Frozen shoulder

Prominent symptoms of a frozen shoulder include:

• Pain and enduring stiffness in the shoulder joint
• A challenge in raising one's arm above the head
• Difficulty extending the arm across the body or reaching behind the back

Frozen shoulder spans out in the following phases:

1. Painful or ‘freezing’ phase
   • Gradual onset of shoulder pain, which worsens over time.
   • Pain is often felt deep in the shoulder and can be particularly intense at night.
   • The shoulder starts to lose range of motion, making daily activities like reaching or dressing challenging.
   • This stage can last anywhere from 6 weeks to 9 months.
2. Stiffness or ‘frozen’ phase
   • Pain might lessen during this stage but stiffness becomes more pronounced.
   • The shoulder joint becomes increasingly immobile, and activities that involve lifting the arm become extremely difficult.
   • Using the affected arm for everyday tasks becomes severely limited.
   • This stage might span anywhere from 4 to 12 months.
3. Resolution or ‘thawing’ phase
   • The range of motion in the shoulder gradually improves, but it may take several months to years to return to normal.
   • Pain might subside, but some discomfort may still be present during movement.
   • Functional use of the shoulder improves, and daily activities become easier to perform.
   • Full recovery or complete strength typically takes from 5 months to 2 years.

Frozen shoulder is a complex condition in which the underlying cause or disease is mostly unknown and cannot be pinpointed to any specific reason. It is initiated by inflammation and thickening of the joint capsule.

In some cases, frozen shoulder may be associated with the following factors:

• Intrinsic: This type is connected to problems with the tendons around the shoulder joint, such as tendinitis or tears. It can also be related to issues with calcium deposits in the tendons.
• Extrinsic: This type is caused by factors outside the shoulder joint, such as previous breast surgery on the same side, neck nerve problems, tumors on the chest wall, past stroke, or issues with the bones in the shoulder region.
• Systemic diseases: This type is associated with conditions that affect the whole body, including diabetes, thyroid disorders (hyperthyroidism or hypothyroidism), or problems with the adrenal gland.

• Age: Frozen shoulder tends to occur more frequently in individuals between the ages of 40 and 60 years.
• Gender: Women are more likely to be affected by frozen shoulders than men. Hormonal fluctuations, especially during perimenopause, menopause, and pregnancy, may contribute to this increased occurrence.
• Previous shoulder injury or surgery: Individuals who have experienced previous shoulder injuries or undergone shoulder surgery are at higher risk of developing frozen shoulder.
• Immobilization: Any condition or injury that leads to prolonged immobilization of the shoulder joint can increase the likelihood of developing frozen shoulder. This can include conditions like injuries, fractures, or prolonged bed rest.
• Systemic diseases: Certain systemic conditions, such as thyroid disorders (hyperthyroidism or hypothyroidism), cardiovascular disease, and Parkinson's disease, have been associated with an increased risk of frozen shoulder.
• Autoimmune conditions: People with autoimmune conditions, such as rheumatoid arthritis, have a higher likelihood of developing frozen shoulder.
• Dupuytren's disease: Dupuytren's disease, a condition that causes the thickening and tightening of the connective tissue in the hand, is associated with an increased risk of frozen shoulder.

Diagnosing a frozen shoulder involves a combination of medical history, physical examination, and possibly imaging tests:

• Medical history: The doctor will begin by discussing your symptoms and medical history. They will ask questions about your shoulder pain, the duration of symptoms, any past injuries or medical conditions, and activities that may have contributed to the onset of the problem.
• Physical examination: During the physical examination, the healthcare professional will check your shoulder's range of motion, strength, and any specific movements that cause pain or discomfort. They will also look for signs of inflammation, swelling, or muscle atrophy in the affected shoulder.
• Imaging tests: The doctor may advise certain imaging tests to rule out other potential causes of shoulder pain and to confirm the diagnosis. These tests may include:
  • X-rays: X-rays can help identify other issues like arthritis or bone spurs that may be contributing to the symptoms.
  • MRI (Magnetic Resonance Imaging): An MRI can provide detailed images of the shoulder's soft tissues, such as muscles, tendons, and ligaments, to evaluate any potential structural problems.
  • Ultrasound: This imaging technique may also be used to assess the shoulder's soft tissues and detect any abnormalities.

Here are some simple and effective measures you can adopt to safeguard yourself from the debilitating condition of a frozen shoulder:

• Daily shoulder and back stretch: Devote a few moments each day to gently stretch your shoulder and back muscles. This helps maintain flexibility and ensures they remain supple and resilient.
• Proper posture and ergonomics: Maintain good posture and ergonomics during daily activities to reduce strain on the shoulder joints. Avoid hunching over or slouching for long periods. Upgrade your workspace for ultimate comfort.
• Warm-up before workout: Prioritize warming up your shoulder muscles before engaging in physical activities or exercises that require significant shoulder involvement.
• Balanced exercise routine: Avoid overloading the shoulder joint and focus on a well-rounded exercise routine that works on various muscle groups. Include exercises that strengthen the muscles around the shoulder, such as the rotator cuff muscles.
• Avoid traumatic injuries: Take precautions to prevent traumatic injuries to the shoulder, such as wearing appropriate protective gear during sports and other activities.
• Prioritize a healthy lifestyle: Adopt a healthy lifestyle that includes a balanced diet, regular exercise, and adequate rest, as these factors can contribute to overall joint health.
• Diabetes management: Diabetes can increase the vulnerability to frozen shoulder, making it crucial to keep blood sugar levels in check to minimize the risk.
• Avoid prolonged immobilization: Try not to keep your shoulder immobile for extended periods, especially after an injury or surgery. It's crucial to follow proper rehabilitation protocols and keep the shoulder joint moving within a pain-free range as soon as possible.
• Listen to your body: If you experience any shoulder pain, stiffness, or limited range of motion, don't ignore it. Seek medical attention early to prevent the condition from worsening.

The treatment of frozen shoulder can be broadly categorized into non-operative methods and operative methods.

Most cases of frozen shoulder can be effectively managed with conservative/non-operative methods, while operative/surgical methods are reserved for severe cases that do not respond to conservative methods.

I. Conservative/Non-Operative Methods:

• Oral Pain Relief Medications: Certain nonsteroidal anti-inflammatory drugs (NSAIDs) may be prescribed to reduce pain and inflammation. These, together with physiotherapy, are the mainstay of treatment for frozen shoulder. Examples include ibuprofen, diclofenac, and paracetamol.
• Corticosteroid Injections: In some cases, corticosteroid injections may be used to reduce inflammation and provide pain relief. However, due to potential negative effects, their usage is restricted.
• Hydrodistention: This process involves injecting sterile water into the joint capsule to help stretch the tissue and make it easier to move the joint. This is occasionally used in conjunction with a steroid injection.
• Electrical Stimulation: This includes two methods:
  • Transcutaneous Electrical Nerve Stimulation (TENS): TENS is a therapy that uses electrical currents to relieve pain and promote muscle relaxation.
  • Ultrasound Therapy: Ultrasound can help improve blood flow and promote tissue healing in the affected area.

II. Operative/Surgical Methods:

Surgery is typically considered a last resort and is only recommended if conservative treatments have not resulted in significant improvement.

• Arthroscopic Capsular Release (ACR) Surgery: During this minimally invasive procedure, a surgeon uses an arthroscope to cut through the tight joint capsule, releasing the adhesions and improving shoulder mobility.
• Manipulation Under Anesthesia (MUA): In this procedure, the scar tissue and adhesions are broken under anesthesia. It is often performed in conjunction with arthroscopic capsular release. Recovery from surgery may take several weeks, and physical therapy is usually prescribed postoperatively to regain full shoulder function.

III. Post-Operative Rehabilitation:

• Post-operative rehabilitation begins promptly after surgery to prevent stiffness.
• Includes gentle range of motion exercises, shoulder stretches, and progressive strengthening exercises.
• Ongoing guidance from a healthcare professional is vital for successful recovery.
• Heat therapy and manual techniques may be used to relax muscles and increase blood flow.
• Consistent and supervised physiotherapy aids in the gradual recovery and restoration of shoulder function.

1. Consume a balanced nutritious diet: Include foods rich in the following nutrients to support joint health:
   • Calcium: Dairy products, leafy green vegetables (kale, broccoli), fortified plant-based milk, and calcium-fortified foods like tofu.
   • Vitamin D: Fatty fish (salmon, mackerel), fortified dairy or plant-based milk, egg yolks, and exposure to sunlight (15-20 minutes of sunlight on arms and legs a few times a week).
   • Omega-3 fatty acids: Fatty fish (salmon, sardines), flaxseeds, chia seeds, walnuts, and canola oil.
   • Antioxidants: Incorporate berries, oranges, spinach, and bell peppers into your diet.
   • Protein: Ensure adequate protein from lean meats, poultry, fish, beans, lentils, and quinoa.
   • Magnesium: Include nuts (almonds, cashews), seeds (pumpkin seeds, sunflower seeds), spinach, and whole grains.
   You can also add nutritional supplements to your diet. Shop Here
2. Practice proper ergonomic posture: Prioritize maintaining an ergonomic posture to reduce strain on your body during daily activities. Avoid heavy lifting to support musculoskeletal well-being.
3. Make sure to get good sleep: Sound and sufficient sleep is crucial for health and recovery. Use a supportive mattress and pillow to ensure undisturbed sleep. Discover our wide range of cervical pillows and mattresses.
4. Try hot and cold therapy: Applying heat or cold packs to the affected shoulder can provide temporary relief from pain and stiffness. Warm showers or heating pads may help relax the muscles, while ice packs can reduce inflammation. Revitalize your body with soothing hot and cold therapy – shop now for instant relief and comfort!
5. Try topical preparations: Consider using topical preparations such as menthol and camphor oil, along with sesame oil, on the affected area to relieve symptoms and promote joint health.
6. Consider OTC pain relief: Over-the-counter (OTC) pain-relieving sprays and creams can be applied to the affected area. Explore our curated selection of pain relief products.
7. Provide joint support: Support weak joints with braces or supports. Explore our detailed guide on how to buy the right orthopedic support and braces.

Culinary Solutions

1. Turmeric (Haldi): It has anti-inflammatory properties that relieve inflammation and swelling. Use it orally as turmeric milk or add it to meals. It can also be applied topically on the shoulder for pain relief.
2. Ginger (Adarak): Its anti-inflammatory and antioxidant properties aid in relieving pain, swelling, and promote quick healing. It can be used in cooking, as ginger juice, or applied as crushed ginger juice on affected areas.
3. Cinnamon (Dalchini): Cinnamon has anti-inflammatory properties which can help relieve pain. Add more cinnamon to food or try crushed cinnamon powder mixed with honey and warm water.
4. Devil's Claw tea: Consume Devil's Claw tea, known for its anti-inflammatory properties. It may help reduce inflammation and ease discomfort. Steep 1-2 teaspoons of dried Devil's Claw root in hot water for 10-15 minutes. It is also available as a supplement or herbal tea. Discover our selection of Devil's Claw supplements.

• Residual pain: After the active phase of frozen shoulder has resolved, some individuals may experience lingering pain in the affected shoulder. This residual pain can persist even after the range of motion has improved.
• Residual stiffness: While the primary symptom of frozen shoulder is stiffness, some individuals may still experience a degree of residual stiffness or limitation in shoulder mobility even after the condition has resolved.
• Fracture of the humerus: If a frozen shoulder is treated too forcefully or aggressively, it can lead to rare complications. One such complication is a fracture in the upper arm bone (humerus), particularly if the bone is already weak due to osteoporosis or other factors.
• Rupture of the biceps tendon: The biceps tendon is part of the shoulder joint and can tear if excessive force is applied during a procedure called Manipulation under Anesthesia (MUA), which is sometimes performed to improve shoulder movement in frozen shoulder cases. This can result in increased pain and difficulty using the shoulder.

Here are some complementary and alternative therapies that have been explored for frozen shoulder. Make sure to take consent from your healthcare provider before initiating any of these:

• Yoga and stretching exercises: To improve frozen shoulder, consider practicing yoga poses like:
  • Garudasana
  • Paschim Namaskarasana
  • Ustrasana
  • Dhanurasana
  • Purvottanasana
  Ensure proper guidance from a qualified yoga instructor to prevent aggravating the condition.
• Tai Chi: Tai Chi is a low-impact, meditative martial art that emphasizes slow, flowing movements. It can help improve balance, posture, and joint flexibility, including the shoulder.
• Cupping Therapy: Cupping involves placing cups on the skin to create suction, which is believed to promote blood flow and reduce muscle tension. It can be applied to the affected shoulder area.
• Acupuncture: Acupuncture is a practice involving the insertion of thin needles into specific points on the body to stimulate energy flow. It has been associated with pain relief and improved range of motion in some individuals with frozen shoulders.
• Moxibustion: Moxibustion involves burning dried mugwort (moxa) near specific acupuncture points. The heat generated is believed to stimulate blood flow and energy flow, aiding in pain relief and reducing inflammation.

Living with a frozen shoulder can be challenging, as it can significantly impact your quality of life due to limited range of motion and chronic pain. It affects daily living activities such as showering, dressing, cycling, swimming, and cooking. It can disrupt sleep and impact social and occupational engagement, which may consequently lead to psychological distress. However, coping with the condition requires a combination of medical treatment, exercises, and lifestyle adjustments. Here are some tips to help you live with frozen shoulder and improve your quality of life:

Lifestyle Modifications

• Adapt your daily activities to minimize strain on your shoulder. Avoid heavy lifting or repetitive movements that can exacerbate pain and stiffness.

Assistive Devices

• Utilize assistive devices like a shoulder sling or brace to support and protect your shoulder joint during activities.

Maintain Good Posture

• Proper posture can reduce stress on the shoulder joint. Focus on keeping your shoulders back and down, especially when sitting or standing for extended periods.

Psychological Support

• Living with a chronic condition can be emotionally challenging. Seek support from friends, family, or join support groups to connect with others who share similar experiences. Psychological support can help you cope better with the emotional toll of dealing with frozen shoulder.

Be Patient

• Frozen shoulder can take time to heal, sometimes up to several months or even years. Be patient and consistent with your treatment and rehabilitation efforts.

Stay Active

• While certain activities may need to be limited, staying physically active is essential for overall well-being. Engage in low-impact exercises that do not worsen your symptoms, such as walking or swimming.

Avoid Activities that Aggravate Symptoms

• Identify and avoid movements or activities that cause increased pain or stiffness in your shoulder.

Take Medication on Time

• Adhere to your doctor's prescribed medication schedule without fail. For chronic joint pain, consult your doctor before taking any painkillers; avoid self-medication. Regularly visit your doctor, particularly if symptoms worsen or return.