“My shoulder hurts if I sleep on it.”
“I Cant Reach my Wallet.”
“I Can’t hook/unhook my Brassier.”
“ I can’t carry my laptop for more than 15-20 mins”
These are the common complains most patients with a Frozen Shoulder present with. Frozen Shoulder also known as “Adhesive Capsulitis” is a stiff painful shoulder joint caused by the thickened and contracted Shoulder Joint Capsule.
There is no known specific cause for Primary / Idiopathic Frozen Shoulder. Secondary frozen shoulder occurs following a precipitating traumatic episode.
Frozen shoulder affects nearly 3-5 % in general population and is usually seen in a person in his/her 4th or 5th decade, more common in women and more so on the non-dominant arm. It is five times more common in diabetic individuals. There is about 30% chance of you developing Frozen Shoulder in the opposite shoulder.
Frozen shoulder is a self-limiting condition lasting for about 12-18 months going through 3 phases. The first phase of pain, “Freezing Phase”, where the there is gradually increasing diffuse pain in shoulder, especially at night and increased by lying on the affected side. Stiffness sets in due to decreased use of the limb by the patient.
In the Second Phase of Stiffness, “Frozen Phase”, patients mainly complaining of difficulty in daily activities, men have difficulty in reaching for their wallet and women have difficulty fastening their brassier. There is dull ache throughout the day and sharp pain during movements.
In the Last Phase of recovery, “Thawing Phase” the pain gradually subsides and the patient improves and the movement of the shoulder returns if the patient has been doing regular physiotherapy through the course. Hence it is important for patients to be patient and follow their doctor’s advice of doing sincere physiotherapy. I mostly see patient hopping from doctor to doctor expecting a miracle.
Restricted movement of the shoulder in all directions is the hallmark of Frozen Shoulder. Treatment in most cases consists of painkillers in the early phase and shoulder exercises through the course. Occasionally your Orthopaedic may suggest a local steroid injection.
In certain severe case a manipulation under General anaesthesia maybe necessary though stringent exercise following this is essential for a good outcome. Resistant case may need a Arthroscopic Capsular release surgery. Open releases have become obsolete with the advent of Arthroscopic Surgeries (key hole surgeries) which are definitely less morbid and have a faster recovery period.
Finally, a word of caution. “Not all shoulder pains are frozen shoulders”. Certain conditions like Tendinosis, Rotator Cuff Tears and Labral lesions which by timely intervention can be fixed get wrongly labelled as Frozen Shoulder. Hence consult an Orthopaedic/Arthroscopic Surgeon at the earliest.
(Dr. Nikhil Iyer, is an Arthroscopic Surgeon and Sports Medicine Consultant)