A wide variety of disorders can result in a stiff shoulder. These conditions range from tightness in certain areas of the shoulder joint as in a throwing athlete with tightness in the back of the shoulder to a more global loss of motion as in a person with a “frozen shoulder.”
Throwing or overhead athletes can develop a disorder called glenohumeral internal rotation deficit (GIRD). Repetitive throwing causes scarring of the back of the shoulder joint. This, in turn, changes the mechanics of the shoulder resulting in loss of internal rotation of the shoulder, pain, and often, muscle tears. Overhead athletes complain of pain in the back part of their shoulder when their arm is in the “cocking” and/or “acceleration” phases of throwing and complain of tightness when the arm is brought across the body or behind the back. Treatment should be centered on stretching the back shoulder muscles and strengthening the rotator cuff or front muscles of the shoulder. It’s also important for pitchers to work on stabilizing and strengthening the shoulder blade. Also, overhead athletes, particularly young throwers, should adhere to pitch count guidelines and continually have their throwing motion evaluated to look for flaws that may contribute to this condition. For information on preventing youth pitching injuries, visit www.STOPSportsInjuries.org.
A “frozen shoulder” is a more global loss of motion, where the shoulder is tight in several different positions. “Primary frozen shoulder,” also known as “adhesive capsulitis,” is a condition which is more common in 40- to 60-year-old women or people with diabetes or thyroid problems. It can be following a minor injury to the shoulder,or more commonly, develop without a particular event. The cause of this condition is not entirely clear, but scar tissue forms in all portions of the joint, most often starting in the front of the shoulder. This disorder goes through the following distinct phases: the “freezing” or inflammatory stage during which pain develops and motion loss occurs, the “frozen” stage where there is significant loss of motion, but decreased pain, and the “thawing” phase where there is a gradual return of motion. In a majority of patients, the shoulder “thaws out” on its own without surgical intervention, but this process may take anywhere from six months to two years. Cortisone injections in the early inflammatory phases and gentle physical therapy may expedite the process. Rarely, manipulation of the shoulder under anesthesia with surgical release of the scar tissue is needed to regain motion.
If one starts developing shoulder stiffness, it is important to be evaluated by a medical professional familiar with shoulder disorders to get an appropriate diagnosis and treatment plan. Often these conditions are misdiagnosed and inappropriate treatment is undertaken initially, prolonging recovery..
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