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Is Frozen shoulder curable?
Yes, they are curable. In most of the cases it is a self limiting disease that lasts no more than 6 to 9 months and after that a complete cure is automatically achieved even without any therapy.
Why does this occur? In whom does this occur?
It is still not well known why does it occur. But it has been found to be 5 times more common in persons suffering from Diabetes. Also, if the shoulder had ever suffered any kind of trauma or instrumentation in past then it is likely that a frozen shoulder will develop.
What are the symptoms of Frozen Shoulder?
Not all pain around the shoulder joint is caused by frozen shoulder. Pain that arises from the shoulder joint proper (Glenohumeral joint) is called Frozen shoulder. The symptoms are
1. Pain over the affected shoulder and also over the upper lateral aspect of the shoulder
2. Reduced range of motion of the affected shoulder in all directions
3. Pain while sleeping on the affected side.
4. When the person himself tries to move the his hand at the shoulder joint, it is called Active movement and when the doctor tries to move the hand at shoulder joint without any patient’s effort, it is called Passive Movement. In frozen shoulder, both Active and Passive movement is painful.
5. X rays of the shoulders are usually NORMAL.
How is it treated? How long does it take to get the relief?
The treatment consists of medicines, physiotherapy, injections and surgery as per necessity.
A. Control of Blood Sugar:
Since the strongest association of frozen shoulder has been found with Diabetes, stringent control of Diabetes is mandatory in management of Frozen shoulder. Those who already have a controlled blood sugar but still have developed the disease may go through the subsequent therapeutic modality for knowledge.
B. STEROIDS:
Often a short course of oral steroids are given for rapid relief of pain. However, it has not been persistently successful in achieving cure in all cases. But a trial of short course of steroids is recommended.
C. PAINKILLERS:
Painkillers or Non Steroidal anti inflammatory Drugs ( NSAIDs) are the mainstay of therapy. They can give rapid relief and improve range of motion around the joint. However, there use is limited by their adverse effects. It is well known that continuous use of NSAIDs can cause stomach ulcers, kidney damage, rise in blood pressure, worsening cardiac condition and it is strictly contraindicated in persons who are asthmatic, sensitive to NSAIDs and patient with Coronary Artery Disease of heart or Heart Failure.
Thus painkillers although of profound benefit cannot be used for a long duration and needs caution in elderly individuals.
D. INTRA-ARTCULAR INJECTIONS:
a. Steroids: Once again, steroids can be injected directly under high resolution USG guidance into the joint space in an OPD basis. Injected steroid can rapidly reduce the inflammatory process of the joint and cause dramatic improvement in range of motion and alleviation of pain. In most cases only ONE injection may suffice but in some cases one may need two injections within a period of 3 months. The frequency of injections should be more than 2 injections in 3 months.
It is practically pain free and with no major adverse effects. But it must be given under USG guidance for exact localisation of the joint space which is actually a very narrow space.
b. Platelet Rich Plasma: Use of Platelet Rich Plasma (PRP) is a new addendum to the armamentarium of treatment of region inflammatory pain syndromes. It has been used in treatment of Tennis Elbow, Achilles tendinitis and Trigger fingers too.
In this technique, 30ml of human (patient’s own) blood is withdrawn in a syringe with a scalp vein set and this blood is put into a centrifuge machine and rotated at around 3500 rpm for 10 mins. This separates the Red Blood Cells from the Plamsa. At the junction of Red Cells and Plasma there is a thin layer of fluid called buffy coat. This buffy coat is withdrawn with a fine syringe and mixed with few millilitres of human plasma and this new mixture is called platelet rich plasma (PRP).
PRP contains high concentration of variable growth factors of our body. When injected under High Resolution USG guidance, PRP can release the growth factors inside the joint which then start repairing the damaged tissues inside the joint.
The effects are promising but slow in onset. Often second injection is necessary after 1 month of the first injection.
Is there a role of physiotherapy?
Yes, indeed. Physical therapy is directed to scientifically guide the movement around the affected joint. A slow and guided physiotherapy will help in improvement of range of movement of the joint quickly. However, in case of persistent pain, physiotherapy should not be continued. An article on Physiotherapy for Frozen shoulder has been shared in the website.
Can I painkiller gels and warm compress? Or should I give Ice Pack compress?
Diclofenac or Aceclofenac Gels can be applied over the affected part 3 to 4 times a day with adequate massage. One may use warm compress after application of the Gel.
Ice Packs are given only in cases of acute injury or trauma irrespective of site. Since, frozen shoulder is a chronic disease, Ice Pack therapy may not help.
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