The shoulder joint is truly an engineering marvel. God’s creation to design a joint that can offer such vast amounts of movement while still being able to keep itself stable is incredible. For the shoulder joint to perform at its optimal level, it requires four basic yet very crucial functions: strength, stability, smoothness and mobility.
Strength and stability were covered in my previous articles before. My articles titled “Doing the Macherena” and “Letting Hang Loose” described the important roles the rotator cuff and bony-labral structures played respectively. The essential role of smoothness will be the topic of interest in my next article. For now, lets dive into the most basic of human need: mobility.
Normal mobility of the shoulder joint is essential for daily functioning. The most common cause of reduced shoulder mobility is adhesive capsulitis or more fondly known as frozen shoulder. Adhesive capsulitis is the fancy medical term that basically translates to the shoulder joint capsule being inflamed and causing it to become “stuck down” so to speak.
Frozen shoulder most commonly affects women between the ages of 40 to 60 years old. Its cause almost always unknown, however, patients with adhesive capsulitis tend to have associated conditions such as diabetes and thyroid disorders. Frozen shoulder should not be confused with a stiff shoulder in someone who’s had a trauma or surgery to the shoulder, as these are different entities. Patients with frozen shoulder go through a natural course of the disease which is divided into three stages: freezing, frozen and thawing.
The freezing stage usually begins with symptoms of gradual onset of pain. This phase can last anywhere between 6 weeks to 9 months. The next stage is frozen. It is during this phase that shoulder mobility starts becoming affected and can last up to around 6 months or more. Lastly is the thawing stage whereby there is gradual return of shoulder mobility. This gradual return of normal movement may take up to 2 years.
As mentioned earlier, the loss of normal mobility of the shoulder joint can be debilitating. The shoulder joint has the greatest range of motion of any joint in the body and one’s daily function can be greatly affected by the loss of it. Simple daily task like reaching out of things out off a high shelve or putting on clothes becomes an unthinkable challenge. Even sleeping on the affected side will become impossible due to the pain.
You would find that your treating doctor would ask if you have any of the above symptoms. If you do, and physical examination of your shoulder also demonstrates a loss in shoulder mobility then further imaging of the shoulder will be necessary. Physical examination of the shoulder would reveal a global reduction in range of motion of the shoulder in every direction, especially external rotation (rotating your arm outwards). Imaging using xrays is necessary only to rule out other possible causes of the reduced movement, as xray findings in frozen shoulder are unremarkable.
Because frozen shoulder is a condition that is characterized by three distinct stages, it should also be treated as such. One should allow the disease to run its natural course. The first line of treatment is always conservative treatment. This requires the patient to undergo home exercise program focusing on regaining range of motion of the shoulder. The exercises should include overhead reach, cross body reach, internal and external rotation. The patient can perform these exercises by stretching the affected limb against a stationary object or by using the other hand as the “therapist” hand.
Trial of the stretching exercises should be exhausted for at least a period of 4 months before other modes of treatment can be considered. This include surgical intervention such as manipulation under anaesthesia (MUA) or arthroscopic release of the shoulder. MUA is a procedure whereby the shoulder joint is stretched out in a control manner until full range of motion is achieved while the patient is under anaesthesia. Arthroscopic release on the other hand is a “key-hole” surgery to release the tight capsule.
While frozen shoulder can be a challenging condition to manage, early diagnosis and appropriate treatment can significantly improve outcomes. It is essential for individuals experiencing shoulder pain and stiffness to seek medical attention promptly. Do not let frozen shoulder freeze your lifestyle.
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