The condition called frozen shoulder begins as a slight pain and progresses to severe discomfort, which becomes worse when the shoulder is moved. Eventually, the shoulder stiffens to the point that it cannot be moved at all. , This disorder is not well understood, but it typically starts with a minor in jury that leads to inflammation. The normal response is not to move the painful joint, thus allowing adhesions, constricting bands of tissue, to form. Adhesions make it even more difficult and painful to move the shoulder, and a vicious cycle develops. Eventually, the capsule lining the shoulder joint shrinks because of scar tissue resulting from the adhesions.
Diagnostic Studies And Procedures
A diagnosis is often based on symptoms and their progression, as well as a physical examination of the affected shoulder. To confirm the presence of adhesions, a doctor may order an arthrogram, a type of X-ray taken after a dye (to increase the contrast of soft tissues) is injected into the joint. The doctor may also examine the inside of the joint by inserting an arthroscope, a periscope like instrument with alighted tip, through a small incision.
Doctors usually recommend aspirin, ibuprofen, or prescription-strength nonsteroidal anti inflammatory medications to alleviate pain. Sometimes cortisone, injected directly into the joint,causes a dramatic reduction in pain and inflammation. Injections have the added advantage of not producing the undesirable side effects associated with oral cortisone and other steroids. Restoring mobility to the shoulder may require manipulating it to break up the adhesions This is usually done under general anesthesia, and can be an outpatient procedure or one that requires a brief hospital stay. Once the adhesions have been broken and the pain controlled, a course of physical therapy will be prescribed to rehabilitate the shoulder.
Medical treatment is usually required to overcome a frozen shoulder, the longer such care is delayed, the more difficult a complete cure will be. However, alternative therapies may help.
Chiropractors treat shoulder pain and stiffness with manipulation techniques similar to those used for back problems. For frozen shoulder, a chiropractor may combine this approach with heat therapy and an exercise program.
Water massage, needle showers, and other types of hydrotherapy may be used in rehabilitation efforts following medical treatment.
Rolfing or other deep massage techniques may help in treating the early stages of the disorder. Other massage methods can alleviate muscle tension in the upper neck and shoulder area that extends to the base of the shoulder blade. Pressure point massage techniques, such as shiatsu and reflexology, may also ease shoulder pain.
Osteopaths, doctors who have special training in manipulation techniques, often use a combination of physical therapy, massage, electrical stimulation, and ultrasound to relax tense muscles and relieve pain. An osteopath is just as qualified as an orthopedist or other medical doctor to break up the adhesions that are responsible for frozen shoulder.
If you experience shoulder pain, stop whatever physical activity is triggering it. Rest your shoulder for at least a day, and take aspirin or ibuprofen to ease pain and reduce inflammation. Apply an ice pack to the painful area for 20 minutes, remove it for 10 minutes, and reapply it for another 20 minutes. Repeat this as often as possible for the first day or two. The cold helps diminish the swelling and inflammation; after the first 48 hours, however, heat may be more beneficial. If the pain and stiffness continue or worsen after a few days of self care, see a doctor, especially if the pain is affecting shoulder mobility. Otherwise, the condition may become permanent. Following treatment for a frozen shoulder, special weight-lifting exercises can help in regaining strength. But any exercise regimen should be undertaken only with the approval of a physician or physical therapist. A session of weight training should be preceded by range of motion exercises to warm up, and followed by muscle stretches to cool down. If your doctor or physical therapist approves, try doing these exercises two or three times a day:
While holding a one to five pound weight, let your arm hang loosely at your side. Swing the arm back and forth gently, gradually increasing the range of the swing each day. You can also lean forward and swing the arm in small circles.
Standing with your injured shoulder toward a wall, reach out with your arm until your hand is touching the wall. Keeping your elbow straight, walk your fingers slowly up the wall until you feel tension in the shoulder. Hold for 10 seconds, then walk your fingers back down. Repeat 10 times, trying to walk your fingers up a little more each time.
Other Causes of Shoulder Stiffness
Arthritis and muscle strain or sprain can bring about shoulder pain and stiffness, as can bursitis or tendinitis when caused by the excessive repetition of a motion, such as a golf swing.