The mystery of frozen shoulder

Frozen shoulder remains a mysterious ailment to the medical profession and no underlying cause has been definitively identified. That’s cold comfort for anyone who has struggled with this disruptive and sometimes painful condition. So how much do we really know about it and how can you best tackle the symptoms if you find yourself suffering from it?

What is a Frozen shoulder?
Frozen shoulder involves a thickening of the capsule of connective tissue that surrounds the muscles, ligaments and tendons of the shoulder joint. This constriction eventually restricts movement and can cause pain.

While the root cause is still a mystery, what we do know is that it tends to affect women more than men and it occurs more commonly in over 40s. We also know that it can sometimes occur as a flow-on effect from other medical conditions which render the shoulder temporarily immobile, such as stroke or some other injury related to the shoulder joint. The frozen shoulder can emerge and persist for an extended period, even well after the original condition has subsided.

Incidence also seems to be more prevalent in people with diabetes, thyroid conditions or Parkinson’s disease.

Three stages of progression
The condition normally progresses in three distinct stages:

  1. The initial “freezing stage” is where any movement of the shoulder causes pain, and you notice the range of motion becoming limited.
  2. The “frozen stage” is where the immobility becomes more pronounced and using the limb can become very restricted, although pain may subside at this point too.
  3. The “thawing stage” is where movement starts to be resumed.

These stages may be spread over an extended period of between one to three years.

Conventional treatment options
Your doctor can diagnose the condition fairly quickly just by performing a physical examination and testing your range of movement. In some cases they may also request an X-ray or MRI scan to help confirm the diagnosis.

Once it has been confirmed the treatment is primarily designed to alleviate symptoms, rather than to treat the condition itself. The pain and inflammation can be treated with aspirin and ibuprofen, although in some cases a stronger analgesic or anti-inflammatory drugs may be prescribed.

Steroid injections are another level of pain relief that your doctor may recommend and this may also improve mobility if used early in the condition’s development.

Non-drug therapy includes heat or cold packs for pain relief or simple exercises that may also assist to regain movement, although these may be limited if there is pain associated with movement or exertion of the joint. One commonly recommended exercise is to simply lean on the edge of a table with your good arm resting on the table, while the affected arm dangles down. You then gently sway the arm back and forward and around in circles to gently coax the joint into freer movement.

More aggressive treatment
In more acute instances, your doctor may consider joint distension, which involves injecting sterile water into the joint to stretch and loosen the joint.

At the extreme end of the treatment scale you can go under a general anaesthetic and have the joint given more aggressive manipulation or even arthroscopic surgery to remove scar tissue and adhesions.

Alternative therapies worth considering
Acupuncture seems to produce positive results for some sufferers and is a relatively painless therapy. The needling may involve parts of the body away from the shoulder as the therapist stimulates what are known as “acupuncture meridians” that transverse the painful area.

Transcutaneous electrical nerve stimulation, also known as TENS therapy, is sometimes used for pain management of frozen shoulder and involves a tiny electrical current being applied to stimulate a nerve pathway. This isn't painful or harmful and it is believed to release pain-inhibiting endorphins that combat pain impulses.

Bowen therapy is another homeopathic approach which claims to glean results for frozen shoulder. Bowen involves applying gentle rolling hand and finger movements on precise points of the body to stimulate the muscles, soft tissue and energy within the body. This may give relief from pain an assist movement to return.

If you have experienced a Frozen shoulder and have any advice to share please leave a comment below.