Understanding Frozen Shoulders - Symptoms, Causes and Treatment
The
shoulder joint has a unique joint structure which is designed to
enable extensive three-dimensional mobility and quick reflexive
responses. However, this amount of flexibility comes at the cost of
its stability and durability.
Stiff
shoulders are one of the adverse sequelae caused due to fractures or
dislocations of the shoulder, cervical or thoracic surgery, or
immobilisation for treating any upper limb surgery.
Often known as ‘adhesive capsulitis’, the
evolution of the frozen shoulder condition can be summarised in four
stages: However, It is traditionally regarded as a self-limiting
condition, which universally settles and recovers with or without
treatment over a variable time course.
Stage
1: After the symptoms have been present for three months, there
is a mild loss of front flexion, abduction and internal and external
rotation, and an aching pain which aggravates while moving the arm.
Stage
2: Also known as the ‘freezing stage,’ which occurs after the
symptoms have been present for 3 to 9 months, and there is a
significant and persistent loss of all movements.
Stage
3: With the symptoms continuing for 9 to 14 months, this ‘frozen
stage’ occurs after the previous painful phase, which has now
substantially settled but leaving a relatively painless but stiffened
glenohumeral joint.
Stage
4: Some amount of gradual improvement occurs in this ‘thawing
stage’, between the 15th and 24th month. The pain is reduced due to
capsular remodelling, which also causes a progressive increase in the
range of movement.
Causes
Of Frozen Shoulder:
There
are three primary causes which lead to a stiff shoulder:
Injury
And Inactivity:
Stiff
shoulders may be caused due to various intrinsic and extrinsic
disorders, such as:
-
Rotator cuff tears
-
Biceps tendonitis
-
Upper limb fractures
-
Cervical spine disorders
-
Intrathoracic pathology
-
Abdominal pathology
Systemic
disorders:
-
Stroke
-
Heart condition
-
Thyroid disorders (hypothyroidism)
-
Parkinson’s disease
-
Diabetes Mellitus
-
Cardiovascular disease
-
Tuberculosis
-
Cytokine secretion
Age
and Gender:
-
Frozen shoulders happen to occur more commonly in females than males.
-
Also, the chances of this condition increase rapidly after the age of 40
Symptoms
of Frozen Shoulder:
Although
hard to detect initially, this condition can be diagnosed by a few
standard symptoms, which include:
-
Feeling stiffness in the shoulder when at rest
-
Reduced range of joint motion in all directions
-
Gradually growing pain and inflammation in and around the joint
Treating
Frozen Shoulder:
All
frozen shoulder treatments are aimed at reducing the time taken for
recovery by relieving pain and improving the range of motion. The
first priority is to reduce pain as, without proper pain relief,
rehabilitation will be inadequate and intolerable.
Medications:
-
You can opt for over-the-counter non-steroidal anti-inflammatory medications that have no contra-indications.
-
Opiate based painkillers must be avoided as they can get quite addictive.
-
You may opt for steroid injections which are directly injected into the joint to relieve pain and improve mobility. Intra-articular steroid injections are more effective if administered in the early stages of the problem.
-
Joint distension is another technique where sterile water is injected into the joint to relax the connective tissues and improve range of motion.
Exercises:
-
The objective of physical therapy is to restore shoulder functionalities by reducing inflammation and pain via stretching exercises and reestablishing normal shoulder mechanisms.
-
A good physiotherapist can guide you through several stretching exercises which help restore range of motion for frontal elevation, external rotation, internal rotation and cross-body adduction.
-
Distension arthrography is another process where fluids are insufflated into the glenohumeral joint for either stretching or rupturing of the joint capsule.
Shoulder
Manipulation Technique:
-
Shoulder manipulation under general anaesthesia (MUA) is a non-surgical procedure where your shoulder joint is stretched in all directions to loosen it up.
-
Provided the clinician is aware of the contraindications to the use of MUA technique, it can be an effective therapy for frozen shoulders that aren’t responding to physiotherapy.
Release
Surgery:
-
The objective of open release surgery is to remove the adhesions in the shoulder joint and free up both intra-articular and extra-articular structures.
-
It is especially useful in treating patients when manipulation might lead to disruption.
-
This ARTHROSCOPIC surgery is performed . through keyholes. It is a one day (day care) procedure
If
you’re having such shoulder trouble for a long time and are in need
of the best shoulder specialist in Mumbai, then you must pay a
visit to Dr Pranjal Kodkani, one of the very few joint preservation
and sports injury specialists today. With exhaustive experience in
treating athletes for joint injuries both surgically and
non-surgically, he is widely known to provide highly effective
options for shoulder treatment in Mumbai. Visit Dr Kodkani’s
website to learn more about his therapeutic and consulting services.
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