Muscle and tendon problems
Unlike our hip joints, which are well adapted to taking our body weight, our shoulders have adapted to allow us a huge range of movement, which allows us to manipulate things with our hands with these. To achieve this the shoulder joint is relatively loose, and its stability is maintained by a group of four muscles, which form the ‘rotator cuff’. The tendons of these muscles cross the joint and are quite vulnerable to mechanical irritation and wear and tear. Thus, over the years they become a potential source of pain and disability.
As a result of irritation there may be swelling of the tendons, leading to associated pain and muscle tightness around the shoulder. The aim of treatment is initially to reduce this reaction, but also to help restore normal movement, both by manual techniques and by more active exercise to help retrain the affected muscles and shoulder area as a whole.
Frozen shoulder/adhesive capsulitis
Less commonly the ligaments around the joint (the joint capsule) can become inflamed and then shortened. This is described as a frozen shoulder, though more accurately a stiff shoulder. It has also been called an adhesive capsulitis under the belief that the loose capsule became stuck together. However more recent evidence suggests that the capsule shortens rather than sticks. This condition tends to occur above 45 years of age, and often develops without obvious physical trauma. Because it is related to soft tissue rather than cartilage degeneration it tends to recover, though often it may take as long as 18 months.
Osteopathic treatment may help in similar ways to previously, but the prognosis tends to be much longer because of the different nature of the tissue disturbance. The aim is to reduce pain initially, and once the shoulder is more comfortable then stronger stretching can be applied both in treatment and by exercise.