ac seperation adhesive capsulitis

by susan
(Canada)

I realize this isn't a "sport" injury but hope you can help. Intermittent left shoulder/neck pain x approx 5 yrs. I began to elevate/shrug both shoulders and extend my neck while keyboarding. Pain increased in 2007 & I developed adhesive capsulitis; Lt shoulder froze Dec 2007 with loss of normal arm swing, very restricted rom all directions and hiking of shoulder.

Subsequently keyboard lowered 7" and now use a chair with arm supports. I've gradually rtw but I can't stop involuntarily elevating (shoulder shrugging) my shoulders with keyboard or other activities requiring use of arms.

Blood/thyroid/sugar levels normal 2007 & 2008. X rays Jan 2008 negative; u/s showed minute calcium deposits throughout a number of muscles and calcium deposit/small amt of fluid in biceps tendon.

Apr 2008 normal arm swing returned and hiking of shoulder was less. I managed to get some of my rom after attending physio Jan - July but still limited (ie currently +5degrees at elbow, forward ext about 5 degrees below shoulder height; sideways extend is about 10 degrees below shoulder). I was told to stop physio in event this was aggravating the ACapsulitis.

Aug 2008 excruciating pain (worst since start) in the back (trapezius?), and I assumed it was an adhesion releasing. Since then my arm is swinging in towards my body instead of back and forth at my side. The arm strikes my leg as I stride. If I carry something the swing goes back to normal but it hurts to carry anything. With effort I can pull my shoulder back but it just rolls forward again when I relax. I also have pain in scapula and it is winging. I have had no improvement in rom since Aug 2008.

In Sep 2008 I had further x rays c/out that show a gap in the AC joint. I don't know the degree. I'm now getting symptoms on the right shoulder which I feel is the start of ACapsulitis . I've lost some rom in forward and sideways raising of rt arm but no pain at end of range so I think I'm just in first stage. I'm back on anti inflammatories (which isn't helping with pain on either side) and have been told to do ROM on the right. I have appt with Spec but not until Jan 2009.

I am anxious the right shoulder will freeze before I have rom back in the left. My questions are:
Will the ac problem, shoulder hiking, shoulder rolling forward and scapula winging resolve as my shoulder unfreezes?

What has caused the AC separation and scapula winging?

Why is my arm swinging in towards my body instead of at my side?

What can I do to stop shrugging my shoulders/any exercises?

Can the problem(s)be addressed while I still have ACapsulitis?

I'm hoping someone will offer me surgery. Any comments?

Any advise for either shoulder while I'm waiting till Jan 2009 is really welcomed.

thanks.

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ac seperation adhesive capsulitis

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Oct 14, 2008
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shoulder questions
by: Bart - SII

It sounds like you may have some type of nerve involvement - perhaps the long thoracic nerve, which is responsible for the serratus anterior muscle that moves the scapula and keeps it from winging out from the spine. Do you remember having any significant sickness prior to starting to develop the shoulder problems - a virus or anything that was more than the sniffles?

Injury to this nerve is not common, but from what you describe, it is something that you may want to look into with your doctors. It can sometimes come from a viral infection that damages the nerve, or from a traction injury where your arm was pulled severely.

The adhesive capsulitis is likely to be a problem as long as you do not have normal shoulder function - which is hard to have when your scapula continues to not move correctly.

The hiking, rolling forward, and arm swinging could all be related to the scapula not stabilizing. If you don't have good muscle function in the back of the shoulder, then all of the other muscles will pull extra on the scapula - that means the trapezius will pull it upwards, and the pectoralis will pull it forward. Until the posterior muscles wake up and counteract the pulling, it will likely continue.

If you could find a therapist that specializes in shoulder rehabilitation, one that believes in scapular stabilization and functional muscle patterns, that could help.

I would also recommend talking to your doctor about the possibility of the nerve issue.

Bart

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Oct 14, 2008
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Submitted by: Bart - SII

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It sounds like you may have some type of nerve involvement - perhaps the long thoracic nerve, which is responsible for the serratus anterior muscle that moves the scapula and keeps it from winging out from the spine. Do you remember having any significant sickness prior to starting to develop the shoulder problems - a virus or anything that was more than the sniffles? Injury to this nerve is not common, but from what you describe, it is something that you may want to look into with your doctors. It can sometimes come from a viral infection that damages the nerve, or from a traction injury where your arm was pulled severely. The adhesive capsulitis is likely to be a problem as long as you do not have normal shoulder function - which is hard to have when your scapula continues to not move correctly. The hiking, rolling forward, and arm swinging could all be related to the scapula not stabilizing. If you don't have good muscle function in the back of the shoulder, then all of the other muscles will pull extra on the scapula - that means the trapezius will pull it upwards, and the pectoralis will pull it forward. Until the posterior muscles wake up and counteract the pulling, it will likely continue. If you could find a therapist that specializes in shoulder rehabilitation, one that believes in scapular stabilization and functional muscle patterns, that could help. I would also recommend talking to your doctor about the possibility of the nerve issue. Bart

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Oct 16, 2008
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Thanks for feedback...
by: Susan

thanks for feedback... A few weeks after the shoulder froze, a working colleague who is a physician, assumed I had a "stiff shoulder" and asked me to relax the arm and then yanked on it outward and upward (like when you pull back to throw a ball). Shoulder reached the end point and I almost fainted with the pain. I had to stop working after that. I think an assumption was made that because I had continued working and plodded on without complaining it wasn't FS but a stiff shoulder, oh well the colleague did mean well. Apart from that I don't recall anything other than flu like symptoms about 12 months prior to shoulder freezing. I'll bring your thoughts to my GP when I see him and make sure I find a physio who can offer me what you are recommending. Thanks again. I'll let u know outcome.