Frozen shoulder, also known as adhesive capsulitis, is a medical condition characterized by chronic pain and stiffness in your shoulder joint. It begins gradually, worsens over time and usually resolves on its own. Though the condition is self-limiting, it can take a lot of time (anywhere between a year to 3 years) to resolve completely, thus making it quite disabling for the sufferer.
It’s not clear why some people develop it, but some groups are more at risk. Frozen shoulder happens more often in women than in men. You’re more likely to get it if you’re between the age of 40 and 60. Your risk might also go up if you’re recovering from medical conditions like stroke, an arm fracture or surgery such as a mastectomy, that keep you from moving your arm.
Certain medical conditions can increase your risk too. About 10% to 20% of people with diabetes get frozen shoulder. Others such as heart disease, thyroid disease, Parkinson’s or Tuberculosis are linked to frozen shoulder, too.
It’s unusual for a frozen shoulder to recur in the same shoulder, but one can develop it in the opposite shoulder.
Conventional treatment involves range-of-motion shoulder joint exercises and painkillers. If they fail to work, injection of corticosteroids and numbing medications into the joint capsule becomes necessary. In a small percentage of cases, arthroscopic surgery may be indicated to loosen the joint capsule so that it can move more freely.
Causes
Your shoulder is made up of three bones viz your upper arm (humerus), shoulder blade (scapula), and the collarbone (clavicle). Together they form a ball-and-socket joint. Strong connective tissue called the shoulder capsule, surrounds your joint like an envelop (socket) to hold everything (bones, ligaments, tendons) together. A synovial membrane lines the joint capsule and produces a “lubricating” liquid called synovial fluid, which helps to reduce the friction between the bones during the joint movement.
Frozen shoulder happens when the tissues in your shoulder capsule get inflamed somehow. Bands of scar tissue form over time, making the capsule so thick and tight that it becomes hard to rotate the joint properly. Also, there is a reduction in the production of synovial fluid, which further limits the joint movement due to increased friction. Resultant joint stiffness, pain, and swelling hamper the range of motion which may incapacitate one from working and performing daily life activities for an extended period of time.
Any fall on the shoulder or any injury to the adjacent tissues of the shoulder can also give rise to this condition. Alternately, it may have an autoimmune component involved as thickening and swelling can occur as a result of a misguided immune response. In some cases, the condition can arise with no absolute cause.
Symptoms
- Freezing stage: Any movement of your shoulder causes pain. This slowly gets worse over time and may hurt more at night, sometimes disrupting sleep. Gradually your shoulder’s range of motion starts to become limited. The stage can last anywhere from 6-9 months.
- Frozen stage: Pain may begin to diminish during this stage. However, your shoulder becomes stiffer, and using it becomes more difficult. It becomes harder to get through daily activities. This stage can last 4-12 months.
- Thawing stage: The range of movement in your shoulder begins to improve. It may even get back to normal. This can take anywhere from 6 months to 2 years.
Diagnosis
Frozen shoulder can usually be diagnosed from signs and symptoms alone. During the physical exam, your doctor may first ask you to move your shoulder in certain ways to check for pain and evaluate your range of motion (active range of motion). Your doctor might then ask you to relax while he or she moves your arm (passive range of motion). Frozen shoulder affects both active and passive range of motion.
Your doctor may decide in case you need an anesthetic injection in your shoulder to numb the pain so that she can better judge your active and passive ranges of motion.
Your doctor may, in addition, suggest imaging tests – such as X-rays, ultrasound, or MRI – to rule out other causes such as arthritis or a torn rotator cuff.
Treatment
Over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin and ibuprofen can help reduce pain and inflammation associated with frozen shoulder. If they fail to help, your doctor may prescribe stronger medication.
Your treatment might also include going to a physical therapist for strengthening and stretching exercises to improve your range of motion so that the adhesions start to loosen up and shoulder can move freely. Applying heat or cold to your shoulder can also help relieve pain.
If your symptoms are intense or don’t improve over time, your doctor might recommend other kinds of treatments, such as:
- Corticosteroid injection in your shoulder joint to reduce pain and improve mobility, especially in the early stages of the process.
- Joint distension. Injecting sterile water into the joint capsule to stretch the tissue. This can help you move your shoulder more easily.
- Physical therapy. Results with this are mixed, and it may be more useful during certain phases of the frozen shoulder than others.
- Surgery. Surgery for frozen shoulder is rare, but if nothing else helps, your doctor may recommend it to remove scar tissue and adhesions from inside your shoulder joint. It’s done arthroscopically. That means it’s done with lighted, pencil-sized tools that are inserted through tiny incisions around your joint.
- Shoulder manipulation. In this procedure, you receive a general anesthetic, get unconscious and hence feel no pain. Then the doctor forcefully moves your shoulder joint in different directions, to help loosen the tightened tissue. It is very rarely done these days. Arthroscopic surgery has replaced it. With this method, there was always an increased risk of complications including fractures.
- Acupuncture: Involves inserting extremely fine needles in your skin at specific points on your body. Typically, the needles are kept in place for 15 to 40 minutes. Since the needles are inserted superficially and are hair-thin and flexible, most acupuncture treatments are relatively painless. They provide pain relief by boosting the endorphins level in the body which are known to reduce the perception of pain.
- 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 and is rather believed to stimulate the release of endorphins that block pain.
Prevention: One of the most common causes of frozen shoulder is the immobility that may result during recovery from a shoulder injury, a broken arm or a stroke. If you’ve had an injury that makes it difficult to move your shoulder, talk to your doctor about exercises you can do on a daily basis to maintain the range of motion in your shoulder joint.
Homoeopathic Treatment
Homoeopathic medicines hold an advantage over other lines of treatment for frozen shoulder as they not only help relieve pain and stiffness but aid in fixing up the underlying cause as well. This way chances of recurrence are also minimized.
Rhus Tox tops the list for severe shooting night pains and stiffness that get better by warmth, moving about and massaging.
Arnica and Ruta are of great help if it’s consequent upon some rotator cuff injury or a ligament tear. They also improve blood circulation to the joint.
Sanguinaria and Phytolacca show an affinity for the right shoulder while Ferrum Metallicum left.
Bryonia Alba and Chelidonium Majus are apt for shooting pains getting worse from the least motion.
While Calcarea Phosphorica gives relief if any change of weather aggravates the pain, Rhododendron is worse during a thunderstorm.
Causticum is most suited for pains in the morning.
If the movement gets so restricted that raising your arm gets impossible, Ledum Pal and Syphilinum get you out of the condition.
Guaiacum and Thuja top the charts for the most stubborn cases of shoulder stiffness.
Detailed case analysis by a qualified Homoeopathic Physician involving taking information about the presenting symptoms, their underlying cause and duration, and modalities peculiar to the patient help select the medicine most suited to the patient. Once rightly administered, it brings back the desired mobility to your shoulder.
Dr Renu Madan 