Thursday, October 24, 2013

Frozen Shoulder

Few disorders in Orthopedics affect a patient as dramatically as frozen shoulder does. Most often the pain starts suddenly without any warning. And what puzzles the patient is that the pain starts without any fall or trauma. The pain is severe and is aggravated by any sudden movement of the shoulder. At times the pain is unbearable. The pain worsens at night and patients are unable to fall asleep. They cannot lie down sideways because of pain. The pain is accompanied by increasing stiffness of the shoulder. The patient becomes very anxious because of this catastrophic onset of pain and inability to move the shoulder. 
Frozen shoulder comes with good news and bad news. The good news is that the disorder is self limiting. This means that it is notan ongoing problem like arthritis which ends up with complete destruction of the joint. On the contrary frozen shoulder undergoes a typical evolution from stage to stage and then completely resolves. Therefore almost all patients of frozen shoulder will eventually be completely cured of their illness. Sofrozen shoulder is not a bad disease to have. What then is the bad news? The bad news is that it takes awfully long for the shoulder to get better. Typically a patient suffers for one year to 18 months before the pain goes away. 18 months is a long time for someone to suffer severe pain and sleepless nights!
What is frozen shoulder? In order to understand frozen shoulder we need to understand some simple facts about the shoulder joint. The shoulder is a ball and socket type of joint. Like all other joints the shoulder is strengthened by ligaments and moved by muscles. Similarly the shoulder also has a covering or lining called the capsule. The capsule makes and keeps the lubricating fluid within the joint. In frozen shoulder the capsule gets inflamed and contracted. This inflammation causes severe pain with the slightest movement of the shoulder. The contracture of the capsule causes the shoulder to become stiff. Frozen shoulder in medical terms is also called 'adhesive capsulitis'. We are still not sure why frozen shoulder occurs. However we do know some definite risk factors. It is more common in diabetic patients. It also is more likely to occur in patients who have not moved their shoulder for a long time due to some other reason like an arm fracture or stroke. Frozen shoulder is generally seen in adults above 40 and is slightly more common in women. There are three stages through which the disease progresses before it finally resolves. First is the stage of inflammation. It lasts for approximately 6 to 12 weeks. It is characterised by severe often unbearable pain. In this stage, pain is more prominent than stiffness. The second stage is of stiffness. In this stage the shoulder is very stiff with almost no movement occurring in some patients. The pain reduces in intensity in this stage. This stage lasts for another 12 weeks. The last stage is of thawing. In this stage the disorder resolves. Movements of the shoulder begin to improve and eventually the patient is cured. This stage lasts for 6 to 12 months. 
Are frozen shoulder patients destined to suffer? Is there any treatment for this disease or can these patients help themselves? There is no medicine to cure frozen shoulder. However the disability from frozen shoulder can definitely be reduced. The aim of treatment is to bring back the movements of the shoulder with range of motion exercise. A physiotherapist helps guide the patient through the exercise routine. Once the patients learn the exercises, they continue doing them at home. Those who try to regain movements by exercise are able to reduce pain and shorten the duration of illness. However exercise is many a times extremely difficult because it worsens the pain. Many patients are just not able to do any exercise. We as doctors help patients reduce pain so as to enable patients to do exercise.Initial pain management is with medicines. Tablets are given only with the intention to decrease pain so that patient can do exercise. Exercise remains the mainstay of treatment. If tablets do not work, local injection of steroid medicine is given to reduce the inflammation and pain. One or two injections of steroids do not harm the joint. Repeated injections should be avoided. Sometimes the patients are able to exercise, but are not able to overcome the severe stiffness. For such cases we do a manipulation under anesthesia. As the name suggests, the patient is given anesthesia so that they do not experience any pain. Then the surgeon forcibly moves the shoulder in all directions to loosen the joint. After the manipulation, the patient needs to continue exercise to gain the movements and benefit from manipulation. In very resistant cases, arthroscopic surgery is done to cut the adhesions and allow shoulder movements. 
To conclude, frozen shoulder patients should not be worried about the pain as the problem is self limiting and will get better in time. All attempts must be made to exercise and gain movements with the help of your doctor. Patients who exercise are able to shorten the period of their disability and achieve a cure quickly! 

2 comments:

Baldev Dudani said...

Thanks for sharing Qued

Priyanka Suri said...
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