Frozen Shoulder

Frozen shoulder, also known as adhesive capsulitis, is a shoulder joint with significant loss of range of motion in all directions and is the result of scarring, thickening, and shrinkage of the joint capsule. The range of motion is limited not only when the patient attempts motion, but also when the doctor attempts to move the joint fully while the patient relaxes. As the condition worsens, the shoulder's range of motion becomes markedly reduced. Frozen shoulder usually affects one shoulder at a time, although some people may eventually develop frozen shoulder in the opposite shoulder.

Frozen shoulder affects about two percent of the general population and most commonly affects patients between the ages of 40 and 60 years, with no clear predisposition based on sex, arm dominance, or occupation. Any injury to the shoulder can lead to frozen shoulder, including tendinitis, bursitis and rotator cuff injury. Long-term immobility of the shoulder joint can also put people at risk to develop a frozen shoulder. Frozen shoulder occurs more frequently in patients with diabetes affecting 10 percent to 20 percent of these individuals. Others at risk for frozen shoulder include those with chronic inflammatory arthritis of the shoulder, or after chest or breast surgery. Other medical problems associated with increased risk of frozen shoulder include hypothyroidism, hyperthyroidism, Parkinson's disease, and cardiac disease or surgery.

Pain due to frozen shoulder is usually dull or aching. It can be worsened with attempted motion. The pain is usually located over the outer shoulder area and sometimes the upper arm. The hallmark of the disorder is restricted motion or stiffness in the shoulder. The affected individual cannot move the shoulder normally. Motion is also limited when someone else attempts to move the shoulder for the patient.

The normal course of frozen shoulder is described as having three stages:

• Stage one: In the "freezing" stage, the patient develops a slow onset of pain. As the pain worsens, the shoulder loses motion. This stage may last from six weeks to nine months.
• Stage two: The "frozen" stage is marked by a slow improvement in pain, but the stiffness remains. This stage generally lasts four months to nine months.
• Stage three: The final stage is the "thawing," during which shoulder motion slowly returns toward normal. This generally lasts five months to 26 months.

Frozen Shoulder can persist for years unless treatment is properly addressed. The rotator cuff which is frequently the cause of frozen shoulder, describes four muscle groups in the shoulder area. This muscle group helps to stabilize the joint in the shoulder when the upper arm moves. Once one or more of the rotator cuff muscles are injured it becomes very difficult to recover 100%. It is almost impossible to keep from re-straining the muscles because even in a sling the shoulder can still move. It is very difficult to stop moving everything and rest the injury properly. Everyone has demands that make them keep going and the process of living can prevent the rotator cuff from healing. What ends up happening is the shoulder is continually reinjured through daily activities.

However, to heal Frozen Shoulder, this constant re-injury needs to be avoided at all costs. Besides prolonging the suffering, constant re-injury leads to the build up of scar tissue in the shoulder and non-uniform healing. Scar tissue is hard, inflexible, and tough to get rid of. The more scar tissue that develops, the more range of motion is lost for that shoulder. As a result, the shoulder doesn't perform as well as it once did and it makes it much more prone to injury again. The patient can end up with permanently reduced range of motion, less strength, and potentially life-long problems. The faster the shoulder is healed, the less chance there is for reinjury.

A doctor can diagnose frozen shoulder based on the patient's symptoms and a physical examination. X-rays or MRI (magnetic resonance imaging) studies are sometimes used to rule out other causes of shoulder stiffness and pain, such as a rotator cuff tear. Frozen shoulder will generally get better on its own. However, this takes some time, occasionally up to two to three years. Treatment is aimed at pain control and restoring motion.

The typical treatment of a frozen shoulder usually requires an aggressive combination of anti-inflammatory medication, cortisone injections into the shoulder and physical therapy. Without aggressive treatment, a frozen shoulder can be permanent. Diligent physical therapy is often key and can include ultrasound, electric stimulation, range-of-motion exercise maneuvers, ice packs, and eventually strengthening exercises. Therapy includes stretching or range-of-motion exercises for the shoulder. Sometimes, heat is used to help decrease pain. It is very important to avoid reinjuring the shoulder tissues during the rehabilitation period.

If these methods fail, nerve blocks are sometimes used to limit pain and allow more aggressive physical therapy. More than 90 percent of patients improve with these relatively simple treatments. Usually, the pain resolves and motion improves. However, in some cases, even after several years the motion does not return completely and a small amount of stiffness remains.

Surgical intervention is considered when there is no improvement in pain or shoulder motion after an appropriate course of physical therapy and anti-inflammatory medications. When more invasive measures are considered, the patient must always consider that most individuals will get better if given sufficient time and that surgery always has risk involved. Surgical intervention is aimed at stretching or releasing the contracted joint capsule of the shoulder.

The most common methods include manipulation under anesthesia and shoulder arthroscopy. Manipulation under anesthesia involves putting the patient to sleep and forcing the shoulder to move. This process causes the capsule to stretch or tear. With shoulder arthroscopy, the surgeon makes several small incisions around the shoulder. A small camera and instruments are inserted through the incisions. These instruments are used to cut through the tight portions of the joint capsule. Often, manipulation and arthroscopy are used together in combination to obtain maximum results. Most patients have very good results with these procedures. After surgery, physical therapy is important to maintain the motion that was achieved with surgery.

Physical therapy can take weeks to months for recovery, depending on the severity of the scarring of the tissues around the shoulder, and can often be painful. A new, innovative method though can heal and resolve the pain of frozen shoulder faster then ever before. The cr17 Hurricane combined with the Camara Myofascial Method utilizes vibration and percussion to more effectively break up adhesions and promote greater blood flow within the plantar fascia and surrounding tissue, enabling the patient to regain full range of motion and strength in a much shorter amount of time than with other treatments and usually with less pain.