While a frozen shoulder can be challenging to manage , early diagnosis and ����������� ��������� ��� ������������ ������� ��������
Column
12 The HEALTH | January-February . 2024
The frozen shoulder
While a frozen shoulder can be challenging to manage , early diagnosis and ����������� ��������� ��� ������������ ������� ��������
BONE TO PICK
Dr Jonas Fernandez is an Orthopaedic Surgeon at Putrajaya Hospital . He is also a member of the Malaysian Arthroscopy Society ( MAS ).
THE shoulder joint is truly an engineering marvel . It is incredible for God ’ s creation to design a joint that can offer such vast amounts of movement while keeping itself stable . For the shoulder joint to perform at its optimal level , it requires four essential yet crucial functions : strength , stability , smoothness and mobility .
Strength and stability were covered in my previous articles before . My articles titled “ Doing the Macarena ” and “ Letting Hang Loose ” described the crucial 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 . Now , let ’ s dive into the most basic human needs : mobility .
Normal mobility of the shoulder joint is essential for daily functioning . The most common cause of reduced shoulder mobility is adhesive capsulitis , 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 shoulders most commonly affect women between the ages of 40 and 60 . Its cause is almost always unknown . However , patients with adhesive capsulitis tend to have associated conditions such as diabetes and thyroid disorders .
A 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 shoulders go through a natural course of the disease , which is divided into three stages : freezing , frozen and thawing .
THE SHOULDER JOINT ’ S FANTASTIC RANGE OF MOTION
The freezing stage usually begins with symptoms of gradual onset of pain . This phase can last anywhere between six weeks to nine months . The next stage is frozen .
During this phase , shoulder mobility is affected and can last up to around six months or more . Lastly is the thawing stage , whereby there is a gradual return of shoulder mobility . This gradual return to normal movement may take up to two years .
As mentioned earlier , the loss of normal mobility of the shoulder joint can be debilitating . The shoulder joint has the most fantastic range of motion of any joint in the body , and one ’ s daily function can be significantly affected by its loss of it .
A simple daily task like reaching for things on a high shelf or putting on clothes becomes an unthinkable challenge . Even sleeping on the affected side will become impossible due
“ Frozen shoulders most commonly affect women between the ages of 40 and 60 . Its cause is almost always unknown . However , patients with adhesive capsulitis tend to have associated conditions such as diabetes and thyroid disorders .”
to the pain .
You would find that your treating doctor would ask if you had any of the above symptoms . If you do , and physical examination of your shoulder also demonstrates a loss in shoulder mobility , further shoulder imaging will be necessary .
Physical examination of the shoulder would reveal a global reduction in the shoulder ’ s range of motion in every direction , especially external rotation ( rotating your arm outwards ).
Imaging using X-rays is necessary only to rule out other possible causes of the reduced movement , as X-ray findings in frozen shoulders are unremarkable .
ARTHROSCOPIC RELEASE OF THE SHOULDER
Because frozen shoulder is a condition characterised 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 a home exercise programme focusing on regaining the shoulder ’ s range of motion . The exercises should include overhead reach , cross-body reach , and 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 .
A trial of the stretching exercises should be exhausted for at least four months before other modes of treatment can be considered . This includes 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 controlled manner until a full range of motion is achieved while the patient is under anaesthesia . Arthroscopic release , on the other hand , is a “ keyhole ” surgery to release the tight capsule .
While a frozen shoulder can be challenging 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 a frozen shoulder freeze your lifestyle . – The HEALTH