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Frozen
shoulder is the name given to a stiff and painful shoulder joint which follows a
typical pattern. It is also known as capsulitis or traumatic arthritis. The
patient is usually aged 45 or over and a frozen shoulder most often occurs on
the non-dominant side i.e. the left handed patient will have a right frozen
shoulder and visa versa.
A frozen shoulder may follow minor injury such as a
fall or even banging into a doorframe or slamming a car door awkwardly. The pain
only comes on a week or so after the incident when the pain can radiate down the
arm to the wrist. The pain gradually increases at first then recedes up the arm
into the shoulder joint over the next 4 months. The patient almost always
describes the pain as being in the muscle of the shoulder, that is the bulk of
the shoulder that gives it its shape. After about a month the arm is painful
even at rest and the patient has difficulty lying on the bad side at night. The
joint becomes progressively stiffer and more painful at first then the pain
eases and the shoulder remains very stiff. Left untreated the shoulder will not
regain full range of movement inside 12 to 18 months.
Pain and
stiffness mean a curtailment of normal activities. Taking the hand behind the
back to do up a bra or a zip is difficult and the patient often finds combing
their hair painful. Tucking a shirt in or reaching into a back pocket is also
usually difficult and painful. The unusual thing about frozen shoulder is that
the capsular pattern of limitation of movement is the same in every patient. So
all patients still have some movement out to the side or up in front but are
almost unable to get their hand behind their back or up behind their head.
The shoulder
like most joints in the body has two surfaces of bone that are lined with
cartilage. These surfaces are kept lubricated with fluid which is held around
the joint in a capsule. This capsule is rather like a thick plastic bag which
attaches to the edges of the bony surfaces and is lax enough to allow movement.
In a frozen shoulder the capsule itself becomes inflamed and swollen restricting
the movement at the shoulder joint. It is never a good idea to push a joint into
pain. If you continue to aggravate the capsule whilst it is swollen and inflamed
then the movement will only serve to increase the swelling, increase the pain
and reduce the range of movement still further.
A GOOD
RULE OF THUMB IS 'IF IT HURTS DON'T DO IT.' Unfortunately because the onset
of frozen shoulder is gradual most people take almost 3 months to realise that
the pain in their shoulder isn't getting any better! If a patient has pain in
the shoulder joint lasting for more than a few days it is important to seek
professional advice rather than waiting to see 'if it goes away'. The sooner
treatment is commenced the less likely the inflammation is to take hold.
Osteopathic
Treatment with Manual Lymph Drainage and Connective Tissue Manipulation aims to
release the tension in the connective tissue around the shoulder which improves
the circulation and reduces the inflammation in the capsule allowing the body to
accelerate the healing process. The pain is reduced and the stiffness improves.
The patient is therefore able to regain full movement and return to normal
activities
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