Frozen Shoulder

February 8, 2017

Frozen shoulder (also known as adhesive capsulitis) is a condition in which the shoulder is stiff, painful, and has limited motion in all directions. Frozen shoulder often starts out of the blue, but may be triggered by a mild injury to the shoulder. The condition usually goes through three phases, starting with pain, then stiffness and finally a stage of resolution as the pain eases and most of the movement returns. This process may take a long time, sometimes as long as two or more years.

Frozen shoulder may be associated with diabetes, high cholestrol, heart disease and is also seen in patients with scar tissue in their hands, a condition called Dupuytrens contracture. It may follow an injury to the shoulder or surgery.

The lining of the shoulder joint, known as the ‘capsule’, is normally a very flexible elastic stucture. It’s looseness and elasticity allows the huge range of motion that the shoulder has. With a frozen shoulder this capsule (and its ligaments) becomes inflamed, swollen, red and contracted. The normal elasticity is lost and pain and stiffness set in.

Frozen shoulder has three stages –

  • Freezing — Pain slowly becomes worse until range of motion is lost. (Lasts 6 weeks to 9 months)
  • Frozen — Pain improves, but the shoulder is still stiff. (Lasts 4 to 6 months)
  • Thawing — Ability to move the shoulder improves until normal or close to normal. (Lasts 6 months to 2 years)

Frozen shoulder affects 10-20 percent of people with diabetes according to the American Academy of Orthopaedic Surgeons. Women are more likely to develop frozen shoulder than men and it occurs most frequently in people between the ages of 40 and 60.

Treatment of frozen shoulder focuses on controlling pain and getting movement back to normal through physical therapy. Sometimes surgery is also considered.

Causes

The causes of frozen shoulder are not fully understood. There is no clear connection to arm dominance or occupation. A few factors may put you more at risk for developing frozen shoulder.

  • Diabetes – Frozen shoulder occurs much more often in people with diabetes, affecting 10% to 20% of these individuals. The reason for this is not known.
  • Other diseases – Some additional medical problems associated with frozen shoulder include hypothyroidism, hyperthyroidism, Parkinson’s disease, and cardiac disease.
  • Immobilization – Frozen shoulder can develop after a shoulder has been immobilized for a period of time due to surgery, a fracture, or other injury. Having patients move their shoulders soon after injury or surgery is one measure prescribed to prevent frozen shoulder.

Risk Factors

Common risk factors for frozen shoulder are –

  • Age – being over 40 years of age.
  • Gender – 70% of people with frozen shoulder are women.
  • Recent surgery or arm fracture – immobility of recovery may cause the shoulder capsule to stiffen.
  • Diabetes – two to four times more likely to develop frozen shoulder for unknown reasons; symptoms may be more severe.
  • Having suffered a stroke.
  • Hyperthyroidism (overactive thyroid).
  • Hypothyroidism (underactive thyroid).
  • Cardiovascular disease (heart disease).
  • Parkinson’s disease.

Symptoms

Early symptoms of frozen shoulder –

  • A feeling of pain and tightness in the shoulder area.
  • A feeling of tightness especially when putting the arm up and back, as you would do it you were throwing a ball overarm.
  • Pain on the back of the wrist. (This specifically relates to frozen shoulder caused by subscapularis trigger points.)

As time goes on, the symptoms will worsen although the pain may be reduced.

Complications

Complications may include –

  • Stiffness and pain continue even with therapy
  • The arm can break if the shoulder is moved forcefully during surgery

Treatment

Medication – More than 90% of patients improve with relatively simple treatments to control pain and restore motion.

  • Non-steroidal anti-inflammatory medicines – Drugs like aspirin and ibuprofen reduce pain and swelling.
  • Steroid injections – Cortisone is a powerful anti-inflammatory medicine that is injected directly into the shoulder joint.

Physical Therapy

  • External rotation — passive stretch
  • Forward flexion — supine position
  • Crossover arm stretch

Surgeries – The goal of surgery for frozen shoulder is to stretch and release the stiffened joint capsule. The most common methods include manipulation under anesthesia and shoulder arthroscopy.

  • Manipulation under anesthesia.
  • Shoulder arthroscopy

Transcutaneous electrical nerve stimulation (TENS) – numbs the nerve endings in the spinal cord that control pain and sends small pulses of electricity from the TENS machine to electrodes (small electric pads) that are applied to the skin on the affected shoulder.

Alternative Treatment

Glucosamine and chondroitin sulphate – reduces pain, swelling, and stiffness

Fish oil – reduces inflammation, stiffness, and the need for painkillers

Powdered ginger – reduces inflammation and muscle spasms

Borage seed oil – reduces pain and swelling

Devil’s claw – reduces back pain and symptoms of arthritis and rheumatism

Stinging nettles and turmeric – may reduce pain, stiffness, and inflammation

Curcumin (used topically) – may reduce inflammation.

Magnesium – Helps the body to reabsorb the calcium.

Bromelain – The frozen shoulder may sometimes lead to disorder of the bone joints that will lead to orthopedic complications. Bromelain, a natural cure for frozen shoulder that is extracted from the stems of pineapple has great anti-inflammatory effects. It greatly reduces bruising and spasm occurring on the shoulder region that brings pain relief exquisitely

Acupuncture is largely considered the single most effective treatment option of any form. The treatment functions to eliminate the trigger points eradicating the condition immediately and permanently.

Stretching is another great way to treat frozen shoulder. You can use a number of different stretching methods, but one of the most effective is lying in bed close enough to the edge to allow the affected arm/shoulder to hang down. This position should be maintained for at least 10 minutes and repeated daily until the shoulder releases.

Craniosacral therapy helps the body to release restrictions in the connective tissue (fascia, ligaments, tendons, etc) anywhere in the body.  As the fascia opens up again, the muscles can relax and lengthen.  The joint is freed up and can move with greater ease, and the brain gets the message that it no longer needs to protect the body through muscle contraction.  Moreover, this therapy is exceedingly gentle and thus more acceptable than many other therapies when the pain level is already so high.

Osteopathic treatment –Many people are referred to an osteopath who can give advice on the best exercises to use. Osteopathic treatment can significantly reduce the recovery time for frozen shoulder. Osteopathic Manipulation Under Anesthesia is a technique used by Doctors of Osteopathy to return range of motion and decrease pain in patients with severely limited joint movement.

The treatment improves articular and soft tissue movement while the patient is sedated under monitorized anesthesia care.

 

Reference –

http://www.hopkinsmedicine.org/orthopaedic-surgery/specialty-areas/shoulder/conditions-we-treat/frozen-shoulder.html

http://www.drugs.com/condition/frozen-shoulder.html

http://www.livemint.com/Leisure/LEqfopMSHccrfZic5299tM/The-bite-of-a-frozen-shoulder.html

http://www.livemint.com/Leisure/LEqfopMSHccrfZic5299tM/The-bite-of-a-frozen-shoulder.html

https://www.bupa.co.uk/health-information/directory/f/frozen-shoulder

http://www.sportsinjuryclinic.net/sport-injuries/shoulder-pain/frozen-shoulder

http://www.frozenshoulder.com/frozen-shoulder-diagnosis.php

http://my.clevelandclinic.org/services/orthopaedics-rheumatology/diseases-conditions/adhesive-capsulitis

http://www.emedicinehealth.com/frozen_shoulder/article_em.htm

http://www.diabetes.org/living-with-diabetes/complications/related-conditions/frozen-shoulder.html?referrer=https://www.google.co.in/

http://www.healthline.com/health/frozen-shoulder

http://emedicine.medscape.com/article/1261598-overview

http://www.saga.co.uk/magazine/health-wellbeing/conditions/bones-joints/frozen-shoulder-symptoms-and-treatment.aspx

https://www.shoulderdoc.co.uk/section/16

 

Posted in MUSCULOSKELETAL