frozen shoulder

Frozen shoulder? Just roll it

http://www.telegraphindia.com/1160725/jsp/knowhow/story_98489.jsp

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Your Health - Dr. Gita Mathai

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The shoulders are joints with a wide range of motion. That helps us painlessly perform a variety of tasks such as combing hair, applying soap to the back or hooking undergarments. If the movements of the shoulder are restricted due to pain, life becomes difficult.

This may occur because the joint is strained from overexertion, the tendons of the muscles surrounding the joint are inflamed, the joint itself may be unstable and dislocated, or because of neck problems. Most often though, no real disease process can explain the pain and it is called a "frozen shoulder."

Women between 50 and 60 years of age are prone to developing frozen shoulders, especially if they also suffer from hypothyroidism or diabetes. It affects the non-dominant shoulder and is seldom bilateral, but the pain restricts even the simplest two-handed tasks. Men can also develop "frozen shoulders", but it is milder and less common.

A frozen shoulder usually starts as lack of free movement in a normal shoulder joint, with no recollection of overuse or injury. The pain then comes in fits and starts, tends to be worse at night, and interferes with sleep, as turning from side to side produces discomfort. This stage lasts for around three to four months.

Later, during the sticking or freezing phase, all movements are restricted by pain. The shoulder is held fixed to prevent involuntary movement. Subconsciously, use of the affected arm reduces. The muscles around the joint get wasted due to disuse. The rounded contour of the shoulder changes and becomes flattened. Just as suddenly as it starts, it spontaneously, inexplicably improves.

The entire cycle takes around 30 months. In seven per cent of sufferers, it does not fully resolve, and pain and functional disability remain for many years.

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A frozen shoulder is usually diagnosed clinically. The normal procedure is to get X-rays, CT and MRI scans done. However, X-rays may only reveal thinning of the bone due to disuse.

Once the shoulder has become relatively immobile, treatment is essentially symptomatic. During the initial painful stages, treatment is directed at relief. The patient has to determine the limit of activity or exercise, pushing their limits a little further each day. All pain free activities are allowed and all painful activities curtailed.

At home, external application of a capsaicin gel followed by ice offers relief. Professional physiotherapy, with alternating heat and cold therapy, passive movements, low load, prolonged stretches and strengthening exercises are helpful. Physiotherapy provides greater benefit when it is combined with intracapsular steroid injections. Non-steroidal anti-inflammatory drugs (NSAIDs) supplemented with other analgesics may be helpful. Long-term use of these drugs is not advised, as it is detrimental to the kidneys.

If functional disability persists despite physiotherapy and medication for six months, an orthopaedic surgeon can perform manipulation of the joint under anaesthesia. Arthroscopic (surgical) release of the capsule can also be done.

It is better to be patient and manage the symptoms rather than go in for surgery immediately as most people recover spontaneously.

Anyone can develop a frozen shoulder. This makes preventive measures a practical necessity to prevent pain and disability occurring.

Yoga has exercises that prevent frozen shoulder from developing if started young, performed regularly and continued lifelong. Shoulder rolls, arm elevations, arm rotations, the plank pose and a complete suryanamaskar all help to maintain the integrity, position and health of the shoulder joint.

The Chinese Tai-Chi exercises confer similar benefits.

These traditional exercises can be combined with biceps curls, triceps curls and lateral lifts using small one or two kilo "baby" dumbbells.

The writer is a paediatrician with a family practice at Vellore and author of Staying Healthy in Modern India. Questions on health issues may be emailed to her at yourhealthgm@yahoo.co.in