In practice I see so many people that come to see us for a condition called Frozen Shoulder. Frozen shoulder, also known as adhesive capsulitis, is a common condition in which the articular shoulder capsule (a sac of ligaments surrounding the joint) swells and stiffens, restricting its mobility. It typically affects only one shoulder, but one in five cases affect both. Even when one shoulder is affected I typically see that the other one will be affected at some time in the future.
The term “frozen shoulder” is often used incorrectly for arthritis, even though the two conditions are unrelated. Frozen shoulder refers specifically to the shoulder joint, while arthritis may refer to other/multiple joints.
Frozen shoulder is thought to cause the formation of scar tissue in the shoulder, which makes the shoulder joint’s capsule (not to be confused with the rotator cuff) thicken and tighten, leaving less room for movement. Therefore, movement may be stiff and even painful.
Frozen shoulder is a condition that targets people between 40 and 60 years of age – women more often than men. But it can be on younger people as well. There can be varying reasons for this.
What causes frozen shoulder?
The cause of frozen shoulder is not understood fully, however, most people with frozen shoulder have suffered from immobility as a result of a recent injury, or from some for of repetitive strain injury. We are seeing more frozen shoulders with people using computers and use a mouse in small movements constantly. Frozen shoulder is also common in people with diabetes
What are the risk factors for frozen shoulder?
- Age – being over 40 years of age.
- Gender – 70% of people with frozen shoulder are women.
- Recent surgery or arm fracture – immobility of recovery may cause the shoulder capsule to stiffen.
- Diabetes – two to four times more likely to develop frozen shoulder for unknown reasons; symptoms may be more severe.
- Having suffered a stroke
- Hyperthyroidism (overactive thyroid).
- Hypothyroidism (underactive thyroid).
- Cardiovascular disease
- Parkinson Disease
- Using a computer regularly
- Repetitive Strain Injuries
What are the signs and symptoms of frozen shoulder?
The most pervasive sign or symptom of frozen shoulder is a persistently painful and stiff shoulder joint. Signs and symptoms of frozen shoulder develop gradually; usually in three stages in which signs and symptoms worsen gradually and resolve within a two – year period.
There are three stages of frozen shoulder:
- Painful stage – the shoulder becomes stiff and then very painful with movement. Movement becomes limited. Pain typically worsens at night.
- Frozen/adhesive stage – the shoulder becomes increasingly stiff, severely limiting range of motion. Pain may not diminish, but it does not usually worsen.
- Thawing stage – movement in the shoulder begins to improve. Pain may fade, but occasionally recur.
How is frozen shoulder diagnosed?
Healthcare providers will most likely diagnose frozen shoulder based on signs and symptoms and a physical exam; paying close attention to the arms and shoulders. The severity of frozen shoulder is determined by a basic test in which a doctor presses and moves certain parts of the arm and shoulder.
Structural problems can only be identified with the help of imaging tests, such as an X – ray or MRI. An X-ray is a type of electromagnetic radiation that can penetrate most solid objects to create images of an object’s interior. An MRI (magnetic resonance imaging) uses magnetic signals to create image “slices” of the soft tissues inside the human body.
What are the treatment options for frozen shoulder?
The aim of treatment for frozen shoulder is to alleviate pain and preserve mobility and flexibility in the shoulder. There is no overnight instant cure but with the right treatment, especially how we treat, it can be fixed quite quickly. Some of our patients have had theirs fixed in 1-2 treatments.
Treatment options for frozen shoulder include:
Acupuncture is a procedure that has been used in China for thousands of years. It 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.
Often termed as biopuncture, where natural anti-inflammatories are injected into acupressure points and can give relief as quick as 20 minutes after treatment. It may take up to 5 treatments to fully fix a frozen shoulder with this therapy, that has been is in Europe for over 30 years.
- Painkillers – relieve symptoms of pain. Nonsteroidal anti – inflammatory drugs (NSAID), such as ibuprofen, are over – the – counter (OTC, no prescription required) painkillers and may reduce inflammation of the shoulder in addition to alleviating mild pain. Acetaminophen (paracetamol, Tylenol) is recommended for extended use. Prescription painkillers, such as codeine (an opiate – based painkiller) may also reduce pain. Not all painkillers are suitable for every patient; be sure to review options with your doctor.
- Exercise – frequent, gentle exercise can prevent and even reverse stiffness in the shoulder.
- Hot or cold compression packs – help to reduce pain and swelling. It is often helpful to alternate between the two.
- Corticosteroid injections – a type of steroid hormone that reduces pain and swelling. Corticosteroids may be injected into the shoulder joint to alleviate pain, especially in the ‘painful stage’ of symptoms. However, repeated corticosteroid injections are discouraged as they could cause damage to the shoulder.
- Transcutaneous electrical nerve stimulation (TENS) – numbs the nerve endings in the spinal cord that control pain and sends small pulses of electricity from the TENS machine to electrodes (small electric pads) that are applied to the skin on the affected shoulder.
- Physiotherapy – can teach you exercises to maintain as much mobility and flexibility as possible without straining the shoulder or causing too much pain.
- Chiropractic -Sometimes the joint actually becomes jammed and impinges the capsule and the nerve pathways of the shoulder and chiropractic manipulation can free the joint and bring relief.
Shoulder arthroscopy – a minimally invasive type of surgery used in a small percentage of cases. A small endoscope (tube) is inserted through a small incision into the shoulder joint to remove any scar tissue or adhesions.
Your healthcare provider will suggest a suitable option depending on the severity of your signs and symptoms.
If you experience stiffness in the shoulder joint it is recommended that you seek treatment and attention sooner rather than later in order to prevent permanent stiffness.
How can frozen shoulder be prevented?
Frozen shoulder can be prevented by using correct posture and not overusing the shoulder joint too much. You also need to take measure to prevent injury to the shoulder joint too. Stretching and regular exercise can help prevent this from occurring too. Regular acupuncture and massage can also prevent frozen shoulder form occurring.
At Shen Therapies we use a combination of Biomesotherapy, Acupuncture and TENS to give the best results for Frozen Shoulder, bringing relief to those with this condition very quickly. Many people whom have come to us have tried many other therapies and lived with this conditions for year and after a few treatments with us, are other pain free, or have had their symptoms reduced in as little as one treatment. Most times, up to 5 treatments may be needed, but this is much better that many other therapies that may require up to 12 months of treatments.