A B C D E F G H I J K L M N O P R S T U V W

PAINFUL ARC - PAINFUL SHOULDER - FROZEN SHOULDER

What is a Painful Arc ?

These are names used to describe painful conditions affecting the shoulder. Frozen shoulder describes a condition in which the shoulder is painful to move and movement is often completely restricted. Painful arc is a term applied to a number of conditions in which only certain movements of the shoulder are painful. The patient is able to move the arm away from the body to a point at which pain starts and continues as the arm is moved further out. Once the arm has been moved out of the painful range, the pain goes and the arm can be moved normally until the arm is above the head. Patients find that by moving their arm in a slightly different way, they can avoid the painful part of the movement.

How does a Painful Arc occur ?

Frozen shoulder starts as a painful shoulder in which movement is still possible, but restricted. Over 6 to 9 months the pain reduces, whilst the stiffness gradually increases. Eventually the pain goes but the shoulder remains stiff. After a further similar period, the movement will return. Some older people may not regain full movement, but the majority do. It is thought that the condition is the result of inflammation of the lining of the shoulder joint. It may be more frequent in people with diabetes, due to deposition of an abnormal protein in the (synovial) lining of the shoulder joint. Painful arc may arise by itself or after a recognized injury to the shoulder. This may occur as a result of a number of underlying problems. These include inflammation of the muscles that move the arm out from the body, a tear in these muscles as a result of a sporting or other injury, or as a result of arthritis in the joint between the collar bone and the shoulder blade.

Treatment Involved for a Painful Arc

Frozen shoulder will often gradually improve of its own accord. Many patients are treated with simple painkillers and anti-inflammatory drugs, and physiotherapy may help. In some cases the shoulder may be manipulated under a general anaesthetic which may be combined with an injection of anti-inflammatory cortisone-like steroids into the joint. Physiotherapy is given to maintain the movement, but manipulation is not always successful and may be associated with increased pain. In painful arc, a course of physiotherapy with the use of an ultrasound machine may help. If this fails, an injection with local anaesthetic and steroid into the tender area may help. Two to three injections may be required over a period of some months before the condition settles completely. Should injections and physiotherapy fail, an operation may be required to treat the inflammation of the tendon, repair the damaged muscle, or remove extra pieces of bone which develop because of the arthritis and rub on the muscle beneath the joint. After surgery, physiotherapy is required to get the best result.

During Treatment for a Painful Arc

Soon after injection treatment for frozen shoulder, an increasing temperature may indicate an infection in the shoulder joint. Should this be the case, medical help should be sought. Sometimes pain following an injection will require stronger painkillers and a sling to rest the arm. After injection for a painful arc , the local anaesthetic wears off after several hours and the pain will return. The steroid in the injection will lead to some further reduction in the pain after 36 to 48 hours. If the area of injection becomes red and hot, this may be due to infection. If this happens, contact your doctor, as you may require antibiotics. During physiotherapy the physiotherapist will recognize any problems that occur. If a home exercise programme is started and movement in the shoulder is lost, this may indicate that a partial tear of the muscle has become a complete tear. In this case, contact your surgeon again. It may require surgical repair. After any surgical treatment, you will be seen until all complications are past. However, any redness or pain around the wound may indicate an infection and should be reported immediately.

After Treatment for a Painful Arc

The frozen shoulder will gradually improve and return to normal, but there may be some loss of movement in the long term. After a manipulation, increasing pain should be watched for, as this may indicate a complication of the manipulation. A painful arc may recur after treatment and further treatment may be required.

If a Painful Arc is Left Untreated

Left alone, frozen shoulder will get better and movements of the shoulder will recover over a period of 1 to 3 years. In many patients with painful arc, the condition will settle with rest, and painless movement will return. In others, if the condition is untreated, a partial tear of the muscle will become complete. The shoulder may become weak until most active movement is lost and movements that require lifting of heavy loads become painful. This leads to marked disability in the shoulder joint.

Effects on Family of a Painful Arc

Frozen shoulder is a painful, disabling condition which may lead to depression because of the length of its course, and the family should understand this and be sympathetic. With a painful arc, help may be needed to perform those activities which are painful.