The bite of a frozen shoulder
5 min read . Updated: 26 Oct 2015, 07:48 PM IST
PremiumPatience and perseverance are key to recovery. Some exercises that can help
OTHERS :
A friend who travels frequently on work had just lifted her generously filled handbag into the overhead compartment of an aeroplane when she felt a sharp pinch in the shoulder joint. That was four months ago and, slowly but surely, her arm became more and more painful, to the point that it started keeping her up at night. She lost a lot of movement in that arm and can’t do nearly as many things as she used to.
If this reminds you of someone you know, then they may be suffering from a frozen shoulder, or adhesive capsulitis. A frozen shoulder means that your active movement (your ability to move your arm) and passive movement (the range available when someone else moves your arm) are nearly equal. The problem is that the joint capsule of the shoulder becomes inflamed and stiff, effectively “freezing" movement. This condition usually affects women more than men and is most common in people aged 40-70.
Adhesive capsulitis is distinguished by bands of thickened capsular tissue, called adhesions, which decrease the flexibility of the capsule. Why the joint capsule becomes inflamed and develops these adhesions is not always clear. In my friend’s case, an injury to the shoulder muscles probably led to chronic low-grade irritation of the joint, triggering a response from the capsule surrounding the joint, leading to this inflammed state. As the joint capsule tightens around the bones of the shoulder joint, it crowds the joint space in the shoulder, making movement of the arm bone difficult and painful. The joint stiffness makes activities like brushing hair or tucking in the shirt difficult and extremely painful.
It can develop as a complication to a minor injury, as described above or surgery, or it can start slowly on its own—the latter is called idiopathic adhesive capsulitis. Idiopathic means the cause is not very clear.
We do know that idiopathic adhesive capsulitis is most common among people with diabetes and this may be because of a link to elevated blood glucose levels or something to do with insulin secretion in the body, but the exact cause is not fully understood. Other common risk factors for frozen shoulder include stroke, lung disease, thyroid disease and heart disease. The exact mechanisms behind these risks are varied and, in some cases, unknown. Many of these conditions can give rise to postural changes, affecting the neck, upper back and shoulder girdles and, in other cases, lead to general deconditioning and loss of fitness and weakness, which, in turn, leads to injury.
The pain is often worse at night and this affects the sufferer’s sleep. As you can imagine, chronic sleeplessness can cause behavioural changes, lack of concentration, and a decrease in tolerance for just about everything. A change in weather can also affect the pain, with colder weather causing more pain and warmer conditions improving general comfort. The condition can also create significant neck and upper-back stiffness as well as pain which can radiate down the arm to the elbow and, sometimes, as far as the hand and fingers.
Treatment and recovery may be long and painful. Most frozen-shoulder injuries get better within nine to 24 months but you need comprehensive physical therapy, pain medication, massage therapy and, occasionally, surgery if the condition is particularly unresponsive to conservative management.
There are usually three stages to a frozen shoulder. The first stage, the most painful one, can last up to nine months. The pain will invariably mean that the person will not want to move the arm; characteristically, the arm will stiffen dramatically.
Stage 2 sees a gradual decrease in pain, but the stiffness remains. This stage can take up to another nine months but the pain settles, you sleep better and your tolerance to exercise and therapy improves, making you feel better and generally more optimistic about your recovery.
Stage 3 is when you see the gradual return of your range of motion. Provided that you are diligent with your exercises, you can expect your arm to return to full function within another five to 24 months.
If you add all the months up in the worst case scenario (for all three stages), you will see that this injury can take a long time to heal—but if you stay focused and work hard, it will get better.
Be patient and persistent with your exercise at home to get your shoulder fully functional at the earliest. Patience and perseverance are key. Remind yourself often that your efforts will eventually be rewarded with a functioning shoulder.
Your doctor will help you with pain by giving you oral non-steroidal anti-inflammatory drugs or perhaps by injecting a corticosteroid into the joint itself.
About 25 minutes of exercise and stretching every day can thaw a frozen shoulder. A programme of daily exercise can help heal your shoulder but do consult a physiotherapist before starting.
Basic home exercise programme
Baby pose
Kneel on the floor on your hands and knees. Lower your buttocks back towards your heels and keep your hands in the starting position. You will feel a stretch building in your shoulders. Hold this pose for up to 2 minutes.
Clock
Lie on your back with a 1kg dumb-bell or 500ml water bottle in your hand. Keep your elbow near your side and allow your hand with the weight in it to fall gently outward until you feel a stretch in the shoulder joint. You should hold this stretch for about 2 minutes but many people find it difficult to do so. So you can work your way up from a shorter time of 30 seconds. Slowly bring the hand up again. As your arm becomes more mobile, you can increase the angle your elbow and arm bone make with your body.
Picnic stretch
Sit on the floor with your feet out in front of you and your hands flat on the floor at your sides. Your fingers should be pointing as far back as possible. Initially, it will be an effort just to put them on the floor next to you but, as time goes on, you will be able to move them further behind you and later, you will even be able to lift your hips up off the floor so that you turn this stretch into a great exercise for the arms, back and posterior leg muscles. Hold your stretch for 2 minutes to get the full benefit.
Wall climbs
Stand in front of the wall at arm’s length. Place your fingertips on the wall and then let them creep up the wall as high as you can, taking as little support from the wall as you can. Let them creep back down the wall in the reverse direction to complete the movement. Do about 10 repetitions in one set.
Heath Matthews is a consultant sports physiotherapist at the Centre for Sports Medicine, Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute, Mumbai.
