Chilling Out with Frozen Shoulder: A Cool Guide to Thawing Out

Frozen shoulder, or as the cool kids in the medical world call it, adhesive capsulitis, is like having your shoulder replaced with a cranky old door hinge that squeaks and resists every time you try to use it. Imagine reaching up to snag a cookie from the top shelf, and your shoulder decides, "Not today, pal." That's frozen shoulder for you.

Some anatomy, if you will. The shoulder is a ball-and-socket joint composed of three bones: the upper arm bone (humerus), the shoulder blade (scapula), and the collarbone (clavicle). It's encased in a strong connective tissue known as the shoulder capsule, which keeps the joint secure. In frozen shoulder, the capsule thickens and tightens, making movement difficult. Scar tissue develops, and the reduction in synovial fluid further restricts joint lubrication, severely limiting shoulder mobility.

The term "frozen shoulder" is quite literal; as your shoulder becomes more painful, you're less inclined to use it. This leads to the shoulder capsule thickening, making movement even more challenging. Essentially, your shoulder decides to play the role of an ice sculpture, stubbornly staying put.

Signs & Symptoms

The hallmark signs of this condition are severe pain and being unable to move your shoulder, either on your own or with the help of someone else. The symptoms of this chilly shoulder condition unfold in stages.

·       First, there's the "freezing" stage, where your shoulder slowly turns into the Antarctic, becoming stiffer and more painful with each passing day. The pain may worsen at night. This can last anywhere from six weeks to nine months, which is just long enough for you to develop a deep personal relationship with your heating pad.

·       Next up is the "frozen" stage. The good news? The pain might dial down a bit. The bad news? Your shoulder's range of motion is now as limited as a penguin's flight capabilities. This stage can last for four to six months, and you'll likely get to know every over-the-counter pain relief cream on a first-name basis. This stage could last anywhere from 2 – 6 months.

·       Finally, there's the "thawing" or recovery stage, where your shoulder starts to loosen up, and you can finally wave goodbye to the pain and stiffness. This can take six months to two years, which is roughly the time it takes for a glacier to move an inch.

Causes?

The exact causes of frozen shoulder remain a mystery. There's no definitive link to whether it affects the dominant arm more or is related to one's job. However, certain factors can increase the risk of developing it. For instance,

·       People with diabetes are more likely to get frozen shoulder. Why? That's still up for debate. But what's known is that diabetics with frozen shoulder often experience more severe stiffness that lasts longer before it starts to ease up.

·       Other health issues can also be connected to frozen shoulder, such as hypothyroidism, hyperthyroidism, Parkinson's disease, and heart disease.

·       If your shoulder has been stuck in one spot for a while, say after surgery or an injury, that could also lead to frozen shoulder. That's why doctors encourage shoulder movement early on after an injury or operation to ward off this condition.

Treatment

The goal is to reduce pain and maintain movement and flexibility in the shoulder. With time and proper treatment, most patients (9 out of 10) find relief. However, the recovery process can be gradual, and symptoms may linger for a few years. There are various methods to manage pain and improve the condition.

Managing pain for frozen shoulder can be approached in various ways.

• Pain Relievers

  • Over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen and naproxen can help reduce inflammation and soothe mild pain. These medications are readily available over the counter.

  • Acetaminophen, also known as paracetamol or Tylenol, is often suggested for longer-term use and is also available over the counter.

  • For more severe pain, prescription medications such as codeine, an opioid pain reliever, may be recommended. However, it's crucial to consult with a healthcare provider, as not every painkiller is appropriate for each individual.
    

• Hot and cold compression packs can alleviate pain and swelling and using them in alternation may be beneficial. These packs are readily available in stores and for online purchase.
  

• Corticosteroid injections can also provide relief, but it's important to avoid repeated use due to potential adverse effects, including possible shoulder damage.
  

• Transcutaneous electrical nerve stimulation (TENS) offers another approach by numbing the pain-controlling nerve endings in the spinal cord. A TENS device sends mild electrical currents to electrodes or pads placed on the skin over the affected shoulder. There is a variety of TENS units from different manufacturers available for online purchase.
  

• Physiotherapy is another option to regain mobility in your shoulder. Depending on your location and insurance policy, you might be able to consult a physiotherapist directly without a referral from your primary care doctor. A physiotherapist will tailor the number of sessions to your specific needs, typically extending over a minimum of six weeks. The duration is flexible and will be adjusted based on the rate of improvement in your shoulder's mobility. Treatments from a physiotherapist include:

  • stretching exercises

  • strength exercises

  • good posture advice

  • pain relief, including giving steroid injections

If you're still experiencing pain after completing your sessions, consider revisiting your primary physician or physiotherapist. They may recommend additional physiotherapy or a different treatment. For more support with physiotherapy, you can visit Kinrocare's website. For severe or ongoing symptoms, alternative treatments include:

• Steroid Injections (also done in physiotherapy) - Injecting corticosteroids directly into the shoulder joint may reduce pain and increase mobility, particularly when administered early in the course of a frozen shoulder.

  
  

• Hydro dilatation. Introducing sterile water into the joint capsule can stretch the tissue, making it easier to move the joint. Often, this is done alongside a steroid injection.

  
  

• Shoulder manipulation. Under general anesthesia, which renders you unconscious and pain-free, a healthcare provider will move your shoulder in various directions to loosen the tight tissue.

  
  

• And for those shoulders that just won't listen to reason, surgery might be the final frontier. While surgery for a frozen shoulder is uncommon, it may be considered if other treatments fail. It's like a pep talk for your shoulder, but with anesthesia and scalpels involved. The procedure involves removing scar tissue from within the shoulder joint through small incisions, using miniature instruments guided by an arthroscopic camera.

Prevention

To prevent frozen shoulder, it's important to keep your shoulder joint fully mobile, especially if you're recovering from surgery or an injury. Gentle, progressive range-of-motion exercises and stretching can help maintain mobility. It's also beneficial to use your shoulder more to prevent stiffness. If you've had an injury or surgery that affects shoulder movement, starting physical therapy promptly can reduce your risk of developing frozen shoulder. Always consult with a healthcare provider before beginning any new exercise regimen.

Exercises to prevent frozen shoulder focus on maintaining shoulder mobility and flexibility. It's crucial to perform these exercises regularly and within a pain-free range to avoid further injury. Examples of exercises include:

• Pendulum swings, where you lean forward and let your arm hang down, gently swinging it in small circles.

• Towel stretches, where you hold a towel with both hands behind your back and gently pull to stretch the shoulder.

• Wall climbs, using your fingers to 'climb' up a wall.

• Cross-body reaches, where you use your good arm to lift the affected arm at the elbow and bring it across your body, can help maintain range of motion.

In conclusion, if you're dealing with a frozen shoulder, don't despair. With a little bit of cold, a dash of heat, some tender loving care, and possibly a stern intervention, you'll be waving that arm around like you just don't care in no time. Just remember, patience is key, and so is a sense of humor. After all, it's not every day your body part decides to go sub-zero on you!

Keep warm, folks!

For more detailed information on treatment options, you can visit reputable sources such as the Mayo Clinic and Harvard Health.

#physiotherapy #frozenshoulder #rehabilitation #Physiatry