The “50 year old shoulder”
In Chinese and Japanese, the “50 Shoulder”, or sometimes also called the “40 Shoulder” refers to pain and stiffness of the shoulder occurring without any apparent cause. It is not confined to the 50 year old, and may occur typically in the 35-65 age group. This is also known as the Frozen Shoulder (or Adhesive Capsulitis in medical terms). However some of these patients may have Rotator Cuff Disease or even Osteoarthritis, both of which also present as pain and stiffness. In many of these cases, the symptoms overlap with the frozen shoulder and some form of imaging (Xrays, Ultrasound or MRI scans) may be needed to differentiate them.
The Frozen Shoulder is a problem involving the shoulder capsule. This is basically a balloon that surrounds the joint, the primary function of which is to hold in the joint fluid. This balloon gets thickened and inflamed in a frozen shoulder resulting in the pain and stiffness. The Rotator Cuff is actually a number of muscles which surround the shoulder ball, sitting just outside the capsule. It is commonly inflamed (tendonitis) or even torn in this age group. Arthritis is damage to the joint cartilage itself.
The natural history of a Frozen Shoulder is that it eventually gets better on its own in most cases, but may take anything from 6 months to even 2-3 years. With treatment however, this period can be shortened dramatically. The primary treatment is that of a stretching programme. The majority of patients will respond to s home programme of capsular stretching but there are always a few that do not. Those who have too much pain to stretch, or do not respond, may need further intervention. This can be in the form of a simple Manipulation, under Anaesthesia or an Arthroscopic Capsular Release. This intervention is merely a way to get over the “hurdle” as the patient still needs to continue stretching for 2-3 months after this.