Frozen Shoulder - Motion Restriction

Frozen Shoulder, also known as Adhesive Capsulitis or Shoulder Contracture, is a condition that affects shoulder movement, and the patient experiences stiffness and pain. Injuries, overuse of the shoulder, or diseases, such as Diabetes or Stroke, usually lead to such a condition.

Causes

A capsule of connective tissue covers the bones, ligaments, and tendons of the shoulder. The thickening and tightening of this capsule around the shoulder joint, leads to Frozen Shoulder and restricts movement.

Frozen Shoulder mainly occurs in:

1. People with prolonged immobilization of the shoulder, especially after a Surgery or an Arm Fracture.
2. People between the age of 40 and 70 years.
3. Women (especially in post-menopausal women), as compared to men.
4. People with Chronic Diseases.
5. People with Dupuytren's Contracture, a condition where small lumps of thickened tissue form in the hands and fingers.

Signs and Symptoms

Constant pain and stiffness are the two main symptoms of Frozen Shoulder. These symptoms develop gradually, usually in three stages. In these three stages, the ailment at first worsens and then gradually cures.

The three stages of Frozen Shoulder are:

1. Painful Stage - In this stage, the shoulder becomes stiff and causes pain during movement.
2. Frozen/Adhesive Stage - In this stage, the shoulder stays stiff with limited range of motion. The pain may not subside during this stage, but it does not usually worsen either.
3. Thawing Stage - In this stage, the pain diminishes and the movement in the shoulder improves. However, the pain may recur occasionally.

Risks of Frozen Shoulder

Certain factors or conditions may increase the risk of developing a Frozen Shoulder, these include:

1. Age and Sex:People in the age group of 40 to 70 years are more susceptible to a Frozen Shoulder. Also, this condition is more common in women than in men.
2. Reduced Mobility or Complete Immobility: People with Rotator Cuff Injury, Broken Arm, Stroke, and recovering from a Surgery, are at a higher risk of developing a Frozen Shoulder
3. Diseases: People suffering with Diabetes, Overactive Thyroid (Hyperthyroidism), Underactive Thyroid (Hypothyroidism), Cardiovascular Diseases, Tuberculosis, Parkinson's disease, and more, are more vulnerable to a Frozen Shoulder.

Consultation

A General Physician or an Orthopedic Surgeon is the subject matter expert.

Tests and Investigations

A Doctor diagnoses Frozen Shoulder based on the signs and symptoms, as well as a physical examination. He may test the range of movement by asking the patient to do some simple stretching exercises. To rule out structural problems he may suggest an X-Ray or an MRI (Magnetic Resonance Imaging). To rule out Diabetes, he may also recommend a blood test.

Treatment Modalities Available

The aim of the treatment for Frozen Shoulder is to control the pain and help in mobility. It may take several weeks, months, or even years to combat a Frozen Shoulder.

The treatment options for Frozen Shoulder include:

1. Painkillers: Paracetamol Tablets, as well as, Non-Steroidal Anti-Inflammatory Drugs (NSAID), help relieving the pain.
2. Corticosteroid Injections: For extreme pain, which does not subside with oral medication, physicians prescribe Corticosteroid Injections which are Steroid Hormones that reduce pain and swelling.
3. Hot or Cold Compression Packs: Application of Compression Packs helps in getting respite from pain and swelling. Applying these hot and cold packs alternately, gives instant relief.
4. Exercises and Physiotherapy: Exercises as suggested by the physician, or performed under a Physiotherapist's supervision, help the patient to get back to leading a normal life.
5. Joint Distension: This is the process of injecting sterile water into the joint capsule, which helps in stretching the tissue in the shoulder and makes it easier to move the joint.
6. Shoulder Manipulation: Shoulder Manipulation is the process of moving the shoulder joints to loosen the tissues after giving the patient a general anesthetic.
7. Acupuncture: This procedure involves insertion of extremely fine needles into the skin at specific points of the body, which gives relief from pain.
8. Transcutaneous Electrical Nerve Stimulation (TENS): Using a TENS machine, the physician passes electric current to key points, such as the nerve endings in the spinal cord. This current stimulates the release of pain-inhibiting molecules (Endorphins) or blocks the pain fibers that carry pain impulses.
9. Surgery or Shoulder Arthroscopy: The last resort to treat a Frozen Shoulder is a minimally invasive type of surgery, known as Shoulder Arthroscopy.

Physical Activity Requirements during the Course of the Treatment

The physical activity of the shoulder remains restricted during the treatment. The patient must indulge in exercises as per the advice of the physician to avoid complications.

Precautions during Treatment

Frozen Shoulder treatment depends on the stage of the disease, as well as the patient's response to the treatment. Hence, the patient must strictly follow the medication and exercises prescribed by the physician to avoid difficulty.

Prevention to Avoid Recurrence

Immobility caused during recovery from a shoulder injury, broken arm or a Stroke, is one of the main causes of Frozen Shoulder. Hence, any patient with any of these ailments must consult a physician who would advise him as to which physical exercises would be best to maintain the range of motion in the shoulder joint.

Support from Family

Patients often panic & get restless due to pain and the lengthy healing process. Reassurance from the family members helps in curing the patient's physiological, physical, and social health.