Chill­ing pain ac­com­pa­nies frozen shoul­der syn­drome

Siloam Springs Herald Leader - - NEWS - By Siloam Springs Re­gional Hos­pi­tal

Sim­ple ac­tiv­i­ties like tak­ing a book off an over­head shelf can be im­pos­si­ble when you have a frozen shoul­der.

Frozen shoul­der (also called ad­he­sive cap­suli­tis) is a com­mon dis­or­der that causes pain, stiff­ness, and loss of nor­mal range of mo­tion in the shoul­der. The re­sult­ing con­di­tion can be se­ri­ous, and tends to get worse with time if not treated. It typ­i­cally af­fects peo­ple be­tween the ages of 40 to 60, and women more of­ten than men.

We don’t fully un­der­stand the causes, but an in­flam­ma­tory process is prob­a­bly in­volved. Some­times freez­ing oc­curs be­cause the shoul­der has been im­mo­bi­lized for a long time by in­jury, surgery or ill­ness. In many cases the cause is far less ob­vi­ous. For­tu­nately, the shoul­der can usu­ally be un­frozen, though full re­cov­ery takes time — and lots of self-help.

The trade­mark symp­toms in­clude pain and pro­gres­sive stiff­ness. At first, the shoul­der is painful, but range of mo­tion is still good. As the con­di­tion pro­gresses, range of mo­tion be­gins to de­crease. By the time the shoul­der even­tu­ally be­comes “frozen,” much of the pain has re­solved, but you have dif­fi­culty mov­ing your shoul­der at all.

Frozen shoul­der is dif­fer­ent from bur­si­tis, an­other com­mon shoul­der ail­ment. With bur­si­tis, pain and in­flam­ma­tion arise from re­peated over­head move­ments like those in­volved in ten­nis, golf, and swim­ming. Pain of­ten oc­curs dur­ing th­ese ac­tiv­i­ties, too. In com­par­i­son, the early pain of frozen shoul­der is present even when the shoul­der is at rest.

The good news is that frozen shoul­der re­solves on its own — but the en­tire cy­cle, from early symp­toms to re­cov­ery, can last from nine months to two years.

Freez­ing, frozen and thaw­ing

Frozen shoul­der has three stages: freez­ing, frozen, and thaw­ing.

• Freez­ing — This is the slow, grad­ual buildup of pain and stiff­ness. Over

We don’t fully un­der­stand the causes, but an in­flam­ma­tory process is prob­a­bly in­volved. Some­times freez­ing oc­curs be­cause the shoul­der has been im­mo­bi­lized for a long time by in­jury, surgery or ill­ness. In many cases the cause is far less ob­vi­ous. For­tu­nately, the shoul­der can usu­ally be un­frozen, though full re­cov­ery takes time — and lots of self-help. time, you no­tice the shoul­der loses more of its range of mo­tion. Dur­ing this pe­riod, the in­flamed shoul­der can be quite painful, and you may get steroid in­jec­tions, spaced sev­eral weeks apart, to help ease the dis­com­fort.

• Frozen — The pain be­gins to dis­si­pate, but your range of mo­tion is the most lim­ited. You can do light chores and carry some weight on that side of your body, but it is still hard to lift your arm over­head. You of­ten have dif­fi­culty with ev­ery­day move­ments, like dress­ing or reach­ing into your back pocket.

• Thaw­ing — Stiff­ness goes away as the shoul­der be­gins to heal. This is when you be­gin stretch­ing ex­er­cises and for­mal ther­apy to help re­store flex­i­bil­ity and range of mo­tion. Typ­i­cally, a physi­cian or phys­i­cal ther­a­pist teaches you the ex­er­cises, which you then do at home for sev­eral weeks or months.

If you think you have a frozen shoul­der or are devel­op­ing one, see your physi­cian or a shoul­der ex­pert for a phys­i­cal exam. To as­sess your shoul­der’s range of mo­tion, he or she will ask you to per­form var­i­ous move­ments with your arm, such as reach­ing across your chest to touch the op­po­site shoul­der or down your back to touch the op­po­site shoul­der blade. He or she may take X-rays to make sure there’s no other un­der­ly­ing prob­lem, such as arthritic changes or a dis­lo­ca­tion. An MRI may be or­dered to check for a ro­ta­tor cuff tear.

Treat­ment is fo­cused on re­liev­ing pain and restor­ing the shoul­der’s nor­mal range of mo­tion. Your physi­cian may rec­om­mend an anti-in­flam­ma­tory med­i­ca­tion such as as­pirin, ibupro­fen (Motrin, Advil), or naproxen (Aleve, Anaprox). An ice pack or bag of frozen veg­eta­bles ap­plied to the shoul­der for 10 to 15 min­utes sev­eral times a day also can help with pain. You may be given a cor­ti­cos­teroid injection into the shoul­der joint or soft tis­sues. But the cor­ner­stone of treat­ment is phys­i­cal ther­apy, con­cen­trat­ing first on ex­er­cises that stretch the joint cap­sule, and later, on strength­en­ing ex­er­cises. A phys­i­cal ther­a­pist can show you how far to push your­self and can teach you the ap­pro­pri­ate ex­er­cises. Once you’ve learned your lim­i­ta­tions, you can prac­tice most of your ex­er­cises on your own at home.

Con­sult your pri­mary care provider if you ex­pe­ri­ence any symp­toms. He or she can con­firm your con­di­tion and guide you through the heal­ing process.

Re­mem­ber that this in­for­ma­tion is not in­tended to re­place the advice of your doc­tor, but rather to in­crease aware­ness and help equip pa­tients with in­for­ma­tion and fa­cil­i­tate con­ver­sa­tions with your physi­cian that will ben­e­fit your health.

If a joint in­jury or other ortho­pe­dic con­di­tion is keep­ing you from en­joy­ing life the way you used to, turn to Siloam Springs Re­gional Hos­pi­tal (SSRH). You don’t have to travel far from home. With the skill and ex­pe­ri­ence of Matthew Coker, M.D., in­de­pen­dent mem­ber of the SSRH Med­i­cal Staff, SSRH is a con­ve­nient choice for ortho­pe­dic ser­vices. Dr. Coker and the en­tire SSRH team are ready to get you back to your life. For more in­for­ma­tion, call 479215-3124.

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