Shoulder pain and stiffness is commonly associated with articular problems, namely glenohumeral joint osteoarthritis and frozen shoulder (adhesive capsulitis). Patients will often present with shoulder pain, stiffness, and an insidious reduction in shoulder range of motion- movements like doing your hair or drying the back of the head will become difficult and painful.
Glenohumeral joint osteoarthritis or shoulder arthritis is more common in women and increases in incidence with age. Risk factors include repetitive motion injuries due to overuse, occupations involving excessive upper limb use, engaging in sports with overhead movements, history of trauma or dislocation, obesity and genetics.
Adhesive capsulitis, or frozen shoulder, is an overexpression of fibroblasts in the capsule. These fibroblasts are mechanosensitive and will detect stress in the shoulder causing a change into myofibroblasts which are contractile. This causes contractions in the shoulder resulting in pain and reduced range of motion.
Frequently Asked Questions
How does a painful and stiff shoulder present?
People experiencing shoulder arthritis will complain of chronic pain that has been gradual in its onset, typically reported in the deep and posterior parts of the shoulder. Due to the chronicity of the pain, you may report disturbed sleep and crepitus or ‘popping’/’cracking’. There will be limited shoulder range of motion due to loss of mobility and atrophy of the muscles due to disuse.
For people with frozen shoulder, pain is often described as extreme, nauseating, and an intense pain affecting sleep and quality of life. In addition to this, people have described the pain to be constant and an unrelenting ache that is dull in nature. There is a considerable loss of external rotation and abduction range of motion.
How is a painful and stiff shoulder diagnosed as osteoarthritis or frozen shoulder?
In glenohumeral joint osteoarthritis, joint damage and joint pain can be indicative of arthritic changes. A loss of passive range of motion is the most reliable indicator of glenohumeral joint osteoarthritis. Your physiotherapist will take a detailed medical history and conduct a physical examination. Joint line tenderness on palpation, crepitus and pain during joint movement, in addition to reduced passive range of motion, can indicate glenohumeral joint osteoarthritis. Diagnostic imaging may be used to confirm the diagnosis, ruling out other pathologies such as frozen shoulder and glenohumeral joint dislocation. You may be referred for a CT scan for evaluation of your affected shoulder.
There is a high probability of frozen shoulder if you are aged 40-65 years, you are experiencing significant shoulder pain and stiffness, the passive and active range of motion of your shoulder is equal and you have lost 50% of your external rotation range of motion when compared to your unaffected shoulder. Diagnostic imaging is not required to treat frozen shoulder, though you may have had an MRI that shows thickening of the joint capsule.
What physiotherapy treatments will improve my painful and stiff shoulder?
Conservative management of your glenohumeral joint osteoarthritis can reduce pain and improve range of motion. Interventions may include joint mobilisation and active assisted mobility exercises to improve joint mobility. Once range of motion has improved and pain has subsided, an exercise program to strengthen the glenohumeral joint may be applied. Early exercises will be isometric, or unloaded isotonic. Through progressive overload and graded exposure, loading of the shoulder girdle will increase strength and function of the upper limb.
If there is minimal improvement with conservative management, surgical management may be considered. Arthroscopic exposure, capsule release or removal of intra-articular fragments may be considered for young subjects or those with incipient stages of pathology. For others, a total arthroplasty can provide significant improvements in pain and function of the shoulder.
For the treatment of frozen shoulder, you can read more here.