Frozen shoulder, also known as Adhesive capsulitis, is a condition characterized by stiffness and pain in your shoulder joint. Signs and symptoms typically begin gradually, worsen over time and then resolve, usually within one to three years.
Your shoulder is a ball-and-socket joint made up of three bones: your upper arm bone (humerus), your shoulder blade (scapula), and your collarbone (clavicle).
The head of the upper arm bone fits into a shallow socket in your shoulder blade. Strong connective tissue, called the shoulder capsule, surrounds the joint.
To help your shoulder move more easily, synovial fluid lubricates the shoulder capsule and the joint.
Symptoms & Stages –
The main symptoms of a frozen shoulder are pain and stiffness that make it difficult or impossible to move it.
If you have frozen shoulder, you’ll likely feel a dull or achy pain in one shoulder. You might also feel the pain in the shoulder muscles that wrap around the top of your arm. You might feel the same sensation in your upper arm. Your pain could get worse at night, which can make it hard to sleep.
You’ll typically go through three phases with a frozen shoulder. Each has its own unique symptoms and timeline.
▪︎ Freezing stage
• You develop a pain (sometimes severe) in your shoulder any time you move it.
• It slowly gets worse over time and may hurt more at night.
• This can last anywhere from 6 to 9 months.
• You’re limited in how far you can move your shoulder.
▪︎ Frozen stage
• Your pain might get better but your stiffness gets worse.
• Moving your shoulder becomes more difficult and it becomes harder to get through daily activities.
• This stage can last 4-12 months.
▪︎ Thawing stage
• Your range of motion starts to go back to normal.
• This can take anywhere from 6 months to 2 years.
Frozen shoulder occurs when the strong connective tissue surrounding the shoulder joint (called the shoulder joint capsule) become thick, stiff, and inflamed. The condition is called “frozen” shoulder because the more pain that is felt, the less likely the shoulder will be used. Lack of use causes the shoulder capsule to thicken and becomes tight, making the shoulder even more difficult to move — it is “frozen” in its position.
Risk Factors –
Adults, most commonly between 40 and 60 years old.
More common in women than men.
• Recent shoulder injury
Any shoulder injury or surgery that results in the need to keep the shoulder from moving (i.e., by using a shoulder brace, sling, shoulder wrap, etc.). Examples include a rotator cuff tear and fractures of the shoulder blade, collarbone or upper arm.
Between 10 and 20 percent of individuals with diabetes mellitus develop frozen shoulder.
• Other health diseases and conditions
Includes stroke, hypothyroidism (underactive thyroid gland), hyperthyroidism (overactive thyroid gland), Parkinson’s disease and heart disease. Stroke is a risk factor for frozen shoulder because movement of an arm and shoulder may be limited.
Doctors will most likely diagnose frozen shoulder based on signs, symptoms, and a physical exam, paying close attention to the arms and shoulders. Structural problems can only be identified with the help of imaging tests, such as an X-ray or Magnetic Resonance Imaging (MRI).
The aim is to alleviate pain and preserve mobility and flexibility in the shoulder. There are several ways to relieve pain and alleviate the condition.
Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen reduce inflammation and alleviate mild pain.
Acetaminophen (paracetamol, Tylenol) is recommended for extended use.
• Hot or cold compression packs
These can help reduce pain and swelling. Alternating between the two may help.
A physical therapist can teach you range-of-motion exercises to help recover as much mobility in your shoulder as possible. Your commitment to doing these exercises is important to optimize recovery of your mobility.
• Surgical and other procedures
Most frozen shoulders get better on their own within 12 to 18 months. For persistent symptoms, your doctor may suggest:
° Steroid injections. Injecting corticosteroids into your shoulder joint may help decrease pain and improve shoulder mobility, especially in the early stages of the process.
° Joint distension. Injecting sterile water into the joint capsule can help stretch the tissue and make it easier to move the joint.
° Shoulder manipulation. In this procedure, you receive a general anesthetic, so you’ll be unconscious and feel no pain. Then the doctor moves your shoulder joint in different directions, to help loosen the tightened tissue.
° Surgery. Surgery for frozen shoulder is rare, but if nothing else has helped, your doctor may recommend surgery to remove scar tissue and adhesions from inside your shoulder joint.
Acupuncture involves inserting extremely fine needles in your skin at specific points on your body. Typically, the needles remain in place for 15 to 40 minutes. During that time they may be moved or manipulated. Because the needles are hair thin and flexible and are generally inserted superficially, most acupuncture treatments are relatively painless.
• Transcutaneous electrical nerve stimulation (TENS)
A TENS unit delivers a tiny electrical current to key points on a nerve pathway. The current, delivered through electrodes taped to your skin, isn’t painful or harmful. It’s not known exactly how TENS works, but it’s thought that it might stimulate the release of pain-inhibiting molecules (endorphins) or block pain fibers that carry pain impulses
• Pendulum stretch
Stand with the shoulders relaxed. Lean forward with the hand of the unaffected arm resting on a table. Let the affected arm hang down vertically and swing in a small circle, around 1 foot in diameter. Increase the diameter over several days, as you gain strength.
• Towel stretch
Grab both ends of a towel behind your back. With the good arm, pull the towel, and the affected arm, up toward the shoulder. Repeat 10 to 20 times a day.
Ayurvedic Perspective –
In Ayurveda , Frozen shoulder condition is referred to as Apabahuka. It is caused by the vitiation of Vata dosha, which when accumulated in the joints absorbs fluid of the musculoskeletal causing the stiffness of the musculoskeletal.
There are two types of Apabahuka.
• One type is associated with dry inflammation and is primarily a vata condition with a racing or moving sensation.
• The second type is associated with moist inflammation caused by kapha or ama blocking the movement of vata and the pain stays in one localized area.
▪︎ Ayurvedic Body Therapies
• Abhyanga/ Snehana
It is a medicated warm oil massage and normally steam therapy is given right after the massage. This therapy is especially effective for relieving stiffness.
It is streaming of hot oil, along with simultaneous massage.
It is an herbal poultice prepared with vata balancing herbs such as Castor leaves, Nirgundi (Vitex negundo), Dashamoola, Devadaru which are tied in a cloth and dipped in warm herbal oil and applied over the shoulder joints.
It is especially useful in degenerative conditions. First Abhyanga (oil massage) is done, and then a rice pack made from cloth is dipped in prepared kashayam and is applied over the affected area of the shoulder.
• Podi Kizhi
It is a mixture of herbal powders tied in cloth linen bags and dipped in oil and applied over shoulder joint.
In it cotton bags are soaked in warm herbal oils and applied to the affected shoulder joints.
Either a single or a combination of above therapies is used in Ayurvedic treatment of frozen shoulder.
Frozen shoulder can only be prevented if it is caused by an injury that makes shoulder movement difficult. Anyone who experiences such an injury should talk to a doctor about exercises for maintaining mobility and flexibility of the shoulder joint.
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