What is frozen shoulder?
Frozen shoulder or adhesive capsulitis is a condition in which the connective tissue around the ball and socket joint of the shoulder gets swollen, restricting movement and causing pain. Since movement is restricted in all directions, it makes even simple tasks such as wearing a shirt or combing hair difficult.
As the joint becomes stiff, doing any overhead activity becomes impossible. Jerks and sudden shoulder movements can cause tremendous pain and cramping that can last for several minutes. This condition can also lead to back and neck pain and make you feel depressed. In cold weather, the pain usually persists throughout the day and worsens in the night.
What causes frozen shoulder?
The exact cause of frozen shoulder is not known. However, immobilsation of the joint for extended periods [such as after surgery], can cause frozen shoulder.
The condition can also be a result of autoimmune reaction, when the body attacks its own tissues leading to inflammation.
At times, it occurs spontaneously without any obvious preceding trigger factors. In such cases it is called ‘idiopathic frozen shoulder’.
Who does it affect?
Frozen shoulder usually affects those over 40 years of age; and women are at a greater risk than men. Those at risk of frozen shoulder include diabetics, those with thyroid problems, rheumatoid arthritis, lung disease and stroke.
Also, heart patients and those with shoulder injuries, or who have had breast, heart or lung surgery are also prone to developing frozen shoulder. When recovery from an injury or surgery requires your joint to be immobile for long, your risk of frozen shoulder increases.
What exactly happens with frozen shoulder?
The cover of the shoulder joint contracts and scar tissues [adhesions] are formed, stiffening the shoulder. Normally the condition progresses in three stages:
- Stage 1: The first stage is the ‘freezing stage, which is painful and which usually lasts six to nine months. The intensity of pain slowly increases and then movements start getting restricted, due to pain.
- Stage 2: The pain starts to ease but stiffness persists. This stage lasts 4 – 9 months.
- Stage 3: This is the ‘thawing’ or recovery stage: After 1 – 2 years, frozen shoulder starts to recover on its own. The shoulder movements slowly start returning to normal in about five/six months.
How is frozen shoulder diagnosed?
Usually, a physician can diagnose frozen shoulder by inspecting the range of movement of your shoulder. He may then suggest a shoulder X-ray to rule out shoulder injury or arthritic changes. An MRI may be done to rule out other shoulder conditions having similar symptoms such tendinitis, bursitis or rotator cuff injury.
How do I manage this condition?
Management involves restoring full range of motion and reducing pain. To begin with, non-steroidal anti inflammatory drugs [NSAIDs] and physiotherapy are prescribed.
Physiotherapy usually begins with application of deep heat [short wave diathermy], ultrasonic therapy and various types of electrotherapy to reduce pain and inflammation.
This is followed by mobilisation of the joint and extensive stretching exercises to increase range of motion and to minimise the loss of muscle on affected arm [muscle atrophy]. A shoulder CPM [continuous passive motion] machine helps increase the range with minimal pain.
As range of movement increases with physiotherapy, different exercises are prescribed to strengthen the shoulder and avoid recurrent stiffness.
These exercises and stretches are to be performed several times in a day. Apart from daily physiotherapy, applying moist heat for 10 minutes by using a hot soaked washcloth on the joint helps as well.
Intra-articular corticosteroid injections in the joint are also commonly used to decrease the inflammation in frozen shoulder. This helps to decrease the pain and in turn allows more stretching and physiotherapy. However, on their own steroid injections are ineffective; they work only in conjunction with physiotherapy.
Will I need surgery for frozen shoulder?
Surgery is recommended only if conservative treatment and physiotherapy fail. An orthopedic surgeon can perform manipulation under general anesthesia [MUGA] of shoulder joint.
In MUGA, the patient is sedated and the surgeon mobilises the arm in order to break shoulder adhesions. [No cuts or incisions are involved in the procedure]. Sometimes, an arthroscope is inserted into the joint to cut the adhesions. This is done with or without simultaneous manipulation of the joint. Another surgical option is surgical capsular release, which is effective in cases where other efforts fail. However, this procedure is rarely performed.
In all above procedures, immediate physiotherapy is important as there is a high chance of recurrence.
Will my shoulder motion return to normal?
Most patients who suffer from frozen shoulder will have little shoulder movement restriction, even years after the condition resolves. However, this limit in motion can be minimized or even nullified with therapy and stretching exercises.
Can frozen shoulder be prevented?
Yes, you can prevent frozen shoulder with regular shoulder exercises. Move each shoulder in all possible directions in complete range—front, back, sideways and rotations.
One must be attentive to any shoulder pain or even minor shoulder stiffness. And if such symptoms are noted, it must not be taken lightly and immediate medical advice should be sorted. This will bring faster correction of problem and less suffering.
- Have a hot water bath just before you do your stretches / exercises. The heat makes its easy to stretch, boosts circulation and increases blood flow to the joint.
- Keep your arms straight and loose by your sides. Lift your shoulders up, hold for a few minutes then bring them down—like when you shrug. Be careful not to jerk. Do 8 –10 repetitions. Inhale deeply when you lift the shoulders; exhale when you bring them down.
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