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Frozen Shoulder


Anatomy
The shoulder joint is a modified ball and socket joint. The ball is at the top of the Humerus (arm bone), whilst the socket is a shallow cup on the end of the scapula (shoulder blade). This is a good design to give mobility to the shoulder joint but it makes it inherently unstable, and dislocation is common. To improve the stability of the shoulder a cuff of four muscles (called the rotator cuff) braces the joint as well as a complex plethora of tough internal ligaments. Surrounding the Gleno-humeral joint (shoulder joint) is a bag called the CAPSULE. When the arm is raised above the head, this CAPSULE is fully stretched; when the arm is lowered to the side, the capsule hangs down in a small pouch-like sack.

 
Frozen shoulder, or adhesive capsulitis, is a condition that causes restriction of motion in the shoulder joint. The cause of a frozen shoulder is not well understood, but it often occurs for no known reason. Frozen shoulder causes the capsule surrounding the shoulder joint to contract and form scar tissue.

What causes frozen shoulder?
Most often, frozen shoulder occurs with no associated injury or discernible cause. There are patients who develop a frozen shoulder after a traumatic injury to the shoulder, but this is not the usual cause. Some risk factors for developing a frozen shoulder include:

  • Age & Gender
    Frozen shoulder most commonly affects patients between the ages of 40 to 60 years old, and it is twice as common in women than in men.
  • Endocrine Disorders
    Patients with diabetes are at particular risk for developing a frozen shoulder. Other endocrine abnormalities, such as thyroid problems, can also lead to this condition.
  • Shoulder Trauma or Surgery
    Patients who sustain a shoulder injury, or undergo surgery on the shoulder can develop a frozen shoulder joint. When injury or surgery is followed by prolonged joint immobilization, the risk of developing a frozen shoulder is highest.
  • Other Systemic Conditions
    Several systemic conditions such as heart disease and Parkinson's disease have also been associated with an increased risk for developing a frozen shoulder.


What happens with a frozen shoulder?
No one really understands why some people develop a frozen shoulder. For some reason, the shoulder joint becomes stiff and scarred. The shoulder joint is a ball and socket joint. The ball is the top of the arm bone (the humeral head), and the socket is part of the shoulder blade (the glenoid). Surrounding this ball-and-socket joint is a capsule of tissue that envelops the joint.
Normally, the shoulder joint allows more motion than any other joint in the body. When a patient develops a frozen shoulder, the capsule that surrounds the shoulder joint becomes contracted. The patients form bands of scar tissue called adhesions. The contraction of the capsule and the formation of the adhesions cause the frozen shoulder to become stiff and cause movement to become painful.

The pain of a Frozen Shoulder can be horrendous. Ask a sufferer what the pain would be on a scale between 1 and 10 and you’ll often hear 20.

  The major symptoms of Frozen Shoulder are:

  • Pain and loss of motion:

  • Night pain and especially when trying to lay on the affected side.

  • Severe sharp catching pain at the front of the shoulder when you inadvertently extend the arm and lasting up to a minute or so. (You have to protectively hold the shoulder tightly.)

  • Pain reaching for the hip pocket, (not necessarily a bad thing if it’s your shout), putting on or taking off a coat, brushing the hair and inability to do up a bra.

  • Pain down the outer upper side of the arm.

  • Inability to drive.

  • Swelling of tendons causes severe limitation in movement, especially reaching up behind the back.


Immobility / Stiffness

This is the key diagnosis of a Frozen Shoulder. You can’t move the arm and neither can anyone else if they attempt to lift the arm for you. If they do try, it’s very painful and you want to kill them for their effort.
From when you first notice the pain, the shoulder becomes stiff or stuck for a period that could be between 48 hours to a month and it’s all downhill from there. If your shoulder is not ‘stuck’ you may not have a true Frozen Shoulder. Many people are forced to give up work as a result of the pain and stiffness that commonly persist for many years.

The inability to work and the constant pain and stiffness can have a considerable impact on you psychologically as well as financially, and you can become extremely depressed and anxious as a result.

Frozen Shoulder Facts:

  • 2-5% of the population suffer from it. This doesn’t mean 98-95% enjoy it.

  • It is more common in women (60%)

  • It is five times more common in diabetics

  • It is common, but not limited to people with Dupuytren’s contracture (an uncommon hand condition where the connective tissue under the skin of the palm contracts and hardens over time.

  • It may be genetic. i.e it can run in the family.

  • It seems to affect 40-70 year olds.

  • About 15% of people get it on both sides.

There are three phases to Frozen Shoulder, (which lasts an average of 30 months. Some say longer).

1. Freezing (1 – 8 months) You notice some things you normally do are starting to hurt.
2. Frozen (9 – 16 months) It’s full on! Any movement using the arm is incredibly painful.
3. Thawing (12 – 24 months) Slowly gets back to normal and pain free use of the arm.

Not much to look forward to, is it.

The pain and loss of function associated with this condition can become so severe that it can significantly affect the quality of life, and prevent some people from sleeping well or working.

What causes a Frozen Shoulder?

There’s no explanation for the development of Frozen Shoulder in most patients. The majority of cases seem to be more prevalent in women. Some who develop Frozen Shoulder have sustained an injury and developed stiffness as a result. The trauma can be quite mild or severe, and the body’s response to the event is probably more important than the event itself.

What is happens inside a Frozen Shoulder?

The shoulder joint is a ball and socket joint. The ball is at the top of the Humerus (arm bone), and the socket is a shallow cup on the end of the Scapula (shoulder blade).
Surrounding the shoulder joint is a bag called the Capsule. When the arm is raised above the head, this Capsule is fully stretched. When the arm is lowered to the side, the capsule hangs down like a small pouch.
To improve the stability of the shoulder a group of four muscles called the Rotator Cuff braces the joint as well as an elaborate bunch internal ligaments.

Inflammation.
In a Frozen Shoulder Syndrome the Lax Capsular Sack and the Synovial Fluid it contains becomes sticky and thick and can sometimes form adhesion's. The stickiness is brought on through inflammation. This can occur after a small injury, but often you may not remember anything about it. Once established, this inflammation spreads into other shoulder soft-tissues and can cause swelling in other shoulder sacks (bursae).

Stiffness.
The stiffness is an ‘overreaction’, or the shoulders attempt to counteract the inflammation within the Biceps groove. The body seems to ‘switch off’ muscles in a coordinated sequence. This sequence is the same for everyone. Arm movements start to diminish, and within a few weeks the arm literally becomes frozen and for many, cannot be raised more than 40° in any direction. The muscles of the Rotator Cuff become weak and start slowly to waste away, leaving the arm to hang stiff and immobile.

The shoulder may not be completely stiff for several months and both active and passive movements are stiff and neither you nor anyone else can lift it because it’s too painful!
 

Traditional treatments may include:

Cortisone Injections:
Cortisone injections are often tried during both the freezing and frozen phases. It is usual to have up to four injections. Cortisone injections may give brief periods of pain relief, but mostly, they seem to give only a few days or weeks of symbolic respite. Cortisone, which is a steroid, is a crystalline substance and is injected into the joint capsule.

Suprascapular Nerve Block:
The suprascapular nerve is the major sensory supply to the shoulder joint and motor supply to the Supraspinatus and infraspinatus muscles.
A Suprascapular Nerve Block has been used in patients with severe pain associated with Frozen Shoulder syndrome. This injection technique is usually performed 3 times over as many weeks. It has given some relief for pain, but has no effect on the stiffness in the shoulder. This injection consists of a local anesthetic and steroid, and is done with x-ray guidance and involves inserting a needle through skin and deeper tissues.
The procedure is not without pain. However, the skin and deeper tissues are numbed with a local anesthetic. Most of the patients also receive intravenous sedation which makes the procedure easier to tolerate.

Manipulation:
Under anesthetic, manipulation can be performed in the freezing phase (after about 6 months). It is performed under general anesthetic and followed up by several months of physiotherapy. Complications arising from this include fractures and dislocations of the Humerus, Rotator Cuff tears, increased inflammation and scarring. Nerve damage can also occur, especially to the Radial Nerve.
Physiotherapy:
Physiotherapy is commonly advised  by doctors during the ‘Frozen’ stage and is mainly aimed at keeping the shoulder mobile through stretching and pushing the joint.  However, it rarely seems to hasten the recovery of the condition.

Yeah
The good news is that even very severe types of Frozen Shoulder syndrome can be treated effectively. Treating Frozen Shoulders is massage based and naturally utilizes the body’s own healing mechanisms. No drugs, no surgery. It utilizes a specific sequence of manipulations to the shoulder joints and soft-tissues.

In a Frozen Shoulder there are masses of inflammation and on top of this the brain starts to recruit the ‘wrong’ muscles to move the shoulder.
The body and the brain is tricked into healing itself by addressing the two main components of the problem … pain and stiffness. Initially the aim is to significantly reduce the pain by treating the swelling around various shoulder tendons, especially the biceps tendon.

Following this, the technique moves on to rapidly ‘thaw’ and improve the range of shoulder motion by stimulating a unique sequence of reflexes hidden within the muscles. One reflex is triggered against another in sequence and the arm is not forced. Instead it’s kept still whilst applying the pressure.

Patients treated in this massage based technique will notice a definite improvement with each treatment session. These should be twice a week for twenty to thirty minutes a session and complete relief should be within twelve weeks.

There is a couple of testimonials regarding Frozen Shoulders you might care to visit, and if you believe you might be displaying the symptoms of this condition… call me to talk about it.

Frozen Shoulders CAN be fixed… but it won’t happen with medication.
 Call for an appointment
208-412-0815
 
Thank you for the information provided
References:
http://www.frozenshoulder.com/all_about_shoulder_pain.php
http://orthopedics.about.com/cs/frozenshoulder/a/frozenshoulder.htm
http://www.townsvillemassage.com/index.php/massage/frozen-shoulders/


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