AN OVERVIEW:
Frozen shoulder, also known as adhesive capsulitis, is a shoulder joint condition. It is typically characterised by severe pain and stiffness that develops gradually, worsens, and then resolves.
The shoulder comprises three bones that come together to form a ball-and-socket joint. They are the humerus (upper arm), scapula (shoulder blade), and the collarbone (clavicle). A tissue known as the shoulder capsule surrounds your shoulder joint and keeps everything together. This is known as the shoulder capsule.
When a person has a frozen shoulder, this same capsule becomes so thick and tight that it makes it difficult to move the arm. Scar tissue forms in the joint, and there is less synovial fluid to keep it lubricated. These things make it even more difficult to move.
This condition is known as "frozen shoulder" because the more the pain, the less the shoulder functions. The shoulder capsule thickens and tightens as a result of inactivity, making the shoulder all the more restrictive and difficult to function– it becomes "frozen" in its place.
CAUSES
It is unknown why some people suffer from frozen shoulder, although some populations are more vulnerable.
Frozen shoulder affects women more than males, and it is more likely to affect people between the ages of 40 and 60. The risk may also increase if somebody is recovering from a medical illness such as a stroke or surgery such as a mastectomy (breast removal) that prevents them from using their arm.
Some medical disorders might also raise your risk. Diabetes may also increase your chances of developing a frozen shoulder. Frozen shoulder affects around 10% to 20% of diabetics. Frozen shoulder is also connected to other medical issues.
SIGNS & SYMPTOMS
The primary symptoms of a frozen shoulder are pain, stiffness and progressive loss of shoulder movements. The condition affects both sides equally, and rarely occurs on both shoulders in a simultaneous fashion
People with frozen shoulders usually go through three stages. Each one has its own set of symptoms and timeframe.
1. Freezing/ Acute/ Painful stage
This stage lasts for about six weeks to nine months and includes the following symptoms.
Severe pain while moving the shoulder
Pain worsening at night
Restricted shoulder movement
2. Frozen /Adhesive/ Stiffening Stage
This stage lasts for about four to twelve months and the symptoms are,
In this stage, pain may lessen, but there may be increased stiffness of the shoulder
This makes it more difficult to complete daily tasks and activities.
3. Thawing/ resolving stage
This stage lasts for about six months to two years and is also known as the recovery stage.
In this stage, there is a big decrease in pain especially at night and the ability to move the shoulder slowly improves.
Full or near full recovery occurs as normal strength and motion return.
RISK FACTORS
Parkinson’s disease
Adrenal disease
Diabetes
Heart and lung disease
High cholesterol
hyperthyroidism
Stroke
Shoulder injury ( rotator cuff tear, impingement syndrome, bursitis, fractures of shoulder blade, collarbone or upper arm)
Prolonged upper limb immobilisation (post-surgery, head injury)
Shoulder arthritis
DIAGNOSIS
Physical examination - the doctor may ask you to move in certain ways to check for pain and evaluate your range of motion (active range of motion). Your doctor might then ask you to relax your muscles while he or she moves your arm (passive range of motion). Frozen shoulder affects both active and passive range of motion.
Shoulder X-rays - to ensure that the origin of the symptoms is not attributable to some other shoulder condition, like arthritis.
Frozen shoulder is frequently diagnosed without the use of advanced imaging procedures such as magnetic resonance imaging (MRI) or ultrasound. They might be taken to rule out other issues, including a rotator cuff injury.
TREATMENT
Until the early phase passes, treatment mainly consists of pain management approaches. If the condition does not resolve on its own, treatment and surgery may be required to recover mobility.
1. Medications
Aspirin and ibuprofen (Advil, Motrin IB, and others) are over-the-counter pain medications that can help lessen the pain and swelling accompanied by a frozen shoulder.
2. Other Procedures:-
Joint distension: It involves injecting sterile water Inside the joint capsule. It helps expand the tissue and enables joint movement.
Steroid injection: Steroid injection helps reduce pain. It helps increase mobility during the early stage of the condition.
Shoulder manipulation: The patient will be unconscious during this surgery since they will be given general anaesthesia. The doctor will next manipulate the shoulder joint in various directions to help relax the constricted tissue.
3. Surgery
Surgery (arthroscopy) for frozen shoulder is rarely required, but it's an option in some severe cases if other treatments have not worked.
4. Physiotherapy
Although several interventions have been examined, the ultimate therapy for frozen shoulder remains unknown. Engaging in a physical therapy programme is the best approach to rehabilitation for the majority of patients.
Treatment methods for different phases:-
1. Freezing Stage:
During this stage, the focus is on pain management and ruling out other possible reasons for your frozen shoulder.
During this painful inflammatory phase, very careful shoulder movements, acupuncture, muscle release, dry needling, and kinesiology can benefit. The use of a TENS machine has been shown to relieve inflammation and improve the range of motion.
Hot packs, for example, can be used either during or before the treatment. Moist heat, when combined with stretching, can aid to enhance muscle flexibility and improving range of motion by decreasing muscle stiffness and induce neuromuscular relaxation.
2. Frozen Stage:
For a quick return to function, gentle and targeted shoulder joint mobilisation and stretches, muscular release treatments, acupuncture, dry needling, and exercises to rebuild range and strength are employed. It is critical to avoid introducing any overly strenuous workouts. Mobilisation with movement (MWM) approaches, in particular, tend to be more beneficial than stretching exercises alone.
3. Thawing Stage:
Provide you with workout progressions, including strengthening exercises, to help you regulate and maintain your enhanced range of motion.
Physiotherapy is most beneficial during the thawing process.
Advanced mostly by improving stretch duration and frequency while keeping the same intensity as permitted by the patient. The stretch can be sustained for longer durations, and the number of exercises each day can be improved. As the patient's irritation decreases, more severe stretches and workouts employing a device, like a pulley, can be administered to stimulate tissue remodelling.
Specific exercises can aid in the restoration of mobility. These can be done under the guidance of a certified physiotherapist. Stretching and range of motion exercises for the shoulder are part of the treatment. Heat treatment is sometimes used to gently release the tension of the shoulder before stretching. Some of the exercises that could be suggested are listed below.
Stretching & Strengthening Exercises
Pendulum stretch
Towel Stretch
Finger walk
Cross-body reach
Armpit Stretch
Inward Rotation
Outward Rotation
HOME REMEDIES FOR FROZEN SHOULDER
Heat pack:
Using a heat pack helps to restore enough blood circulation to the shoulder and prevents additional damage. Warm it up the shoulder by using heat packs (you can even take a hot water bath) and slowly move it in circular motions. You must ensure that the motion is moderate and gradual. Any sharp action might harm the shoulder
Add Epsom salt while bathing:
You may also add a little amount of Epsom salt to your water while bathing to assist with the heat supplied to your shoulders.
Massage:
Gentle massage on the affected area once or twice a day with warm oil (not too hot) can prove to be beneficial in easing pain and can even help release tension in the muscles.
Practice exercise daily:
2 to 3 times daily, perform mild and simple shoulder exercises. It is advised to perform a few exercises after warming up the shoulder. Exercises can improve the movement of the frozen shoulder and contribute to the physiotherapy session.
RECOVERY
Physical therapy is required post-surgery to retain the mobility gained during surgery. Recovery durations range from six weeks to three months. Whilst healing is a gradual process, your dedication to therapy is the most significant aspect in resuming all of your favourite hobbies.
Long-term results are typically favourable, with most patients experiencing minimal or no discomfort and a better range of motion. Furthermore, in some cases, even after many years, the mobility does not recover fully and some stiffness persists. After surgery, diabetic people frequently experience some degree of shoulder discomfort.
The frozen shoulder might reoccur, particularly if a predisposing condition such as diabetes is still present.
FAQs
1. Is it possible to cure frozen shoulder with exercises?
Ans: Stretching and exercising regularly basis can benefit people with frozen shoulders, it can help reduce discomfort and improve mobility. It generally takes time and consistent application of procedures to see results.
2. What is the fastest way to get rid of a frozen shoulder?
Ans: The majority of frozen shoulders resolve on their own in around twelve to eighteen months. Steroid injections may be recommended by your doctor if you have chronic complaints. At times, Injecting corticosteroids into the shoulder joint may significantly minimize discomfort and increase mobility, particularly in the early stages of the condition.
3. What aggravates frozen shoulder?
Ans: Immobility caused by a shoulder injury, a broken arm, or a stroke is one of the most prevalent causes of frozen shoulder. Talk to your doctor about exercises you can perform to preserve your shoulder joint's range of motion If you've suffered an injury that makes moving your shoulder difficult.
4. What helps with frozen shoulder pain at night?
Ans: To help you sleep comfortably, place a pillow beneath your afflicted arm, with your hand firmly on your stomach. Make sure you don't sleep on your afflicted shoulder if you sleep on your side. Similarly, hug your injured arm over your chest with a pillow.
5. How long does a frozen shoulder take to thaw?
Ans: Following a diagnosis from your doctor, therapy typically consists of three sessions per week with a physical therapist for ten to twelve weeks. The purpose is to start the "thawing" process, which might take around 2-3 months.
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