Understanding the Condition
Also known as adhesive capsulitis, a frozen shoulder is a result of a thickening and tightening of the shoulder’s joint capsule (not to be mistaken for the rotator cuff), which then causes pain and stiffening of the shoulder.
Causes of this condition is yet to be fully discovered and understood. Sometimes it comes with unidentifiable reasons. Other times, it develops after sustaining an injury or fracture. And while it mostly occurs to people between the ages of 40 and 60, women are more prone to the condition compared to men. It may also develop in people who are diagnosed with diabetes.
Frozen Shoulder is NOT Arthritis
Most of the time, people consider indications of pain in the joints as arthritis. While joint soreness may be one major symptom of the condition, it could be a product of something else. Pain that is felt specifically in the shoulder can be at least two things: arthritis or adhesive capsulitis. Both ailments are very different and yet they seem like they’re related because it has similar symptoms. The difference is that an adhesive capsulitis affects a specific joint, while arthritis can affect more than one.
Experiencing shoulder immobility is one of the chief signs of developing the condition. This symptom comes with three phases:
First: the “freezing” phase. Here, pain in the shoulder occurs gradually. As the soreness gets worse, the body will start to lose mobility. Usually, this stage lasts between six and nine months.
Second: the “frozen” phase. The pain over time becomes tolerable, but the stiffness continues. Within four to six months of this phase, engaging in various physical activities may become a heavy burden.
Third: the “thawing” phase. The flexibility slowly recovers. Daily activities can be done almost without experiencing pain. This last stage can take about six months to two years.
As implied, a stiff shoulder can go away by itself with time. But it will take months to years to fully recover. Thus, treatment may be done to quicken the healing process.
The doctor will have to identify which frozen shoulder phase a patient is currently undergoing to determine the kind of treatment to recommend. It will also depend on the level of stiffness and pain the patient suffers.
Since the first phase of adhesive capsulitis involves mild to severe pain in the shoulder, the focus is on relieving it. A doctor may recommend not exerting too much effort or stress to avoid exacerbating the pain; that means stretching, reaching, or carrying (especially heavy items) are not allowed. Yet not moving the shoulder or arm at all is likewise prohibited.
To help with the soreness, pain medication such as paracetamol, ibuprofen, NSAIDs (non-steroidal anti-inflammatory drugs), or a combination of codeine and paracetamol may be prescribed.
If the pain proves to be persistent even after taking anti-inflammatory drugs, it may be treated with corticosteroid injections. Corticosteroids can help in improving mobility and severity of pain, as it is an anti-inflammatory and painkiller medicine. This medicine may also be paired with a local anaesthetic. Some drugs have better results when injected, because it doesn’t have to pass through the stomach, where it gets broken down even before it’s absorbed; that is why some medicines cannot be given in pills.
The injections can relieve the pain and stiffness only temporarily. It isn’t advised to get injections frequently because it causes more harm and damage to an already injured joint. Usually, the doctor will only allow three injections with three to four weeks between each session. Over time, the usefulness of corticosteroid injections will diminish. It is either the patient opts for natural treatment, which is to let the body deal with the condition on its own, or find another treatment that will work.
After the pain slowly goes away, in this phase, the stiffness, which still remains, will be the next primary symptom that needs to be dealt. Here, the doctor can suggest stretching activities.
Exercises need not tire the shoulder too much; they should be just enough to give the affected joint some movement. Extreme exercises will make the pain come back. But not moving at all will also stiffen the shoulder even more.
Apart from stretches and certain exercises, a good massage and an application of warm and cold temperature packs will also alleviate the symptoms. There hasn’t been any clinical evidence that shows acupuncture or TENS (transcutaneous electrical nerve stimulation) to be effective. Before scheduling a shiatsu massage or anything else other than what was recommended, inform the GP about such treatments.
Procedures and surgery
In some situations, an adhesive capsulitis can be a stubborn condition to treat. Being unable to use a shoulder might become too much of a burden, specifically when it has been several months or almost a year since you last moved your shoulder properly. At this point, procedures or surgery will be necessary.
One common procedure is manipulation, wherein the shoulder is being manipulated by stretching. This is done with general anaesthesia and injected corticosteroid to reduce any swelling or pain.
Another is arthroscopic capsular release, an option to shoulder manipulation. It’s a semi-invasive surgery, involving making three small incisions in the shoulder to take out the stiffened parts building up in the affected area. After surgery, plenty or rest will be needed to speed up the recovery. Physiotherapy will only be performed when the shoulder is fully healed.
Whether you have arthritis or adhesive capsulitis, the problem should be dealt with as soon as possible to avoid making the symptoms worse. As indicated, sometimes the pain becomes intolerable, and you wouldn’t want that to happen to you.
In rare cases, this condition can affect both shoulders at the same time; this makes it difficult to differentiate from arthritis when you haven’t seen the doctor. Thus, seek medical attention the instant stiffness and soreness in the shoulder hasn’t gone away after several days.