Frozen shoulder is painful inflammatory condition associated with stiffness and loss of motion in shoulder. The pain gradually grows and becomes chronic leading to restricted movement. Due to inflammatory conditions the muscles surrounding the shoulder becomes stiff. Frozen shoulder has vague triggers, which usually surfaces as a complication commonly in people with diabetes, thyroid disorders, heart disease, and Parkinson's disease and people with chronic rheumatism or arthritis. The general approach towards frozen shoulder is prescription of painkillers, anti-inflammatory and physical therapy to restore the ROM.

What is the suffering ....
As the chronicity advances the movement of the shoulder is severely restricted, with progressive loss of both active and passive range of motion. The condition is sometimes caused by injury, leading to lack of use due to pain, but can also arise spontaneously with no obvious trigger (idiopathic frozen shoulder). Rheumatic disease progression and recent shoulder surgery can also cause a pattern of pain and limitation similar to frozen shoulder. Intermittent periods of use may cause inflammation.

In frozen shoulder, the synovial fluid becomes scarce resulting in diminished joint lubrication between the head of humerus (Upper arm bone) and the socket of the scapula. Due to friction as precipitating factor, the shoulder capsule swells, thickens and tightens due to stiffness of ligamentous bands of scar tissue. As a result, the joint movement becomes stiff.

How to know ...
First sign of a frozen shoulder is that the joint becomes so tight and stiff that it is nearly impossible to carry out simple movements, such as raising the arm. The movement that is most severely inhibited is abduction and external rotation of the shoulder. Lots of tests are done clinically to assess the frozen shoulder. One of the best test is “Scratch Test” and 2^nd is the Lateral external rotation.

People complain that the stiffness and pain worsen at night or the pain is worse during morning. Pain due to frozen shoulder is usually dull or aching. It can be worsened with attempted motion. A therapist or practitioner may suspect the patient has a frozen shoulder if a physical examination reveals limited shoulder movement. XRay of rhe shoulder or an MRI scan may confirm the diagnosis, though its mostly diagnosed clinically.

The frozen shoulder, according to the chronicity is categorised into stages.

Stage one:  "freezing" or painful stage, which may last from six weeks to nine months, and in which the patient has a slow onset of pain. As the pain worsens, the shoulder loses range of motion.
Stage two: "frozen" or adhesive stage is marked by a slow improvement in pain but the stiffness increases. This stage generally lasts from four to nine months.
Stage three: "thawing" or recovery, when shoulder motion slowly returns toward normal. This generally lasts from 5 to 26 months.

What to Do....

Frozen shoulder makes the person so disable that he cannot work without pain. Management of the frozen shoulder is focused on restoring joint movement and reducing shoulder pain, involving medications, physical therapy and /or surgical intervention. Treatment may continue for months, there is no strong evidence to favour any particular approach. Medications frequently used include NSAIDs and corticosteroids. Alternative medicines like homeopathy, ayurveda also gives great results. Alternative measures like physical therapy, exercise therapy, yoga have good impact in increasing the range of motion.

The most important challenge is to maintain the range of motion.

Dr Harkirat S Wilkhoo                                                        www.wellnessdrwilkhoo.com