Mid-Week MOT: Shouldering the blame - Part Two.
Following on from last weeks shoulder article talking about rotator cuff dysfunction and acromioclavicular joint injury, this week will discuss biceps tendon issues, and traumatic injuries.....
Of course it is possible to have several issues going on at once within the shoulder complex and sometimes it is hard to pin point where the problem is coming from.
The biceps muscle is a two headed flexor of the arm and shoulder and its tendons can become inflammed from either overuse or trauma and can often accompany rotator cuff tears, bursitis or arthritis. The patient experiences pain at the front of the arm and shoulder and difficulty moving the arm forwards or flexing at the elbow. Biceps tendinitis typically effects the long head which attaches into the shoulder socket. There may be a clicking or snapping sound heard on movement which may may not be painful.
The diagram below shows the anatomy of the biceps with its attachment points:
The area at the front of the shoulder may be tender to press, feel hot and show some swelling.
Treatment in the first instance involves rest, ice and anti inflammatory medication.
If the symptoms persist then a hydrocortisone steroid injection may be given into the area by the doctor. Good manual therapy to improve function can be helpful too.
The shoulder joint is a shallow ball and socket joint and is prone to dislocation either forwards or backwards, up or down if it is landed on, bumped, knocked, or you have ligament laxity.
It is usually quite obvious when someone has a dislocated shoulder..... their arm will be hanging limply down, they will be ashen white in colour and in obvious pain. The shoulder socket may have a depression in it or step where the humerus bone has moved. Relocating or reducing a dislocation should not be performed outside of the emergency department as there may be an accompanying fracture or compression of the nerves and blood vessels. Long term damage can be done if the right treatment is not accessed fairly quickly.
Recovery from one-time dislocations is usually very good but the joint may be more prone to dislocations in the future due to ligament stretching. This may necessitate an operation to tighten the ligaments and restore joint stability.
This particular shoulder condition is indeed pesky and can be hard to diagnose and treat, largely because symptoms are often slow to progress and quite vague and diffuse. If you suffer with diabetes, heart disease, thyroid dysfunction or have had a stroke you are at increased risk! You will generally be between the ages of 40 - 60 and the condition is more prevalent in women. (According to NHS choices webpage)
It is generally recognised that frozen shoulder or adhesive capsulitis, has 3 stages of disease: freezing, frozen and then thawing. The capsule of the shoulder joint thickens with scar tissue and becomes swollen.
Each stage can last up to 6 months as the shoulder gradually loses range of motion and aches, particularly at night and when lying on it. The joint remains stiff, pain may lessen but the disability continues with some muscle wasting evident in most cases. The gradual recovery of movement signals the final phase and a period of intense manual therapy will help to rehabilitate the joint, gain strength and improve function.
If you have frozen shoulder on one side then unfortunately you are at an increased risk of it travelling to the other side at some point - we don't quite know why.
Other courses of treatment include pain management, corticosteroid injection, manipulation under anaesthetic, exercises and manual therapy.
As stated before, if you are experiencing shoulder pain please see your GP or primary health practitioner (such as an osteopath), so that testing can be done to rule out any red flag symptoms and to start your recovery as soon as possible.
As always, for osteopathy in High Wycombe and beyond call Lucy from OsteoFusion on 07833 321604 or visit www.osteofusion.co.uk.
Thanks for reading.
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