Unable to move your hand up and down? It could be a frozen shoulder

Frozen shoulder

Frozen shoulder or adhesive capsulitis is diagnosed clinically. However, it does have some imaging findings on magnetic resonance imaging (MRI) which can suggest frozen shoulder in a patient.

What is frozen shoulder?

Frozen shoulder is a condition that causes severe painful restriction of motion of the shoulder joint. It may be associated with pain, swelling and stiffness making everyday activities more difficult and can worsen over time to a point where it can affect night’s sleep. This typically affects women more than men between the ages 40-60 years. Frozen shoulder can be caused due to immobility or decreased movement. It can also be seen in patients with diabetes mellitus or old trauma/ injury/ surgery or even prior vaccinations. Prolonged immobilisation by wearing a sling can worsen the problem. The underlying problem is thickening of the ligaments around the shoulder which can restrict movement. Restriction in movement leads to reduced movement and decreased movement causes more restriction and is a vicious cycle. Therefore it is important to diagnose this problem and start treatment. Without proper treatment this painful condition can last for years.

How is it diagnosed?

Initially patients may experience dull aching pain and shoulder becomes painful and stiff that slowly builds up. This can last anywhere between 2-9 months. In second stage, pain begins to subside however, motion restriction worsens. Patients may have some sharp/shooting pain with sudden movements or forceful movements beyond their normal range. This stage can last 4 months to 1 year. Final stage is where the range of motion returns to normal. However, shoulder experiences more permanent damage due to cartilage loss and wasting of muscle (muscle atrophy) which can prolong recovery or make it difficult for recovery.

When to see a doctor?

It is advised to see a doctor(usually an orthopedic doctor) in initial stages of pain. The doctor usually orders an x-ray of shoulder to rule out other causes of pain.

How is frozen shoulder treated?

Physical therapy is underrated but can be very helpful in patients with frozen shoulder to maintain the range of motion. Even little stretches and gentle movements can relieve some restrictions and break some of the adhesions or fibrous bands that help in recovery. Practicing physical therapy and continuing to move can not only improve movement but also help strengthen muscles around shoulder joint. Any movement in body is with the help of bones and muscles. Without movement, the bones tends to loose minerals essential for strength, bone density and muscles loose their proteins and are replaced by fat. So it is important to keep moving, even if it is little to maintain range of motion. Orthopedic doctors or musculoskeletal radiologists can also inject steroid into the joint along with a pain medicine, under ultrasound which can help movement while reducing the pain levels and are better than taking long term oral pain medicines. Steroid is given into the joint so it has fewer side effects on the body and not absorbed systematically into the body. Steroid also helps break some of the fibrous bands/ adhesions.

However, it is important to watch blood glucose levels for 2 weeks after injection in patients with diabetes. Any movement, physical therapy, yoga are helpful and should be done on a regular basis to avoid long term complications. However, pain needs to be addressed first, as decrease in pain score can improve movement.