From Adhesive Capsulitis to Frozen Shoulder

Your shoulder joint is carefully encapsulated in a fibrous covering that encloses the shoulder joint structures. The inside of this covering contains a synovial membrane, which produces synovial fluid that helps to reduce friction between bones involved in the shoulder joint. Inflammation of this joint capsule leads to a frozen shoulder.

When the capsule becomes inflamed, the shoulder bones cannot move freely in the joint. The inflammation of the capsule covering the joint gives it the other pet name—adhesive Capsulitis, which means the fluid inside the capsule is now sticky like glue.

Frozen shoulder is more common among women aged 40-60 and in diabetic individuals. 

What Freezes Your Shoulder?

Doctors and Researchers worldwide are still figuring out what exactly freezes your shoulder. Doctors primarily call this disease "idiopathic" of unknown origin. However, two major causes are attributed to the occurrence of Frozen Shoulder: 

1. The inflammation of the joint capsule along with the surrounding tissues (Capsulitis)
2. Post-surgical non-use of shoulders can cause the capsule around the shoulder joint to thicken and tighten. It can also form scar tissue around the capsule, which can further lead to a frozen shoulder.

Risk Factors and Associated Conditions of Frozen Shoulder

Since this disease is attributed to unknown causes, identifying the risk factors and associated medical conditions is essential. The following are the significant risk factors associated with a frozen shoulder.

Symptoms and Diagnosis of Frozen Shoulder

The common symptoms of a frozen shoulder are as follows.

• Unexpected onset of general shoulder pain is often associated with any noticeable loss of motion.
• Severe restriction of both active and passive range of motion.
• Severe restriction of range of movements.
• Dull shoulder pain.
• Changing severity of pain.

The signs and symptoms of frozen shoulder depend upon the disease's stage. In the following sessions, we will examine the stages of frozen shoulder.

Stages of frozen Shoulder

The Symptoms you experience and the treatment given to your frozen shoulder will be according to the stages. So, you must understand these stages.

There are 3 stages of frozen shoulder -

Stage 1 : Freezing or painful stage

Stage 2 : Frozen or transitional stage

Stage 3 : Thawing stage

Diagnosis

How your doctor identifies frozen shoulders is very crucial. Your doctor employs physical examination and laboratory investigation to identify the culprit. A doctor will inspect your shoulder area and assess the range of your movements. Physical examination is usually enough to diagnose a frozen shoulder.

Additional Investigations—A doctor can use X-ray, Ultrasound, and MRI to confirm a frozen shoulder and rule out any associated medical conditions.

Treatment Options

The conventional treatment options include non-operative as well as operative protocols.

Non-operative treatments

• Analgesics or pain killers
• Hot fomentation
• Physiotherapy
• Intra-articular injection of steroids
• Shoulder mobilisation exercises

Operative treatments

• Surgical manipulation under anaesthesia
• Minimally invasive procedure using an arthroscope (an instrument used to inspect or operate the interior of a joint)

Recovery and Rehabilitation: What Should You Keep in Mind

Recovering from a frozen shoulder can be time-consuming, but with proper tips and guidance, regaining a full range of motion is possible.

• Maintaining a healthy weight - Increased weight can put your bones and joints under stress
• Use a sling or a brace - it supports your shoulder and reduces pain 
• Proper posture - Helps in the proper alignment of your shoulder joint
• Try to avoid repetitive movements - it can irritate your shoulder joint
• Always do warm-ups before exercise - It helps to prepare your shoulder muscles.
• Apply ice or heat to your affected shoulder according to the stage. ( link the blog on heat and cold Therapy)
• Massage your Shoulder - Relaxes muscles and improves circulation.
• Rest is essential - It promotes healing and reduces stress.

Physical Therapies and Exercises to Unfreeze Your Shoulder

Physical Therapy is essential to treating a Frozen shoulder; it can help stretch the shoulder capsule and strengthen the muscles around the shoulder joint.  

STRETCHING EXERCISES

These exercises help to loosen the tight and immobile shoulder capsule and improve your shoulders' range of motion. Some joint stretching exercises for frozen shoulder include:

Pendulum Stretching:

1. Stand with your affected arm hanging at your side.
2. Gently swing your arm forward and backward in a small circle.
3. Gradually increase the circle size as you feel more comfortable.

Cross-Body Stretch:

• Position yourself with your affected arm at your side. Keep your other arm bent across your chest.
• Use your other hand to gently pull your affected arm across your chest til you feel a stretch in your shoulder.

External Rotation Stretch:

• To do this stretch, sit on your back with your affected arm at your side. 
• Then bend your elbow at a 90-degree angle and place your hand behind your head. 
• Use your other hand to slowly pull your elbow towards the ceiling until you feel a stretch in your shoulder.

STRENGTHENING EXERCISES

Strengthening Exercises help to build the muscles around your shoulder joint. This further helps improve your shoulder joint's range of motion and stability. Some common strengthening exercises for frozen shoulder are: 

Wall Slides:

• Position yourself with your back against a wall and your arms at your sides. 
• Slowly slide your arms up the wall until they are overhead. 
• Hold this position for 5 seconds and slowly slide back down to the starting point.

Shoulder Shrugs: 

• Stand with your arms at your sides. 
• Shrug your shoulders towards your ears, holding for 5 seconds. 
• Slowly lower your shoulders.

Rows: 

• Sit on a rowing machine or use a resistance band to perform rows. 
• Rows work the muscles in your back and shoulders, increasing your shoulder range of movement.

PHYSICAL THERAPY

Physical Therapy should be done only after consulting an experienced physical therapist. Your physical therapist can curate a specialised personalised exercise programme based on your needs and progress.

Manual Therapy: 

• It is a hands-on approach that your physical therapist uses to loosen the tight shoulder capsule and improve the range of motion.

Modalities: 

• Modalities such as heat, electrical stimulation, and ice may help reduce pain and inflammation and improve range of motion.

What Can Ayurveda Do to Heal Your Frozen Shoulders? 

Being aware of your treatment options is crucial when you are suffering from a frozen shoulder. Steroidal injections and surgery are not the only options available. Ayurveda is the most popular alternative to overcome the frozen shoulder. Let us look in detail.

In Ayurveda, Apabahuka is the term for frozen shoulders. Different internal medications and panchakarma procedures are mentioned for treating apabahuka.

• The general line of treatment employs oleation therapy - both external and internal. Oleation therapy includes the internal administration of medicated fats like ghee or oil and the external application of medicated oils.
• Administering medicines through your nasal cavity, called Nasya therapy, helps manage frozen shoulders.
• Abhyanga, the external application of medicated oils such as Karpasasthyadi oil, is used. 
• In addition, Ayurvedic herbal formulations like Amrtottara Kashaya, Prasaranyadi Kashaya, etc, are used.
• Panchakarma procedures include massaging with dry medicated powder (udvarttana), pouring medicated oils or other medicated liquids over the affected region (dhara), and applying medicated herbal paste (lepa) are the commonly used panchakarma procedures.

Conclusion 

Understanding frozen shoulder is crucial for managing and treating it effectively. You can make informed decisions about your healthcare by learning about what causes it, recognising its symptoms, and exploring the various treatment options.

Whether you opt for non-surgical methods like physical Therapy and lifestyle changes or more invasive surgical interventions, seeking the proper treatment can be the key to restoring your shoulder's mobility and relieving pain. So take that first step towards a healthier, more flexible future for your shoulder joints today.