The Frozen Shoulder
The condition termed as a frozen shoulder is also known as Adhesive capsulitis or shoulder contracture. It initially starts with localised pain within the shoulder area leading to subsequent tightness and stiffness. The symptoms worsen gradually over a number of weeks and into months. Pain tends to remain localised within the shoulder area. I do in certain cases see localised stiffness to the side of the neck also and some pain in the shoulder blade at the back.
It commonly occurs after the age of 40, more so in women and tends to affect the non dominant arm. In the experience I’ve had we have found that it can be caused by a slight minimal injury or catching the shoulder. For example, walking down the stairs and accidentally catching your hand as you slip that can cause a simple jarring of the joint and setting these symptoms off. If caught early enough and seen either by a GP or a physiotherapist, symptoms can be diagnosed early and management can commence straight away to prevent long term pain and stiffness.
How does it happen?
A typical frozen shoulder occurs when the tissue and capsules surrounding the joint becomes inflamed, thickened and tightened. As explained, in certain circumstances there isn’t always a reason behind it, but then in other instances there can be sometimes be a minor pulling or trauma to the area that can set these symptoms off. It is very important that in the early stages that an accurate diagnosis is made and that the symptoms are not confused with a local tendonitis to the joint in which the management of the problem can be quite different. In most cases frozen shoulder will eventually get better but with early diagnosis, painkillers, potentially injections, some shoulder exercises and local physiotherapy, the outlook is good.
I sincerely have every empathy with patients that attend our clinic with a frozen shoulder. It is a drawn out process, requires a lot of compliance from patients but the efforts in the early stages are really worth it in the long term. Some clinical treatment trials suggest acupuncture may improve recovery in frozen shoulders either when used alone in combination with physiotherapy. Acupuncture can reduce the pain, inflammation, muscle and joint stiffness by stimulating muscles, nerves and other tissues to increase endorphin levels, reduce inflammation and increase blood flow, a modality I find myself works really well here.
On average a frozen shoulder may last from 6 months, to up to 2 years to fully heal. In my experience, the earlier the diagnosis the better. The majority of patients require a cortisone injection that’s done either by your local GP or via a consultant if referred early enough. Sleep tends to be, a real issue to patients. I often suggest trying to sleep with 1 pillow and a rolled up towel at the bottom of the pillow case in order to help support the neck and give the shoulder room to manoeuvre during the night. Strong pain killers often help and I do suggest patients putting some form of weight in their hand and trying some gentle traction exercises to alleviate the pressure on the joint in standing. In certain cases localised heat often helps reduce muscle spasm. With adequate pain relief on board, I often suggest patients try some generalised stretches both at home and if possible try to attend a local swimming pool, swimming ideally 2-3 times a week initially just doing gentle stretches in the water and then pushing through to proper swim strokes, ideally breast stroke initially.