Oh the joys of a frozen shoulder. Most people have heard of such a thing but what exactly are they? As a Physical Therapist for two decades I have seen my fair share of this irritating and painful condition that continues to fox the medical fraternity in many ways. This painful, debilitating condition is characterized by loss of movement and pain at the shoulder, the degree of which can vary considerably. It affects both men and women, more so in middle age and often has no obvious causative factor. On closer analysis however it regularly transpires that there have been minor incidences of seemingly innocuous trauma to the shoulder. The medical profession has been treating this condition for years with, I have to say, limited success. The reason I say this is because despite intervention a frozen shoulder will often last for many months. Early intervention seems to be a great help in their resolution but again is not guaranteed to yield results. Initial treatment consists of physical therapy to reduce pain and regain movement. If unsuccessful, injections into the joint of hydro-cortisone and local anaesthetic, with or without manipulation under anaesthetic, are commonly performed. After treating many cases of capsulitis and experiencing treatments with many different approaches the sum of this experience is as follows: 1. They eventually get better on their own (if their is no other underlying cause) 2.Night pain is often markedly worse. 3. Patients who exercise seem to do better that those who do not but progress can be painfully (yes and I do mean painfully) slow. 4. Diabetic patients should get help sooner rather than later as their symptoms can be more severe. 5. There are no wonder cures. The best approach after many years of experience treating this problem is: 1. Get early intervention. (re Pain relief, advice and movement.) Get adequate pain relief. Acupuncture; TENS and local heat can be beneficial. In my experience oral analgesia and anti-inflammatory medication is somewhat beneficial in the early acute stages if movement is extremely painful or if patients have difficulty sleeping and resting with the shoulder pain. *Sleeping is often much more comfortable in a propped up position supported by pillows, under the arm too. * Take analgesia if necessary thirty to forty minutes before going to bed. * If the shoulder is in the very painful early stage, rest is fine but it needs to be balanced with some normal activities, even if they are just very light daily tasks. Adhesive capsulitis will have 'its fling' and as there is often not a great deal we can do to stop this process, fighting it tooth and nail is not in my experience successful. It just leads to a very irritated shoulder and patient. In the early stage rehabilitation exercise should be performed two to three times daily to prevent furthur stiffness and maintain as much normal movement as possible. There is a great deal of difference in both symptoms and approach to rehabilitation in the early, painful stage and the later stiffness stage. In this latter stage the angry inflammation has subsided. The focus now is on movement and functional return. This is, however, easier said than done. Patients who do quality, regular exercise rogrammes tend to do much better than those who just wait for normal movement to return. Either way progress can seem very much like two steps forward and one back because of the gross resistance to stretching of the muscles around the shoulder. Research has shown that in adhesive capsulitis the muscles around the shoulder become thickened and shortened. There are however some very simple exercises that I have found to be the most effective in rehabilitating normal movement to the joint, which if done regularly will aid a speedier return to normality. So resolving and dealing with this condition can very much be a self help situation. With the correct advice and the knowledge that eventually it will resolve you can successfully cope and treat this painful condition. The only other information you need is a successful programme of rehabilitation exercises to perform at the relevant stages. So,l wherever you are with this blight of a condition good luck and remember - it will eventually resolve! Copyright 2006 Robert Ryles |
