If you find it painful and difficult to carry out the full range of normal shoulder movements and perform everyday tasks, such as putting on a belt or reaching the bra hook behind your back, you are experiencing shoulder movement problems.
Stiffness and pain in the shoulder joint are early symptoms of frozen shoulder.
While the exact causes of frozen shoulder are not known, it has been theorised that an autoimmune reaction may be responsible. Normally, the body’s defensive system protects it from bacteria, viruses, foreign objects and abnormalities such as cancer cells and affected tissues. In the case of a frozen shoulder, the defensive system mistakenly begins to attack the tissues of the body and this causes an inflammatory reaction in the tissue that is under attack. When the resulting inflammation in the shoulder joint becomes so severe that it causes the joint capsule to contract and become “frozen”, the shoulder joint will no longer move normally.
No one knows why frozen shoulder occurs so suddenly. It may begin after a shoulder injury or surgery. It can also start if the shoulder has not being used for a while, such as after a wrist fracture when the arm is kept in a sling, or even while recovering from cardiovascular disease.
Frozen shoulder might be an antecedent symptom for other shoulder problems like tendonitis, rotator cuff tear, or shoulder impingement syndrome. These problems may cause chronic inflammation that leads to the patient using the shoulder less than normal, leading to a situation that can cause frozen shoulder. The frozen shoulder should be treated first before the underlying problems are addressed.
More common in women than men, frozen shoulder mostly affects people ages 40 to 65 years old and is found in 10 to 20 per cent of patients with diabetes. It is also associated with other health conditions such as thyroid, ischemic heart disease, depression, Parkinson’s disease and upper limb injuries
The symptoms of frozen shoulder typically begin with shoulder pain and a reduced range of motion in the joint. The range of motion is the same whether you are trying to move the shoulder yourself or someone else is trying to move it for you. There comes a point in each direction of movement where the motion stops, as if something is blocking it and the shoulder usually hurts at that point. The shoulder can be painful at night. The tightness in the shoulder can make it difficult to do daily activities like combing hair, getting dressed, putting on a belt, or reaching for things, such as a bra hook or zip.
The diagnosis of frozen shoulder is usually made on the basis of the patient’s medical history and a physical examination. With the above symptoms, simple x-rays are not usually helpful. As the ability to move the shoulder increases, doctors may perform tests to rule out underlying conditions, such as impingement or a rotator cuff tear. The tests include:
l X-rays to find any bone abnormalities
l Ultrasound or magnetic resonance imaging (MRI) to view the tissues around the shoulder joint
Treatment mainly involves range-of-motion exercises though corticosteroids and numbing medications injected into the joint may sometimes be given. In a small percentage of cases, arthroscopic surgery may be indicated to loosen the joint capsule so that it can move more freely.
DR CHATHCHAI POOKARNJANAMORAKOT is an orthopaedic surgeon attached to the Sports and Orthopaedic Centre of Samitivej Sukhumvit Hospital Call (02) 711 8494-6.