31 May Frozen Shoulder vs Rotator Cuff

Diagnosing the Shoulder

Here at Galway Physiotherapy & Rehabilitation we have had many clients in lately misdiagnosed by their GPs with the lazy diagnosis for all shoulder movement restrictions, “Frozen Shoulder”.
While I don’t mind misdiagnoses as they are common place, happen all the time in all clinical settings and as shown by my recent post on a US clinical study they in fact often occur on the analysis of MRI and other scans. What is very frustrating however is when a medical professional declares their finding as fact and then advises a treatment plan which is the exact opposite of what should be prescribed if another very common condition is in fact the cause. We must know better and consider all options. If we lazily diagnose all movement restricted shoulders as “frozen” simply because it isn’t moving well then, we send people down the road of rest, movement restriction and pain acceptance. What if there is a rotator cuff issue which needs physiotherapy, movement, exercise, rehabilitation and active recovery and actually can improve quite quickly and we have just advised months of rest? Frustrating.

Assessing the Shoulder

Firstly, and these are not true for all people, most often reduced with FS is external rotation not horizontal abduction. Secondly, when we assess active, active assisted and passive range of movement of the aforementioned movements we almost always will find much more restriction with FS rather than a rotator cuff issue. And I for one, very rarely see this in clinic.
I had a lady in two weeks ago diagnosed with a frozen shoulder by her doctor. She was given strong anti-inflammatories, further medication for her stomach due to the NSAIDs and advised to rest, rest, rest. She was 3 months down the line and much worse. I listened to her intently, acknowledged her beliefs on the situation, recognized her emotion and stress especially not being able to lift her grandson and used my own situation to explain I understood and we should get her going! I assessed her shoulder and said I felt she may have a rotator cuff muscle issue and that nothing was ‘frozen’. I explained all about the rotator cuff to give her some knowledge and control of her situation and asked would she like to try some work at home for a week or two and go from there. She said she like the positivity and confidence rather than worry and negativity and said she would love to!

Treating the Shoulder

Together we made a plan to reduce and remove medication she didn’t want and implement a gradual exposure movement plan to the shoulder starting with home active assisted work. We have taken her from ‘frozen shoulder’, meds, stomach pain, fear, rest, stress and pain to positivity, confidence, relief, movement, control and improvement.
She messaged me this morning to a say she has moved on to her active work yesterday and woke up this morning to no after effects of the exercises.
If these sounds like issues you are experiencing and want help with contact @thegalwayphysio.