Shoulder: Shoulder is one of the largest complex joints in the body, that combines with several tendons and muscles, which helps us to rotate the hand in a circular motion.
It is made up of three bones
- Clavicle (collarbone)
- Scapula (shoulder blade)
- Humerus (upper arm bone) as well as associated muscles, ligaments and tendons.
Our Shoulder joint acts as a fulcrum facilitating the rotation of hands in a circular motion, and for performing overhead activities.
The Function of the shoulder:
- It provides strength
- Helps us in full range of motion
- Shoulder joint helps us in performing motions as Extension, Internal Rotation, External Rotation, Scapular Plan, Abduction, and Horizontal Adduction
Frozen shoulder: Frozen shoulder is a gradually progressing condition that results in stiffness and pain centred within the shoulder joint. Over time, the pain gets worse; the range of motion declines; and this progression is gradual taking several years.
The shoulder is made up of three bones that form a ball-and-socket joint. There is a tissue surrounding the shoulder joint that holds everything together, called a shoulder capsule. In this condition, the capsule becomes so thick and tight that it becomes hard to move the shoulder, and the Synovial Fluid which lubricates the joint gets depleted. The other name for Frozen Shoulder is Adhesive Capsulitis.
- In the majority of the cases, injury, stroke, or other trauma to the shoulder region are the reasons for developing frozen shoulder. This condition takes a long time to resolve, even several years.
- With frozen shoulder, the bones, tendons, and ligaments surrounding the shoulder joint get thickened.
- This condition is seen frequently in people who have the following conditions: Hyperthyroidism, hypothyroidism, diabetes, heart disease, tuberculosis, or Parkinson’s disease.
- Chances of developing frozen shoulder are more If you have a shoulder injury. A rotator cuff injury, a stroke, a broken arm, or a trauma is a precursor to developing a frozen shoulder.
- Women above 40 years of age are prone to develop a frozen shoulder. Women recovering from a mastectomy are at more risk.
Symptoms of frozen shoulder:
The symptoms of frozen shoulder tend to feel worse at night time. The symptoms are last for some months and appear at 3 stages of frozen shoulder. Namely, they are:
1. Freezing stage:
- Pain is sharp, arms range of motions starts to get hampered.
- This can last anywhere from 6 to 9 months.
2. Frozen stage: Phase of stiffness:
- pain lessens, but the stiffness increases arm feels weak, and using it becomes more difficult.
- This stage can last 4-12 months.
3. Thawing stage:
- Slowly, the range of motion returns to the affected joints. Shoulder Range of motion begins to improve.
- This can take time from 6 months to 2 years.
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Causes of frozen shoulder:
- It happens more often in women compared to men, and you’re more likely to get it at the age between the ages of 40 and 60.
- Women recovering from a mastectomy are at more risk.
- Doctors aren’t sure why this happens to some people although some medical conditions increase risk in people who have the following diseases: hyperthyroidism, hypothyroidism, diabetes, heart disease, tuberculosis, and Parkinson’s disease.
- Shoulder immobility that may result during recovery from a shoulder like, injury, arm broken or a stroke is one of the most common causes of frozen shoulder
Treatment for frozen shoulder:
- Early aggressive uninterrupted, continues physiotherapy.
- Pain control with medications.
- Shoulder manipulation and injection.
- Surgery is sometimes helpful to release the contractures.
Frozen Shoulder Treatment in India
Over-the-counter pain relievers prescribed by an orthopaedic doctor can help to relieve the pain and swelling in your shoulder. If it doesn’t help, the doctor might prescribe a stronger medication.
Your treatment might also include going to a physiotherapist for strengthening exercise to improve your range of motion. A physiotherapist can teach you a range of motion exercises to help recover as much mobility in your shoulder as possible; your commitment to doing these exercise is important to optimize the recovery of your movement.
Most frozen shoulders get better on their own within 12-18 months. For persistent symptoms, Your doctor may suggest:
- Steroid Injections: A corticosteroid injection is injected in your shoulder joint to reduce your pain and improve your range of motion, and improve shoulder mobility, especially in the early stages of the process.
- Joint Distension: in this process doctor will inject sterile water into your shoulder capsule to stretch it, which helps you move your shoulder more easily.
- Physical therapy: This therapy is useful in certain phases of frozen shoulder. We need a physical therapist who has experience in treating people with orthopaedic, or musculoskeletal, problems.
Surgery: Surgery of frozen shoulder is rare, if nothing else has helped, your doctor may recommend surgery to remove scar tissue or adhesions from inside your shoulder joint.
- Doctors may usually perform this surgery with lighted, tubular instruments inserted through small incisions around your joint (arthroscopically).
Shoulder manipulation: it helps to lose up your shoulder tissue.
- In this procedure, you will receive general anaesthesia, so you will be unconscious and feel no pain. Then the doctor will move the shoulder in a different direction, to help loosen the tightened tissue.
- There are complications with this process may cause a fracture.
- Ice and heat can also reduce pain by relaxing the joints.
We all have seen an earth mover or a crane, with a long handle, and at the end of that handle, there is a bucket or a hook for lifting/removing things. Although the bucket and the hook look important, it is the long handle that is providing the strength.
The shoulder is similar to the long handle of a crane or an earth mover. So, one needs to exhibit precaution when lifting heavy weights, rotating hands in circular motions, and when pulling or pushing.
- If you intend to do any of the above activities, make sure to wear harnesses/support devices around the shoulder to protect the shoulder joint from absorbing the jolt.
- To improve the strength and flexibility of the upper extremities, you need to exercise regularly.
A shoulder once dislocated can have multiple recurrences, so it is advised to pursue strength and stability exercises recommended by your treating shoulder surgeon, Dr Chandrasekhar for your injury.