Thursday, March 19, 2009

All about shoulder pains

All about shoulder pains
Wed, Jan 21, 2009
The Business Times

By Cheah Ui-Hoon

FROZEN shoulders are common, but till today, how they come about continues to baffle doctors.

What doctors do know is that women around 40 to 50 years old and people with diabetes are more prone to it. Frozen shoulder is characterised by pain and loss of motion or stiffness in the shoulder, and what happens is that the capsule around the shoulder becomes congested and inflamed, with progressive stiffness. The pain may be so severe that it affects sleep and mobility.

'We can't even say whether a patient who gets it is one who's more active or less active . . . the level of activity doesn't seem to contribute to the cause of frozen shoulder,' says Chan Beng Kuen, consultant orthopaedic sports & upper limb surgeon at IslandSports Medicine and Surgery. Not a bad thing to know if you're wondering if lack of exercise, or over-exercise has given you a frozen shoulder. Cortisone injections to reduce the inflammation followed by aggressive physiotherapy is the main treatment modality, says Dr Chan.

If all else fails however, doctors would also recommend manipulation, which is done under general anaesthesia. During shoulder manipulation, the capsule is literally stretched by controlled tearing. However, if manipulation fails, Dr Chan says that arthroscopic capsular release can be performed. This involves three keyhole incisions through which the shoulder capsule and scar tissue are released under direct vision. This treatment modality is more predictable in severe cases of frozen shoulder, and patients can expect 80 to 90 per cent return of their range of motion after surgery.

'The problem is that many patients would have experienced pain for about two to three months before they come to see a specialist, by which time, their shoulders would have become extremely stiff,' he adds, advising early consultation. Another condition which affects the shoulders can be impingement, not to be confused with frozen shoulder although impingement can lead to the latter. Impingement is common in both young athletes and middle-aged people - those who do repetitive lifting or overhead activities. 'Early symptoms may be mild and the pain is usually localised to the front of the shoulder or the side of the arm,' says Dr Chan.

Look out for sudden pain when lifting or reaching, and there's also pain and stiffness when the arm is lifted. As the problem progresses, there may be pain at night. X-ray and MRI scans of the shoulder may reveal a bone spur as the cause of the impingement.

Again, the main treatment modality is cortisone injection and physiotherapy. Surgery is the last option and involves removal of the bone spur using the keyhole technique. If there is an accompanying tendon tear, repair of the tendon is performed at the same time, says Dr Chan.

To contact these doctors, please call Parkway Health's 24-hour helpline: 6735-5000 or e-mail

This article was first published in The Business Times on Jan 17, 2009

No comments: