There are certain health conditions, the exact causes of which have not been found out till date. But luckily, the healthcare industry has been able to find out the possible remedies or the treatments for such conditions. Frozen shoulder, which causes pain and stiffness in the shoulder, is one such health condition. It is a chronic condition caused by a mechanical block of movements at the shoulder joint in all directions. The term "frozen shoulder" was first described by Codman. The condition is also referred to as adhesive capsulitis.
Frozen shoulder usually manifests as pain and stiffness of the shoulder joint over weeks or months. The condition is usually unilateral and more often affects the non-dominant side, i.e. left shoulder in case of right-handed people. Often the range most affected is external rotation, followed by abduction and then by internal rotation. Studies have found that middle-aged women form a majority among the affected population.
What Happens Exactly?
In adhesive capsulitis of the shoulder or in the so-called 'frozen shoulder', an inflammation of the glenohumeral capsule (capsule of shoulder joint) takes place and it results in the thickening and the contraction of the capsule leading to severe pain and marked restriction of ROM (Range of Motion) in the shoulder.
The exact underlying cause of frozen shoulder is unknown but it has been noted that this condition virtually never recurs at the same site. Some experts believe that shoulder injuries of the past or some collagen disorder or even diabetes can provoke a gradual shrinking of the capsule, making the shoulder to freeze. After many case studies several researchers have identified that some of the conditions like muscle imbalance caused due to inactivity, Reflex Sympathetic Dystrophy (a chronic pain condition which affects an arm or a leg more commonly), Central Cord Syndrome (an acute cervical spinal cord injury), cervical disease or surgery and cardiac surgery can also lead to frozen shoulder.
Clinical Symptoms of Frozen Shoulder
Since the condition is gradual and progressive in nature, initially the patient describes an acute onset of pain which does not get relieved by rest. Pain is the primary complaint during the first week and it disturbs sleep. As the condition progresses, the pain at rest subsides with restricted, painful movement becoming the primary complaint of the patient. The pain stands in the way of day to day activities like overhead activity, reaching back, dressing etc.
Diagnosis of Frozen Shoulder
Diagnosis of frozen shoulder is mainly based on physical examination. Pain and restricted range of both active and passive motion in the shoulder joint especially the external rotation is severely affected. A person's medical history is another key to suspect frozen shoulder. X-rays should be deployed from different planes to rule out bony pathology.
Treatment of Frozen Shoulder
The treatment of frozen shoulder is based on its stage and severity. Each case needs to be discussed individually to plan an accurate treatment program.
- Initially when pain is the primary complaint, the main goal of treatment is to ensure pain relief. Experts suggest that until the night pain disappears, no other treatment methods apart from the use of pain killers should be adopted. To relieve pain NSAIDs, intra-articular anesthetics and steroid injections may be prescribed.
- Hot packs, electrotherapy modalities like TENS (transcutaneous electrical nerve stimulation), ultrasound, low grade mobilization and acupuncture can also be administered.
- Once the pain at rest subsides, the aim of the treatment is to recover the lost range of motion. The treatment includes physical therapy in which high grade mobilization is given to break the capsular adhesions and to regain the range of motion at the shoulder joint.
- Along with mobilization, auto-assisted active exercises (using a walking stick or wand or pulley that is grasped by both the hands but guided by the non-affected side) and pendulum exercises can be performed in order to improve the range of motion.
- Isometric exercises can also be performed to strengthen the muscles surrounding the shoulder joint.
- Self stretching should be initiated to maintain flexibility. An individual may also require postural correction. Recreational activity like swimming in warm water can be started in later stages.
- Rarely, in some of the severe cases, manipulation under anesthesia or capsular release via either arthroscopic or open techniques is generally done to manage the condition.
Any type of physical disability may come in the way of your daily activities. Living with pain and discomfort is no fun! So it's better to get treated as soon as possible.
