“I can’t comb my hair.” “I can’t wash my back.” “I have a difficult time putting on my jacket.” “It’s hard for me to tuck my shirt in.” “I can’t reach for things on a high shelf.” These are all very common complaints from people with frozen shoulder. Also known as adhesive capsulitis, frozen shoulder is a condition that results in a tightness of the shoulder reducing its overall movement.
The bones which make up the shoulder joint are held together by a lose capsule of connective tissue. The connective tissue is loose to allow maximal movement of the shoulder, the most mobile joint in the body. With frozen shoulder, this loose connective tissue capsule tightens which restricts the overall movement of the shoulder. Another way to understand frozen shoulder is to look at the construction of the shirt or blouse you are presently wearing. All shirts have extra fabric in the armpit. This extra fabric allows for freedom of movement for the shoulder. Try this: grab the extra fabric under the armpit of your shirt and tightly squeeze it. Now, try to raise your arm over your head. You will notice that you will be unable to raise your hand over your head due to the restriction of the tight fabric. The fabric of the shirt is very similar to the connective tissue of the shoulder. A tightening of the connective tissue will restrict movement of the shoulder.
How does this connective tissue become tight? This is not completely understood. While some conditions are due to trauma, prolonged tendonitis or bursitis, most patients with frozen shoulder will state that “it just happened.” They indicate that they did not fall on it or suffer an injury; however, a gradual loss of movement occurred over the past several months. They do typically indicate that certain movements are painful such as reaching overhead or reaching behind their back. It is known that middle aged women are most prone to this condition and that individuals with diabetes are more commonly affected. Interestingly, right-handed individuals more commonly get frozen shoulder on their left side.
Treatment for frozen shoulder is varied. Most cases require some form of medical intervention. Physical therapy is commonly used to decrease pain, improve strength and range of motion and ultimately function. The physical therapist makes the tight connective tissue more pliable usually with moist heat and ultrasound immediately followed by manually stretching the connective tissue. As the connective tissue is stretched the movement of the shoulder gradually returns. This is a gradual process and treatment may last for several weeks or months. In severe cases, a surgeon will stretch out the connective tissue while the patient is under anesthesia. Following this surgical stretching, the patient is typically sent to physical therapy to maintain the stretch.
As indicated above, most cases of frozen shoulder require medical intervention. If you suspect that you might have frozen shoulder, it is recommended that you see your family physician or orthopedic surgeon and get a referral to a physical therapist.
Movement Is Your Best Friend - If you think you have frozen shoulder, you need to move the shoulder and move it a lot. If you baby the shoulder and protect it from movement the condition will get worse.
Pain Is Your Worst Enemy Yes, move the shoulder as much as you can but do not move it to the point of pain. If you move the shoulder to the point that it is now painful – the frozen shoulder will typically get worse. The bottom line is you want to move the frozen shoulder as much as possible without causing pain.
Warm-Up The Shoulder Before Movement – Use a heating pad, hot shower or bath, or brisk walking to warm up the shoulder before you perform range of motion exercises.
Use a Cold Pack or Ice – after the exercises to control pain and inflammation. Do the exercises 10-15 times each within the limits of pain 3-5 times per day.
Contributions: Gary Mattingly, PT, PhD, Professor, University of Scranton, Department of Physical Therapy, Associate, Mackarey Physical Therapy (deceased).
Read Dr. Mackarey’s Health & Exercise Forum – every Monday – next week: “The Throwing Shoulder”
This article is not intended as a substitute for medical treatment. If you have questions related to your medical condition, please contact your family physician. For further inquires related to this topic email: drpmackarey@msn.com
Read all of Dr. Mackarey's Articles at mackareyphysicaltherapy.com
Paul J. Mackarey PT, DHSc, OCS is a Doctor in Health Sciences specializing in orthopaedic and sports physical therapy. Dr. Mackarey is in private practice and is an associate professor of clinical medicine at GCSOM.
Patients frequently ask me about the purpose of colorful tape worn by athletes on their shoulders, elbows, knees and other areas during the competition. It turns out that this look is more than “just a fashion statement!” Medical researchers have studied and published on this topic to assess its value.
The tape worn by competitive athletes is called Kinesio Tape (KT). It has become very popular in athletes using repeated overhead use of their shoulder as in volleyball, basketball and tennis. It is also used for other joints and muscles such as elbow, wrist, knee, calf and ankle. It is a special flexible tape designed to mimic the qualities of human skin. KT is very different that other forms of athletic tape. It is latex free with acrylic adhesive that is heat activated. It can be worn in the shower or pool. The cotton fibers allow for quick drying and evaporation and can be worn for 3-4 days. KT is approximately the same thickness as skin and can be stretched 30% to 40% of its length at rest.
Some reports propose that the tape has several benefits. It provides stimulation of the muscles and tissues that support the shoulder, improves space in the joint to limit pain and inflammation from impingement, and improves sensory stimulation to improve coordinated movement of the arm. Studies have found that those athletes using KT on the shoulder reported significantly less pain with overhead activities as compared to a sham tape application. No differences were reported in range of motion or ability to perform daily activities.
Impingement – when one or more of the rotator cuff muscles gets pinched between two bones. This is very common and very painful especially when you attempt to raise your hand over your head.
Rotator Cuff Tear – the rotator cuff is made up of muscles which hold the joint together. A rotator cuff can become torn (partially or fully) due to trauma such as falling on the shoulder or following wear and tear from years of overhead activities. Rotator cuff tears are common both in athletes and in the older population.
Rotator Cuff Tendonitis – inflammation of one or more of the rotator cuff tendons is often caused by overuse. Repetitive overhead activities can cause this problem.
Bursitis – inflammation of a fluid filled sack that tries to lubricate and protect the shoulder from impingement.
This is just a partial list of some of the more common problems, which can result in shoulder pain from impingement. All of these conditions are uniquely different and need to be treated differently. Some of these conditions respond well to oral medications, others to injection, others to physical therapy and still others may need surgery. If you have shoulder pain that lasts for more than three days or you notice that you cannot raise your hand over your head, you need to see either your family doctor or an orthopedic surgeon.
Read Dr. Mackarey’s Health & Exercise Forum – every Monday next week “Frozen Shoulder”
This article is not intended as a substitute for medical treatment. If you have questions related to your medical condition, please contact your family physician. For further inquires related to this topic email: drpmackarey@msn.com
To read all of Dr. Mackarey's articles visit: https://mackareyphysicaltherapy.com/forum/
Paul J. Mackarey PT, DHSc, OCS is a Doctor in Health Sciences specializing in orthopaedic and sports physical therapy. Dr. Mackarey is in private practice and is an associate professor of clinical medicine at GCSOM.
Prevention of Shoulder Injuries in Tennis: Strengthening. Part 1 of 2
HAPPY MEMORIAL DAY! You can tell that summer is in the air, not only by the arrival of the sunshine, warm air and longer days, but also by the beautiful sound of a tennis ball hitting a racquet hitting at Scranton Tennis Club and Birchwood Racquet and Fitness Club. So, get your racquets out and join the fun! However, take time to “tune up” in order to prevent injury, especially to the shoulder. In a sport that relies so heavily on the use of the shoulder, it is very common for tennis players to develop occasional shoulder pain or a more chronic problem such as shoulder rotator cuff tendinitis. That is exactly what happened to professional tennis star, Maria Sharapova and many others over the past few seasons.
For many, tennis is more of a seasonal sport. For example, in high school it is played in the fall for girls and spring for boys. In the off-season, a shoulder can lose much of its essential strength. This loss will result in a deconditioned shoulder at the start of the season and making it more susceptible to injury. Practicing with a deconditioned shoulder commonly results in sprain, strain and pain. Pain and weakness will significantly interfere with the ability to perform at a high level.
To prevent shoulder problems, one must participate in an exercise program specifically designed for tennis. A well-balance shoulder strengthening program includes rotator cuff and scapular (shoulder blade) muscle exercises, reeducation, biomechanics, and a stretching program pre and post hitting. This column will discuss some of these principles to properly prepare your shoulder for the tennis season and avoid injury.
STRENGTHENING EXERCISES FOR TENNIS
To avoid shoulder pain it is necessary to maintain shoulder strength. Stretching exercises are also important and will be discussed in next week in, Prevention of Shoulder Injuries in Tennis - Part II. Strengthening exercises need to concentrate on three groups of muscles: power muscles (the large muscles of the shoulder), shoulder blade stabilizer muscles (the muscles which stabilize the shoulder blade, and the all important rotator cuff muscles (the muscles which move the shoulder and control the cocking and follow through phases of the tennis stroke, while keeping the joint in proper position). Strengthening the power muscles of the shoulder is fairly easy; latissimus pull downs, pectoralis bench presses, and bicep curls will cover all bases. While these exercises are important in maintaining strength and power of the throwing shoulder, they are not as important as the exercises for the shoulder stabilizers and rotator cuff muscles.
PHOTO 1 - Rotator Cuff Internal Rotation (Tennis Forehand Stroke): Holding a light or medium resistance band, imitate a forehand stroke with slight bend in the elbow…can be performed with band tied to tennis racket.
PHOTO 2- Rotator Cuff External Rotation (Tennis Backhand Stroke): Holding a light or medium resistance band, imitate a backhand stroke with slight bend in the elbow. can be performed with band tied to tennis racket.
PHOTO 3- Latissimus Pull downs – Kneeling or sitting:
PHOTO 4- Bench Press - Lying on back with knees bent
PHOTO 5- Biceps Curls - Sitting or standing
Models: Katherine Weaver, SPT & Lauren Calvey
Visit your doctor regularly and listen to your body.
Contributor: Gary E. Mattingly, PT, PhD: Professor Emeritus, University of Scranton, Dept. of Physical Therapy
NEXT MONDAY – Read Dr. Paul J. Mackarey “Health & Exercise Forum” in the Scranton Times-Tribune. Part 2 “Prevention of Shoulder Injuries in Tennis”
This article is not intended as a substitute for medical treatment. If you have questions related to your medical condition, please contact your family physician. For further inquires related to this topic email: drpmackarey@msn.com
Paul J. Mackarey PT, DHSc, OCS is a Doctor in Health Sciences specializing in orthopaedic and sports physical therapy. Dr. Mackarey is in private practice and is an associate professor of clinical medicine at Geisinger Commonwealth School of Medicine.
