Restricted Movement

Why movement becomes restricted

A useful clue for doctors is the difference between active movement (what you can do yourself) and passive movement (how far the examiner can move it). If both are limited, the problem is usually inside the joint, as in frozen shoulder or arthritis. If only active movement is limited, it suggests pain, a tendon tear or weakness.

Common causes

Arthritis

Osteoarthritis gradually narrows joint space and forms bone spurs, causing stiffness that improves within 30 minutes of moving. Rheumatoid arthritis causes swollen, warm joints, often in the hands and feet on both sides, with morning stiffness lasting over an hour.

Frozen shoulder

Frozen shoulder (adhesive capsulitis) is thickening and tightening of the shoulder joint capsule. It causes pain followed by severe stiffness, especially in turning the arm outward and reaching up or behind the back. It is more common in people aged 40 to 60 and in those with diabetes, and recovers over 1 to 3 years.

Tendon and soft tissue injuries

Rotator cuff tears, tennis elbow, Achilles injuries and ligament sprains limit movement through pain and weakness.

Bursitis

Inflamed fluid-filled sacs (bursae) near the shoulder, elbow, hip or knee cause a tender swelling that hurts with certain movements. See bursitis.

After injury, surgery or immobilization

Weeks in a cast or sling cause muscles to shorten and joint capsules to tighten. Scar tissue after surgery or burns can tether movement. If not addressed, this can become a fixed joint contracture.

Neurological causes

Stroke, Parkinson's disease and spasticity limit movement through stiffness, weakness and slowness.

A painful lump with restricted movement

When a lump and limited movement come together, the lump may be pressing on structures, inflamed, or a sign of an injury. Common examples:

Lump in the inner arm with pain and restricted movement

On the inner upper arm or near the armpit, the most common causes are a swollen lymph node (from an infection in the hand or arm, a recent vaccine, or skin infection), a strained or torn biceps or other muscle, a hematoma after injury or an infected hair follicle or cyst. A painful, swollen cord along the inner arm can be a superficial vein clot, especially after an IV line. See a doctor if the lump is hot and red, you have fever, the arm is swollen, the lump keeps growing or is still there after 2 to 4 weeks.

How doctors find the cause

A doctor will ask when the restriction started, whether there was an injury, which movements are affected, and whether the joint locks, gives way or swells. They compare active and passive movement, check the other side, feel for swelling or lumps, and test strength and sensation.

Tests may include:

• X-ray for arthritis, fractures and bone spurs
• Ultrasound for lumps, fluid, bursitis and tendon tears
• MRI for cartilage, ligament and deep soft tissue problems
• Blood tests: inflammatory markers, rheumatoid factor and anti-CCP, uric acid
• Joint aspiration: drawing fluid from a swollen joint to check for infection, gout or pseudogout

Treatment

• Relieve pain so you can keep moving: ice or heat, and NSAIDs or acetaminophen (paracetamol) following the label dose
• Physical therapy: stretching and strengthening to restore range, the core treatment for most causes
• Corticosteroid injections for frozen shoulder, bursitis and arthritis flares
• Disease-modifying medicines for rheumatoid and other inflammatory arthritis
• Drainage of abscesses or large effusions, and antibiotics for infection
• Surgery for locked joints, complete tendon tears, severe arthritis or stubborn contractures

Preventing loss of movement

• Move joints through their full range daily, especially after injury or surgery when allowed.
• Do not stay in a sling or brace longer than advised.
• Keep active with a mix of stretching, strengthening and aerobic activity.
• Manage diabetes and inflammatory conditions, which increase stiffness.

Frequently asked questions

What causes restricted movement in a joint?

Common causes include arthritis, frozen shoulder, tendon and ligament injuries, bursitis, swelling inside the joint, torn cartilage and stiffness after immobilization. Neurological conditions such as stroke and Parkinson's disease can also limit movement through stiffness or weakness.

What is this lump that hurts and restricts my movement?

A painful lump that limits movement is often a swollen lymph node, abscess, hematoma, bursitis, cyst or a torn muscle. A hot, red lump with fever suggests infection. A hard, growing lump, especially larger than 5 cm or present for more than a month, should be imaged.

Can restricted movement be fixed?

Usually it can be improved. Physical therapy restores range in most cases, and treating the cause, such as injections for frozen shoulder or surgery for a locked knee, helps further. Long-standing contractures and advanced arthritis are harder to reverse, so early treatment matters.

When should I see a doctor for limited range of motion?

See a doctor promptly if the joint is hot and swollen, you have fever, it locks, you cannot bear weight, or movement was lost suddenly after injury. Book a routine visit for stiffness that has lasted several weeks or keeps getting worse.