Shoulder stiffness: Causes, Symptoms, Treatment and Cost

Shoulder stiffness is a feeling of tightness in the shoulder joint that can make it difficult to move the arm freely. It can occur due to an injury, long-term shoulder strain or age-related conditions such as arthritis.

• Osteoarthritic shoulder stiffness: This type of shoulder stiffness results from arthritis or osteoarthritis that has affected the joints of the shoulder.
• Postoperative shoulder stiffness: After a surgical procedure, scar tissue formation can lead to postoperative shoulder stiffness and a limited range of motion.
• Adhesive capsulitis (Frozen Shoulder): Adhesive capsulitis is a common disorder that causes inflammation and thickening of the tissue outside the joint capsule, resulting in painful restrictions in movement and loss of motion in the shoulder joint. It is also known as frozen shoulder but can also be referred to as 'peripheral joint arthritis'.
• Bursitis: Bursitis is an inflammation or irritation of several small fluid-filled sacs (bursae) located around the shoulder joint, commonly caused by impingement due to repetitive movements or direct trauma to the area. Painful symptoms like swelling, tenderness and difficulty moving your arm are likely to occur with bursitis.
• Injury/trauma-induced shoulder stiffness: Trauma or injury caused by a fall, contact sport or car accident can result in pain and an inability to move your arm which can cause severe limitation in range of motion at the affected area-resulting in true “stiffness”.

• Shoulder stiffness can be caused by an injury or irritation of the shoulder joint or surrounding structures, including muscles, ligaments, and tendons.
• Overuse injuries like rotator cuff and labral tears can also contribute to shoulder stiffness.
• Diseases such as osteoarthritis, rheumatoid arthritis, and gout may also cause shoulder stiffness.
• Wear and tear on the joints due to ageing can lead to stiffness in the shoulders.
• In some cases, neck problems such as herniated discs or spinal stenosis can cause the shoulder muscles to become strained and tight, resulting in shoulder stiffness.

• Unable to move shoulder freely with reduced range of motion.
• Painful or achy sensation in the shoulder.
• Weakness or fatigue in the shoulder.
• Popping, cracking sound when moving the shoulder.
• Limited flexibility or mobility of the joint.

• Regularly stretch and strengthen the shoulder muscles.
• Avoid activities which involve repetitive motions of the arm.
• Practise good posture and maintain balance while sitting or standing for long periods.
• Increase flexibility and range of motion exercises regularly.
• Take regular breaks from desk work or other activities which require static postures for long periods of time.
• Ice your shoulder after strenuous activities such as playing sports or lifting weights, to reduce inflammation and pain.

• Medical history:A doctor will ask questions about your symptoms, when they began, if you have had any injuries to the shoulder, and other relevant medical information.
• Physical examination:A physical exam may be performed to check for range of movement, swelling, or weakness around the shoulder joint. The doctor may check for tenderness in the soft tissues around the joint, and assess your ability to make certain movements with your arm and shoulder.
• Imaging tests:X-rays or MRI scans may be used to view the inside of your shoulder joint and help detect any injuries or damage in bones or soft tissues.
• Nerve conduction studies:This test uses electrodes placed on the skin over specific nerves in order to measure how well a nerve conducts electrical signals from one point to another.
• Muscle strength/mobility testing:Your doctor may have you perform certain movements with your arm and shoulder which will test their strength and mobility (flexibility).
• Range of motion testing:This is performed with a handheld goniometer which allows the practitioner to measure each degree moved during certain movements such as raising an arm forwards in front or up above one’s head—a side-bending motion—in order to gauge how much motion is available at each joint where stiffness occurs.
• Aspiration/injection procedure:Injections of local anaesthetics can help diagnose specific sources of pain through localised areas where inflammation is believed to exist; this can also nominally often provide temporary relief from stiff muscles (also referred as trigger point injections).

• Limited range of motion:Movement is restricted and any attempts to move the shoulder can cause increased pain.
• Muscle weakness:Weakened muscles due to lack of use can cause instability and further reduce range of motion.
• Joint stiffness:joints become increasingly tight over time, decreasing mobility and flexibility in the shoulder joint, leading to pain and discomfort with activity.
• Tendonitis:Inflammation of the tendons within the shoulder which can lead to difficulty moving the arm or performing activities due to the excessive strain placed on irritated tendons.
• Instability:Weak muscles can make it difficult to stabilise the arm while doing overhead motions which can result in discomfort or even injury from rotating out of position.
• Damage to cartilage/bone:Without proper treatment, bones or cartilage in the area may start to wear down due to lack of movement, potentially leading to arthritis or bursitis.

• Gently massage the affected area with warm sesame oil and make sure to move in circular motions.
• Take a lukewarm bath with Epsom salt for 15-20 minutes.
• Massage shoulders with an analgesic balm made from camphor, menthol and eucalyptus 3-4 times a day for five to 10 minutes each time.
• Drink ginger tea 2-3 cups per day, to reduce inflammation and pain of the shoulder joint area.
• Make a paste of garlic cloves and mustard oil, apply it gently on your shoulder region, cover the affected area with a cloth soaked in hot water and take rest for 45 minutes.

• Eating anti-inflammatory foods can help in reducing shoulder stiffness. These foods include fresh fruits and vegetables, whole grains, lean proteins like fish, nuts, and seeds; and healthy fats like olive oil, avocado, and oily fish.
• Eat healthy sources of omega-3 fatty acids as they can reduce inflammation and improve joint lubrication. Foods such as salmon, mackerel, tuna, walnuts, and flaxseeds are rich in Omega-3s.
• Add spices such as turmeric or ginger to your meals to naturally reduce the inflammation that causes shoulder stiffness.
• Choose mineral rich foods like legumes (beans & lentils) , dark leafy greens , sweet potatoes , squash , bell peppers etc to benefit from their anti-inflammatory properties.
• Hydrate yourself with plenty of fluids like water or herbal teas throughout the day.

• Processed Foods:Processed foods such as burgers, pizza, chips, and other ready-to-eat meals are often high in saturated fat and sodium, both of which can contribute to joint pain and stiffness.
• Fried Foods:Fried foods can be hard on the joints because they are usually loaded with unhealthy trans fats that cause inflammation.
• Sugary Foods:Consuming too much sugar can increase inflammation and worsen shoulder pain, especially if it is caused by osteoarthritis or bursitis.
• Alcohol:Excessive alcohol consumption causes dehydration and can worsen pain associated with frozen shoulder syndrome or tendinitis by causing a decrease in range of motion in the shoulder joint.
• Red Meat & Poultry:High levels of uric acid produced by red meat consumption can make arthritis worse and lead to joint stiffness and immobility.

• Stretching exercises:Stretching exercises can help to reduce shoulder stiffness. Performing stretches of the neck, upper back and shoulders can improve flexibility and reduce tightness in these areas. You should stretch these muscles gently without any forceful movement while being sure to take regular breaks in between stretches.
• Arthroscopic Subacromial Decompression (ASD):A procedure where a camera and surgical instruments are inserted into the shoulder joint to remove any inflamed tissues, resulting in reduced stiffness and pain.
• Rotator Cuff Repair:A minimally invasive procedure to reattach torn rotator cuff muscles to the bone, allowing for motion and decreased stiffness.
• Capsular Release:Surgical release of tight tissue surrounding the shoulder, relieving discomfort and restoring mobility.
• Total Shoulder Replacement:Surgical replacement of the entire shoulder joint with an artificial one for cases of advanced arthritis or soft tissue damage causing stiffness.

For shoulder stiffness, it is important to consult an orthopaedic doctor or a physiotherapist who specialises in musculoskeletal conditions. They will be able to diagnose what is causing the shoulder stiffness, recommend treatment and physical therapy exercises that can improve mobility of the shoulder joint.

• Nonsteroidal anti-inflammatory drugs (NSAIDs):These drugs help reduce inflammation, pain and swelling associated with shoulder stiffness. Common examples include ibuprofen, aspirin, naproxen and celecoxib.
• Corticosteroids:These drugs are used to help reduce swelling, relieve pain and treat other symptoms caused by shoulder stiffness. Common corticosteroid medications prescribed for shoulder stiffness are methylprednisolone and prednisone.
• Opioids:Opioid medications, like codeine or hydrocodone, may help to reduce the pain associated with shoulder stiffness.
• Muscle relaxants:These medications can help relax the muscles around the joint, easing the tension and reducing stiffness in the shoulder joint. Medications such as cyclobenzaprine or diazepam can be prescribed to relieve shoulder stiffness symptomatically in certain cases.
• Steroid injections:Local steroid injections can provide relief from severe pain and limit inflammation at problem spots around the shoulders, especially in cases of rotator cuff tears or damage to tendons in that area of the body.

Recovering from shoulder stiffness depends on the individual and the severity of their condition, however typically it may take 4-6 weeks to make a full recovery with appropriate physical therapy or other treatments.

The results of treating shoulder stiffness depend on the severity and cause of the condition. For most cases of shoulder stiffness, treatment can help to reduce symptoms and increase flexibility. However, it is important to understand that in some cases, symptoms may reoccur and treatment may need to be repeated at regular intervals. Generally speaking, the more regular and consistent a person’s treatment regimen is, the longer lasting effects can be achieved.

• Post-treatment for shoulder stiffness should begin with physical therapy to help relearn motion and increase strength and flexibility.
• The therapist may focus on a range of motion stretching, manual joint mobilisation, soft tissue massage, and therapeutic exercises.
• Ice, electrical stimulation such as e-stim or TENS, and heat can also be used to encourage an easier range of motion in the shoulder area.
• Patients should continue regular exercise to maintain good postural alignment and improve muscle endurance, as well as being mindful to avoid activities that aggravate the affected shoulder region more than usual.

The cost of a shoulder stiffness treatment in India can vary depending on the severity and type of treatment required, as well as the region in which it is sought. Generally, treatments such as physical therapy start at around ₹500 per session, while more invasive treatments such anti-inflammatory medications and steroid injections can range from ₹1500-2500. Surgery may cost upwards of ₹15000 or more depending on the complexity.

Some common side effects from treating shoulder stiffness may include increased pain, soreness and swelling.

In some cases, there may be other complications such as nerve impingement or a frozen shoulder.

Other possible side effects could be reduced range of motion and tissue damage due to the treatment procedures.

If you are suffering from any complications relating to Shoulder stiffness then you should consult a doctor nearby as they can cause complications like 'muscle weakness, tendonitis, damage to bone' in which treatment courses can range from a few months to years depending on the severity of the situation.