STIFF SHOULDER-FROZEN SHOULDER
The shoulder has three bones (shoulder blade, upper arm bone and the collarbone) and the tendons of four muscles. The tendons of these muscles, which connect to the bones help to move your arm.
Frozen shoulder is where the joint gets stiff with restriction of motion. The upper arm bone does not move in the socket of shoulder blade. The soft tissue connecting these two bones (ligaments and surrounding capsule) becomes inflamed causing shoulder pain along with stiffness. The cause of a frozen shoulder is not well understood, but it often occurs for no known reason.
Most people with frozen shoulder have difficulty reaching overhead and reaching to the low back. The stiffening is the body's natural response to inflammation that develops in or near the shoulder. Stiffening is a protective reflex that protects the shoulder from further injury.
In 95 percent of cases, frozen shoulder is totally reversible, although full recovery may take several months. Stiffness and pain do not develop all of sudden, but evolve slowly over a period. In the initial stages (Painful/Freezing Stage) this is most painful. Movement starts getting restricted slowly. This painful stage typically lasts 6-12 weeks. Then in second stage (Frozen Stage) the pain usually eases up as there may not be any movement with total stiffness of the joint. This frozen stage can last 4-6 months. Then finally as the recovery starts (Thawing Stage) motion steadily improves over a lengthy period of time. The thawing stage can last more than a year.
The symptoms of a stiff shoulder:
·Shoulder pain; usually a dull, aching pain.
·Limited movement of the shoulder
·Difficulty with activities such as brushing hair, putting on shirts/bras
·Pain when trying to sleep on the affected shoulder. It can even be more problematic if the second shoulder also develops the same problem which can happen with some interval.
Most often, frozen shoulder occurs with no associated injury or discernible cause. There are patients who develop a frozen shoulder after a traumatic injury to the shoulder, but this is not the usual cause. Some risk factors for developing a frozen shoulder include:
- Age & Sex - Frozen shoulder most commonly affects patients between the ages of 40 to 60 years old, and it is twice as common in women as in men.
- Endocrine Disorders - Patients with diabetes are at particular risk for developing a frozen shoulder. Other endocrine abnormalities, such as thyroid problems, can also lead to this condition.
- Shoulder Trauma or Surgery - Patients who sustain a shoulder injury, or undergo surgery on the shoulder can develop a frozen shoulder joint. When injury or surgery is followed by prolonged joint immobilization, the risk of developing a frozen shoulder is highest. Here in addition to the inflammation of soft tissue around the shoulder described above there is damage to the muscles and bones around the shoulder with bleeding leading to scarring which further restricts movements. In these cases recovery may take even long and may not be complete.
- Other Systemic Conditions - Several systemic conditions such as heart disease and Parkinson's disease have also been associated with an increased risk for developing a frozen shoulder.
Treatment of frozen shoulder is intended to minimise the patients suffering and to reduce the duration of the suffering. It is not possible to completely cure at once after the diagnosis is made. Frozen shoulder treatment primarily consists of treatment to control pain and to regain movement. Most patients find relief with these simple steps, although the entire treatment process can take several months or longer.
Drugs to reduce the pain and inflammation can be taken. Local creams may also help. Steroid injections can be extremely effective in some cases when given in to the actual area of the problem in the shoulder.
Physiotherapy should be started to prevent loss of movement and to regain the lost movement. Stretching exercises are the treatments of choice for frozen shoulder. Massage and heat are useful to increase blood flow. Heat lamps and hot water bottles are the most effective way to increase blood flow which carries oxygen and nutrients to the part. The other benefit of massage is that it helps to reduce the amount of scar tissue which is associated with all muscle, tendon and joint injuries.
If the above treatments do not resolve the frozen shoulder, occasionally a patient will need to have surgery. As a first attempt orthopaedic surgeons may try a gentle manipulation of shoulder under anaesthesia. This may help loosen the stiff tissue. If patient subsequently continues to maintain the regained movement with physiotherapy - though initially may be very painful- no further intervention may be necessary. However if the tissue is very stiff, undue force may damage the bones while manipulating. In these cases the surgeon may decide to surgically release all the tight tissue carefully.
Healthy Joint Club says:
Stiff shoulder is quite a common condition associated with significant pain. The doctors may not be able to offer 100% cure for the condition, but certainly the treatment is going to reduce the suffering and perhaps reduce the duration of suffering. So do not hesitate to seek help but have a realistic expectation of the treatment and then one doesn’t get disappointed.