Shoulder joint

Because different shoulder pain problems often cause pain in similar areas and can also be caused by nerve irritation in the neck and referral from abdominal organs, finding the source of the problem is the important first step to effective treatment.

Frozen shoulder
Also known as Adhesive Capsulitis, & called ‘50 year-old shoulder’ by the Japanese, which reflects the age group that typically gets it, this is pain and limitation in all directions of shoulder movement.

Movement restriction is caused by inelastic scar tissue actually ‘gluing’ the rounded ball shape at the top of the arm to the socket against which it is supposed to move. It also causes the natural folds in the sleeve-like capsule around the joint to stick, preventing them from unfolding when the arm needs to move. The pain may be due to bleeding into the joint or from irritating the scar tissue by forcefully stretching it.

Frozen shoulder can result from both trauma or an insignificant movement, such as simply reaching back in the car to get something in the back seat. It can also come on for no apparent reason on either side. It is often associated with diabetes and is more common in women.

Typically there is a 3-phase history lasting around 18 months in all: pain in all directions, but with normal range of motion, then pain and stiffness in phase two, and finally, improving stiffness with little pain.

Manual therapy such as osteopathy is more effective during the first phase, which is why early diagnosis is important. If this is ineffective, then a steroid injection may be suggested by a specialist with varying success. The last resort is either manipulation under anaesthetic to break the restrictions (rather less popular these days due to the trauma that can result), or keyhole surgery to remove them. This last technique is much newer and reportedly offers a much faster recovery rate.

Impingement ('pinching')

This is commonly pain felt at the top of the arm when raising it above shoulder height. The pain is usually from pinching of soft, inflamed tissues in a very narrow and crowded space between the top of the arm (the humerus), and the bone directly above it. You might have been told you have bursitis, which is the same thing.

Causes include muscle imbalance affecting the mechanics of the shoulder, and inflammation of pinched structures, sometimes with tears to one of the important shoulder muscles which also runs through this space. Calcification through trauma or long term over use is another cause because the calcium lumps can rub and inflame the soft tissue and further crowd out that narrow space.

Whilst the symptoms may take a while to clear, osteopathy will often help unless degeneration is too far advanced.  Ice application on the area often helps, especially if you have night pain lying on the area.  And trying to avoid repeated pinching will help the tissues calm down.



Less common than in the hip or knees because the shoulder joint doesn't carry our body weight, arthritis here results in limited movement due to extra bone being deposited in the joint, as well as wear and tear to the normally smooth and shiny cartilaginous surface on the top of the humerus. Short of surgery, the trick is to find a balance between continued use of the shoulder and avoiding doing too much. But disuse should be avoided!

More recent surgical intervention includes resurfacing the ball-shaped end of the humerus with a curved implant which eventually is grown into on its under surface by the patient’s own bone.

If you’ve got shoulder pain, remember - early action can make a big difference to your recovery time.



Jill and Chris were both trained in the U.K and started Osteoworks back in 2004 when they moved to N.Z from London with their son.