Keys to Overcoming Frozen Shoulder
October 01, 2004
By: Steve Siwy for Shoulder1
“Frozen shoulder” is a painful condition in which joint tissue stiffens and limits the shoulder’s mobility, and the Wall Street Journal recently reported that with the population aging, and risk-factors like diabetes and obesity on the rise, it’s becoming more common. Doctors hope that an increase in awareness of the condition and its symptoms will allow doctors and patients to catch the condition early, and work together to treat it as effectively and thoroughly as possible.
The shoulder capsule, made up of connective tissue in the shoulder socket, surrounds and attaches to the ball at top of the humerus (the upper-arm bone). Frozen shoulder occurs when the shoulder capsule’s tissue becomes inflamed, causing it to thicken, contract, and develop scar tissue. No one is sure precisely what causes frozen shoulder, but it may develop after an injury to the shoulder (including surgery), or following a musculo-skeletal condition such as bursitis or tendonitis. Sometimes, no definite cause can be pinpointed at all (a condition like frozen shoulder without an identifiable cause is called “idiopathic”).
|What can you do to correctly manage frozen shoulder?|
1) Seek diagnosis and treatment as soon as possible - Any aching, burning, or stiffness in the shoulder that persists is cause to see a physician
2) Ask your physician what anti-inflammatory medication is available
3) Physical therapy to improve range of motion: doctors report that maintaining shoulder mobility through daily movement will avoid a more profound case of frozen shoulder
4) Additional treatments as recommended by your doctor may include cortisone or in rare cases, surgery
Frozen shoulder is formally known as “adhesive capsulitis,” and it usually occurs in people between the ages of 40 and 60. Although anyone can develop the condition, according to the Center for Orthopaedics and Sports Medicine women make up a full 70% of frozen shoulder cases.
Also at particular risk are people with diabetes, 10 to 20 percent of whom will have problems with frozen shoulder at some point, as compared to about two to five percent of the general population. Doctors aren’t sure why diabetics are more susceptible to the condition, but according to the American Diabetes Association (ADA), one theory is that since glucose (sugar) molecules attach to collagen, which is a major component of ligaments, cartilage, and tendons, the shoulder capsules of people with diabetes might accumulate abnormal collagen deposits in those connective tissues, which would cause the shoulder to stiffen.
Adhesive capsulitis usually first makes itself known via stiffness and pain in the shoulder joint, and a progressively reduced range of motion. The course of frozen shoulder has three stages: In stage one, which can last from two to nine months, the main symptom is an aching or burning pain, which increases with movement of the shoulder and can be worse at night. Stiffening begins during stage one, but becomes more pronounced in stage two, when the pain begins to diminish, and the shoulder’s range of motion becomes noticeably and progressively more limited (up to 50% more than the unaffected arm). In the third stage, the joint begins to “thaw,” and becomes easier and less painful to move.
Though frozen shoulder is a “self-limited” condition that arises and diminishes on its own, if left untreated it will often lead to a more stiff and restricted shoulder joint even after it passes. That’s why doctors advise that diagnosis and treatment should be sought as early as possible. Dr. Lori B. Siegel, MD, of Finch University of Health Sciences/Chicago Medical School, tells the ADA, “If we catch it early, it might be possible to work through it with physical therapy, even if there’s some pain. But once you enter the middle stage, there’s already been some stiffness and that makes it tougher to work through.”
The most common treatments for adhesive capsulitis are simply anti-inflammatory medication and, most importantly, physical therapy. The therapy focuses on moving the shoulder through as wide a range of motion as the patient’s pain threshold will allow, as often as possible. Doctors agree that maintaining shoulder mobility through daily movement is probably the most important way for a patient to stave off more profound shoulder freezing, and to regain lost range of motion.
If physical therapy alone doesn’t satisfactorily improve a frozen shoulder (which is more likely if treatment begins when the condition is into its second or third stages), a doctor may recommend additional treatments. A shot of cortisone to decrease pain and inflammation, and thus improve the patient’s ability to participate in therapy, may be administered (though not to diabetics, as cortisone can raise blood-sugar levels). A doctor may put a patient with adhesive capsulitis under general anesthesia, and break up scar tissue by manipulating the shoulder through a range of motion that would be too painful for the patient to bear normally. Rarely, arthroscopic surgery may be performed, to remove some of the scar tissue and adhesions from the joint.
Last updated: 01-Oct-04