Pain can stop even the most productive of people and with 1/3rd of the diabetic patients suffering from frozen shoulders, how can you spot the symptoms and deal with the pain before it is too late? Dr. Bhuvaneshwar Machani, Consultant Orthopedic Surgeon specialized in Upper Limb treatment explains all…
The Frozen Shoulder is a severe inflammatory condition where the lining of the joint-the capsule becomes severely constricted and tight making the joints shrink therefore not giving enough room for the shoulder to move. It’s commonly known as Adhesive Capsulitis.
Dr. Bhuvaneshwar Machani, Consultant Orthopedic Surgeon specialized in Upper Limb treatment, says “It’s very important to know that why it’s called frozen shoulder or why does it happen only in the shoulder. We never hear about frozen knees or frozen hip, so it’s imperative to know why it is peculiar to that joint only. A lot of research has been done for this and a lot of evidence has also been presented however we haven’t found any answers to this. And because there isn’t any particular cause of the frozen shoulder, it can be very difficult to prevent it in most cases.”
There are primarily four stages of the frozen shoulder:
- Inflammatory Stage or the Active Stage: This is the stage where the pain slowly becomes worse. The pain doesn’t increase gradually but usually overnight or suddenly and worsens in the first few days. This can last up to 3 to 6 months.
- Frozen: In this stage the pain slowly improves becoming slightly less painful but the shoulder becomes stiffer. This stage lasts for about 3 to 6 months after the first stage.
- Thawing: In this stage the ability to move the shoulder improves significantly with practically no pain but the shoulder remains still very stiff.
- Recovery Stage: This is the stage where the movement starts coming back on its own.
The whole of this process from beginning of the symptoms till the recovery stage can take up to 24-36 months however, some patients might recover quicker. Also, there can be some overlapping between the stages too. This is the normal process in over 90% of the patients, however, diabetic patients, especially those on insulin (type 1) may not recover as quickly or they may not recover at all. In such cases a doctor’s intervention is very crucial in treating them.
The Affect of Diabetes
This condition is more common in diabetic patients. In fact more than 1/3rd of the diabetic patients suffer from primary frozen shoulder. For instance if there 100 diabetic patients more than 30 patients will get primary frozen shoulder at some point in their life and they can get it on both shoulders too. Diabetes is very common in the UAE, more common than most people think and frozen shoulder has a direct association to diabetes. The incidence is on the rise in this part of the world due to luxurious living and eating conditions as well. Therefore, diabetic patients should be careful and should keep the blood sugars under control to avoiding all complications. Additionally, this is also a condition which is more common in female patients, common age group being 40-50, Dr. Bhuvan added.
Dealing with the Pain
Once the frozen shoulder has occurred, the treatment is mainly to improve the pain by consuming strong painkillers to reduce the pain along with a sling to the shoulder for brief period. At times when the pain becomes unbearable and even the normal injections don’t work a steroid (cortisone) injection is inserted to the joint which acts as an anti-inflammatory. This helps in controlling the pain but not curing the problem completely. Also, physiotherapy is not recommended in the first few weeks because if you try and move the shoulder it can be very painful and will cause more grief to the patient. When the pain starts improving is when physiotherapy is recommended as it helps in getting the movement back. In order to improve pain and range of movements, hydro-dilatation procedure can be recommended. This procedure involves injecting a large amount of fluid into the joint space which expands the space breaking up the scar tissue and loosening the joint. During this process a needle is inserted into the capsule that surrounds the joint and a fluid mixture consisting of saline, steroid and an anaesthetic is injected so that the capsules are ruptured and the movement improves. There is however no scientific evidence which proves that this procedure works in all the patients or in most of the patients.
Treatment of frozen shoulder essentially focuses on controlling the pain and getting the movement back to normal through physical therapy. Firstly, we need to ensure that the patient does not have any underline tendon tear or arthritis in the shoulders and therefore a plain x-ray of the shoulder is done to make sure that there is no arthritis in the shoulder which can lead to stiffness.
In patients who do not improve even after two years or those patients who need to gain early range of movements for their work, “There are principally two ways to treat the frozen shoulder and get the movement back. First is to put them to sleep and then just bend (manipulate) the shoulder with controlled agression. You will hear sounds of adhesions breaking with noise post which you get the movement back. This process is however very risky as you are unaware of what has been damaged inside apart from the capsule- you may have torn the tendon or ligament or damaged the cartilage and there are sometimes cases when you break the bone resulting in a fracture. So, this is not necessaril, entirely a safe procedure to do it, although a lot of people do it. Therefore, it is advisable to go for the Keyhole or Arthroscopic Surgery which is performed using a camera called an arthroscope. In this surgery an endoscope is inserted into the joint through a small incision. So, you exactly know which ligaments you are divided and there is no damage to other structures. This can be uncomfortable with pain for few days following the procedure, but the results are very fruitful” says Dr. Bhuvan.
It is therefore advisable to consult an orthopedic surgeon specializing in treating shoulder problems in order to know the right treatment options for frozen shoulder.