CHENNAI: The shoulder is a ball and socket joint between the humerus which is the upper arm bone and the scapula, which is the shoulder blade. There are various ligaments, muscles, and tendons connecting these bones, and a liquid called synovial fluid within the joint acts as a lubricant making the movement at the joint smooth. The joint surfaces with the synovial fluid and synovium (tissue producing the synovial fluid) are enclosed in a connective tissue covering, which surrounds the joint and holds all this together called the shoulder capsule.
In some people, this capsule becomes inflamed and painful. If left untreated at this stage it becomes very thick, hard and rigid, and over some time, the capsule shrinks. Bands of scar tissue develop around the joint and capsule while the synovial fluid reduces in quantity. All these create a condition wherein the person is unable to move the shoulder easily or painlessly. There is enormous pain, stiffness, and discomfort while moving the upper arm and shoulder. This condition is called adhesive capsulitis or frozen shoulder.
MAIN CAUSES
It’s still not clear what causes these developments, but there are various risk factors or people at risk.
- People in the age group of 35 to 60 years are more at risk than youngsters.
- Women are more at risk than men.
- People suffering from diabetes, heart disease, hyper/hypothyroidism, Parkinson’s disease, tuberculosis or chronic inflammatory arthritis of the shoulder.
- People recovering from a stroke or those who have had surgery (such as mastectomy) that prevents them from moving their arm freely.
- People who have had a rotator- cuff injury or a fracture of the upper arm or shoulder bone.
- Any condition which requires wearing of a shoulder sling for a long time.
SYMPTOMS
The condition can last anywhere between few months to two years and goes through three stages freezing, frozen and thawing with moderate or severe symptoms such as:
- Pain and stiffness in the shoulder that worsens at night.
- Loss of range or flexibility in shoulder movement.
- Sleeping on the side of the affected shoulder is painful or uncomfortable.
- Reaching out for high objects or getting dressed with movements that involve moving the hand behind the back is painful or uncomfortable.
- Inability to throw a ball.
- Pain or discomfort while combing the hair (front or back).
- Pain or discomfort while wearing a seatbelt on the side that is affected.
- A sharp or quick movement of the shoulder or upper arm on the affected side, is painful or uncomfortable.
- Both active and passive movements of the affected shoulder reduce or are painful.
DIAGNOSIS
The orthopaedic doctor will undertake one or more of the following:
- Physical Exam: The doctor will first ask you to move your shoulder (active test), then move it for you (passive test) and note down the precise movements or positions that cause either more or less pain and discomfort.
- Imaging Tests: Ultrasound, MRI and CT scan are done to rule out or confirm rotatorcuff injury or arthritis of the shoulder
- Arthrogram: This may be done to rule out congenital defects in the shoulder structure or damage due to any recent injury. This involves injecting a dye into the shoulder area and observing its spread on a screen.
TREATMENT
Depending on the nature, severity and stage of your condition, the orthopaedic specialist may prescribe one or more of the following:
- Acupuncture and/or Dry Needling: These should be performed by an expert, else there are risks if not done right.
- Kinesiology Taping: A cotton tape is applied by expert professionals on the deltoid muscle to relax the muscles, relieve the pain and improve mobility in the area.
- Over-the-Counter Medicines: Nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin and ibuprofen are given to reduce inflammation and relieve pain in the shoulder.
- Shoulder Mobilisation Techniques: One such option is joint distension. In this procedure, the doctor will inject sterile water into the affected shoulder-capsule to stretch it. This will help you move the shoulder easily.
- Corticosteroid Injection: This is given to your shoulder joint to reduce pain and improve your range of motion.
- Physiotherapy: This is the most common and sustainable option of treatment for frozen shoulder. It is also long-term and can last between 3 to 9 months till the shoulder regains full functionality, strength and flexibility. An experienced physiotherapist will massage the affected area to release or relax the affected muscles. You will also have to do simple exercises to stretch and strengthen the muscles in the affected area, under the guidance of the physiotherapist. The physiotherapist will be constantly monitoring your progress and will vary the exercises or massage accordingly.
- Surgery: If none of the above methods works, the orthopaedic specialist may recommend surgery to treat the condition. However, this is rare. In this procedure, called arthroscopic surgery, tiny cuts are made in the shoulder area. Then, lighted, pencil-sized tools are inserted through these cuts and the affected area is examined. Based on the finding, the specialist may initiate the next course of action.
(The author is Senior Consultant- Institute of Orthopaedics & Joint Replacement, Gleneagles Global Health City, Chennai.)
CONSULT FOR CARE
If you or any of your dear ones are displaying any of the symptoms of frozen shoulder, do not panic. Consult a reputed hospital. Such hospitals have some of the best orthopaedic specialists in Chennai, with enormous expertise or experience in treating frozen shoulder. He/she will diagnose your condition
correctly and design the best course of treatment.