Frozen Shoulder: Role of Physiotherapy and Shoulder Replacement

What is a Frozen Shoulder? Frozen shoulder, medically known as  Adhesive Capsulitis, is a painful condition which restricts shoulder movement.  In a healthy state, the shoulder capsule stretches up when one raises his hand above the head and vice versa. However, with Frozen Shoulder the capsule becomes thick and swell because of scar tissues within, which gradually stiffens the movement due to lack of space in the upper arm joint. What are the causes of Frozen Shoulder? Symptoms are triggered by:

1. A Shoulder Injury or Shoulder Surgery
2. Diabetes
3. Dupuytren's Contracture
4. Heart Disease
5. Stroke

 How to find the signs and the symptoms? It has 3 stages: The Freezing Phase - Continues for 3 to 8 monthsThe Frozen Phase - Lasting 4 to 12 monthsThe Thawing Phase - Continues for 12 to 42 months. Symptoms:

1. Unbearable pain, even at early stages.
2. The pain is aggravated during nights.
3. Pain spreads up to elbow level.

 Which specialist to consult? One should consult an authorized General Medical Practitioner or an Orthopedic. What are the screening tests conducted to confirm the condition?Physical Examination: Once the suspected symptoms occur, the specialist carefully accesses the shoulder's range of motion.

Imaging Tests:  Generally X-rays give a clear idea about skeletal structure. Similarly, the Magnetic Resonance Imaging (MRI) and ultrasound give a better knowledge about scar tissues.

What are non-surgical treatments available?

Approximately 90% of patients respond well to simple treatment of non-steroidal anti-inflammatory drugs and anti-inflammatory steroid injection. Physiotherapy Specific exercises under the physiotherapist supervision can really make a noticeable difference. The therapist can use various methods for pain management, restricting its effects and monitoring any progression or advancement into different stages. Physiotherapy is widely focused on maintaining as much shoulder movement as possible and when in the thawing stage ensuring a speedy recovery and return to normal shoulder movements. The Corticosteroid Injections have shown good results to ease the effects of the inflammatory stage.  Exercises like stretching or various shoulder motions can loosen the muscles.  However, regularity is must. Implementation of hot pack or bath before exercises and ice pack after it will make it easier. Physiotherapy speeds up even the post-surgical recovery. What are the Surgical Treatments? When symptoms persist, doctors recommend surgery. There are two variations; first one is manipulation under anesthesia where the practitioner moves the frozen shoulder of the unconscious patient to break the stiffness. Eventually, it leads to increased easy movement by tearing and stretching the scar tissues. The other one is shoulder Arthroscopy, in which the surgeon cuts the stiff portions of shoulder capsules using pencil sized instruments which get in through small incisions around the shoulder. Surgical recommendation is during the frozen phase. In freezing and thawing phase surgery is non-permissible. What are the Dietary Restrictions?

1. Say no to acidifying and allergenic food.
2. Caffeine, pasteurized milk, hydrogenated oil must be avoided.
3. Increase the water intake. It should be minimum two liters a day.

How can you prevent the disorder from happening or recurring? Once fully resolved, re-occurrence is a rare instance, only the diabetic cases are exceptions. As a caregiver, how can you help the patient cope with Frozen Shoulder? People often get panic because of the pain and a lengthy healing process. Reassurance, advises on pacing activities improves and cures patient's physiological, physical and social health. Frozen Shoulder is a medical condition which is completely curable! Image source: www.moveforwardpt.com