement is a very successful procedure for taking away the dreadful pain of an arthritic shoulder and increasing function.

Bursitis/tendonitis

What is it: The rotator cuff tendons pass through a relatively narrow space made up of bone and ligament at the top of the shoulder. Inflammation can develop in this area known as bursitis. Bursitis and tendinopathy of the rotator cuff tendons is a common cause of shoulder pain in the general population.

Symptoms: Pain, usually an aching or burning sensation that comes on gradually and is felt over the shoulder and upper arm. It may be made worse by reaching away from the body or behind the back but the range of motion is usually much better compared to frozen shoulder where stiffness a major problem.

Treatments: Once the correct diagnosis is made the surgeon should recommend a course of therapy and may also offer to arrange a steroid injection to the affected shoulder. If an expert course of therapy and injections fail to relieve the patient of their symptoms then a simple day case keyhole operation is an option to relieve the patient of their pain.

Shoulder instability

What is it: The shoulder consists of a ball and a shallow socket surrounded by soft tissues, which includes the capsule lining the joint, ligaments, and the rotator cuff tendons.

It is a relatively loose joint to allow great flexibility in movement but this makes it vulnerable to dislocation particularly in contact sports. When the shoulder dislocates it tears tissues attached to the rim of the socket and stretches the ligaments of the joint leaving a weak point in the shoulder and this predisposes the patient to suffering further dislocations in the future.

Symptoms: The shoulder may start to dislocate frequently requiring multiple hospital visits for relocation. Sometimes the shoulder only slips partially out of the socket (subluxation) and it may be possible to return it into the correct position yourself.

There may be a feeling of insecurity and apprehension when the arm is in certain positions such as when the hand is raised above the head and away from the body and this will almost certainly affect your ability to play certain sports.

Treatments: Therapy is very important following a dislocation to help the patient regain the range of movement and strength in the shoulder. If the patient suffers ongoing symptoms of repeated dislocations or subluxation or even apprehension that their shoulder dislocate which limits their activities then surgery maybe considered. In high level athletes or young persons participating in contact sport may wish to undergo surgery early on to minimize the risk of future dislocations and interference with their sport.

Mr Tony Corner is a Consultant Orthopaedic Surgeon and expert in shoulder surgery practicing at Spire Harpenden Hospital.