Shoulder Pain

Frozen Shoulders

We humans, were all evolutionarily designed to move about in the dense jungles, hunt for food and fight for territories. Our closest animal species, the primates, are doing just that! Our shoulders particularly, are “evolved” for that purpose in the first place. In modern times, most of our lives are so sedentary that sometimes the most we would have used our shoulders for is to scratch our own back. But the human shoulders were not designed to sit still. They were supposed to be the major source of power-generation to throw spears and projectiles as a method of hunting prey. So, it becomes very clear that we are under-using our shoulders.

Sedentary tissues can cause trouble and can undergo biological failure. The less you move your body, the more problems it can give you. Our shoulders are made of tissues as well, and when we do not use them as much as we are supposed to, there is a higher risk of developing a condition called Adhesive Capsulitis or simply, “Frozen Shoulders”. There is a huge misconception that frozen shoulder is a repetitive strain injury. No, it is not. People with a long period of immobilization of their houlder joint are actually the ones with higher risk of developing this condition. A very good example would be stroke patients. After an episode of stroke, it is normal for stroke patients to lose mobility in a paralysed arm for a few months. Meanwhile, the shoulder capsule (see Figure 1 below) undergoes a period of thickening (because of under-use of the shoulder tissues), hence restricting the movement of the shoulder. This tightening or hardening of the shoulder capsule is Frozen Shoulders.

frozen shoulder physiotherapy singapore
Figure 1


The defining symptoms of frozen shoulders are:

  • Decreased ability to move shoulders in 3 stages

       1. Freezing – Moving the shoulder can be painful and the range of motion decreases ignificantly
       2. Frozen – Shoulder gets stiffer but level of pain can decrease as well, making movement of shoulder just             more rigid
       3. Thawing – For some fortunate patients, shoulder slowly starts to become functional again

  • Lying on the shoulder while sleeping is particularly painful
  • Initial loss of movement will be the ability to reach behind the back
  • The coracoid process area (Circled in Figure 1) is very sensitive and hurts


Treatments for Frozen shoulders

Frozen shoulders apparently cannot be cured, research says. However, it can be managed and minimised. Once diagnosed, patients normally get referred to a physiotherapist as preservation of range of motion is important. Once range of motion improves, pain can be reduced as well. If you believe you are in the early stages of frozen shoulder, immediately begin doing range of motion exercises without excessive discomfort. That means these exercises should hurt only minimally. This is a nice collection of exercises for the shoulder, with good illustrations.


Shoulder Tendinitis

Shoulder Tendinitis is a common injury that comes with overuse of the shoulder muscles, ligaments and tendons. It is especially frequently developed by people who use their arm in an overhead motion often, such as Badminton and Swimming athletes as well as assembly workers. The pain is usually felt to originate at the tip of the shoulder and radiate down the arm, when you try to lift your arm overhead or twist it. In some extreme cases, the pain will be present all the time, even when the arm is at rest.

Physiology of the Shoulder

shoulder pain singapore
Figure 1: Image taken from


The shoulder joint is mainly made up of three bones: the collar bone, the shoulder blade and the arm (Figure 1). In order for the joint to function, the shoulder needs ligaments, muscles and tendons. From Figure 2, we understand that there are three main muscle groups that help support the shoulder joint and allow for movement of the arm. The supraspinatus muscle is a small muscle that connects the top of the shoulder blade to the top of the arm. The subscapularis muscle is a large triangular muscle which fills the entire shoulder blade and extends to the top of the arm. The infraspinatus muscle fills the back of the shoulder blade and connects to the back of the arm. Each of these muscles are connected to the arm bone by their respective tendons (Supraspinatus tendon, Subscapularis tendon, Infraspinatus tendon).

Causes of Shoulder Tendinitis

Shoulder Tendinitis occurs when the tendons in the shoulder become irritated and inflamed. It is mostly a wear and tear condition. This means that one specific trauma might not be the direct cause of this condition. When a person uses his shoulder very often, there might be repeated small traumas to the tendons and this can eventually lead to shoulder tendinitis.

Another cause of shoulder tendinitis is impingement of the tendons. With age and the onset of arthritis, the acromion (See Figure 1) may develop bone spurs that narrow the space between the acromion and the top of the arm. This might result in the tendons getting pinched in the narrow space, causing the tendons to become inflamed and swollen.

Continual irritation to the tendons can lead to their deterioration and tearing. The supraspinatus tendon is most likely to tear as it is most commonly involved in movements.


  • Clicking of the shoulder
  • Painful to lift your arm to shoulder height
  • Painful to move your hand behind your back or head
  • Upper arm pain, up till elbow
  • As condition deteriorates, painful even at rest


Treatments for Shoulder Tendinitis

Firstly, avoid activities that require heavy use of the shoulder. Applying ice to the affected area might help as well. Anti-inflammatory medicines can help relieve pain to a certain extent. Surgery is normally not recommended unless there is a severe tear in the tendon that requires repairing.

Non-invasive treatments for shoulder pain at The Pain Relief Practice

1. Radiofrequency Therapy is a form of noninvasive treatment that uses radio-frequency energy to help activate cell metabolism restoring its natural balance, increasing vascularisation and the internal temperature of the targeted tissues.

2. Shockwave Therapy uses powerful acoustic energy to stimulate deep tissue repair. Its main assets are fast pain relief and mobility restoration.

The effects of shockwave therapy on frozen shoulder has been actively researched upon. Many researches have proven that shockwave therapy can cause changes in the cells and tissues and bring about pain relief. Surgery is largely discouraged by physicians as it is invasive and generally does not produce impressive results overall.

If you suffer from difficult pain, aches or stiffness, simply call, SMS or WhatsApp 9782 1601 to find out how Radiofrequency Therapy & Shockwave Therapy can help you feel better.


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350 Orchard Road

#10-00, Shaw House

Medical Suites @ Orchard

Singapore 238868

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