Frozen Shoulder is a condition in which the shoulder is completely or partially unmovable and extremely painful. Frozen shoulder can appear to start from nowhere or may be triggered by injury to the shoulder. Even when the condition appears to come from nowhere there are usually biomechanical changes causing some of the muscles in the shoulder to work harder.
The condition usually goes through three phases, starting with pain, followed by stiffness and finally the easing of pain and the return of most the movement. This process may take as long as two or more years.
Frozen shoulder has been associated with diabetes, high cholesterol, heart disease and Dupuytren’s contracture. It may follow an injury to the shoulder or surgery.
The shoulder joint is a very mobile joint and because of this there is a trade off, it is not as stable as many joints in the body. The joint requires the coordinated support of the surrounding muscles, particularly the rotator cuff muscles. Although it is not clear on the mechanism leading to many frozen shoulders one thought is that if the muscles become tight and often weak due to Trigger Points they are less able to support the joint and joint capsule. With a frozen shoulder this capsule becomes inflamed and contracted, hense the medical name for this condition, Adhesive Capsulitis, thus losing the normal movement and causing pain and stiffness.
Three stages of development:
A typical frozen shoulder develops slowly, and in three stages lasting approximately two years if left untreated:
- Freezing phrase: Pain increases with movement and is often worse at night. There is a progressive loss of motion with increasing pain. This stage lasts approximately 2 to 9 months.
- Frozen phase: Pain begins to diminish but the range of motion is now much more limited, with pain at the end range of movement. This stage may last 4 to 12 months.
- Thawing phase: The condition may begin to resolve and is normally painless. Most patients experience a gradual restoration of motion over the next 12 to 24 months.
Most often, a frozen shoulder can be diagnosed on examination, and no special tests are needed. An x-ray is usually obtained to ensure the shoulder joint appears normal, and there is not evidence of traumatic injury or arthritic changes to the joint. An MRI is sometimes performed if the diagnosis is in question, but this test is better at looking for other problems, rather than looking for frozen shoulder. If an MRI is done, it is best performed with an injection of contrast fluid into the shoulder joint prior to the MRI. This will help show if the capsule of the shoulder is scarred down, as would be expected in patients with a frozen shoulder.
Frozen shoulder treatment primarily consists of working to increase the movement in the shoulder without further inflaming the joint capsule. If treatment is affective the patient will first start to gain some pain relief and then slowly gain small increases in Range of Motion. This sort of treatment can be provided by a Remedial Massage Therapist, Acupuncturist, Physiotherapist, Chiroractor or Osteopath. The treatment process can take many months.
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