Frozen Shoulder

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“Frozen Shoulder” is a phrase dreaded by all who have suffered shoulder pain. It is also one of the most poorly understood problems in orthopaedic medicine and because of the time it takes to resolve (if at all), it is also considered “untreatable”.

Though what causes frozen shoulder is not really known or understood, any shoulder injury can potentially put you at risk of developing it. Frozen Shoulder is called “Adhesive Capsulitis” by doctors and it actually means swelling (inflammation) of the capsule covering the shoulder joint and causing it to shrink and stick to its own folds. Obviously when this happens, the range of movement in the shoulder reduces and the shoulder cannot move freely. Classically in Frozen shoulder movements in all directions will be restricted. The amount of restriction will depend on the amount of capsular shrinkage and will differ from person to person.

Frozen shoulder can be secondary to some other trauma to the shoulder (eg. Cuff injury, Fracture, Tendonitis, Arthroscopic Surgery, Bursitis, Labral Tear etc.), or it could also be primary, i.e. a slow onset of shoulder stiffness for no apparent reason. Frozen shoulder affects more women than men and if you are diabetic or a chronic smoker you are more at risk. It almost never affects the young and is mostly found in the 40-70 year age group. Frozen shoulder typically affects only one shoulder but in Diabetics both shoulders are often involved.

Pain from a frozen shoulder can be horrendous in some and initially may be worse at night. It also travels down the side of the arm up to the elbow. At first movements to the back of the body and to the side will become restricted. The painful stage of frozen shoulder may last from 3 weeks to 6 months or sometimes even a year.

Once diagnosed with a frozen shoulder, the treatments are all aimed towards pain relief, and maintenance of available range of motion and strength. These treatments do not offer a cure but help you to retain function while the inflammatory reaction settles. Physiotherapy and exercises are a mainstay of treatment, but excessive unnecessary exercises in this phase will cause a flare-up of symptoms. Sometimes over enthusiastic physios and doctors may make the problem worse, so you need to understand your shoulder and listen to the signals your body gives you.

Cortisone injections, nerve blocks, surgical release of the adhesions and mobilization under anaesthesia all might be suggested by surgeons and can be tried after due consideration. But if the inflammatory reaction is going on, none of these might help, and waiting for the shoulder to quieten itself is your only hope.

Once the initial inflammatory (painful) stage passes, the stiffening phase might start. In this phase a little aggressive exercise schedule can be practised as advised by your physiotherapist. This might be supported with electrotherapy as required and should be monitored closely for any flare-ups. This stage may last from 3 months to about 12 months and might be very frustrating as all your efforts may seem useless!!

Most sufferers do see a light at the end of the dark tunnel and go in to the “resolving” or “easing up” phase where the shoulder finally starts opening up and becoming stronger. This phase again may last from 3 -12 months and may result in an (almost) full recovery or a partial opening up of the shoulder range. But most people make their peace with their shoulder by then and are functionally very happy.

Your recovery in frozen shoulder will depend very heavily on your belief in yourself and your doctor throughout the first two stages as the outcome of the third stage depends upon the input in the first two stages. Remaining positive, understanding what is happening to your shoulder in each stage, keeping yourself active physically and listening to your body will help tremendously.