Frozen Shoulder

Overview of Frozen Shoulder

The joint capsule adheres to the anatomic neck and becomes thickened and contracted. It can be idiopathic (primary adhesive capsulitis) or related to other conditions such as diabetes mellitus, thyroid disease, hyperlipidemia, pulmonary disorders, and trauma (secondary adhesive capsulitis). Women in their sixth decade are most commonly affected.

There are three phases in the natural history of this condition. Gradual spontaneous improvement of the pain occurs 1 to 3 years after onset, but there is often some residual limitation of shoulder motion. Because prolonged immobility of the Glenohumeral joint allows adhesions to form, early mobilization is key.

Your risk of developing frozen shoulder increases if you’re recovering from a medical condition or procedure that prevents you from moving your arm — such as a stroke or a mastectomy.

Treatment for frozen shoulder involves range-of-motion exercises and, sometimes, corticosteroids and numbing medications injected into the joint capsule. In a small percentage of cases, arthroscopic surgery may be indicated to loosen the joint capsule so that it can move more freely.

It’s unusual for frozen shoulder to recur in the same shoulder, but some people can develop it in the opposite shoulder.[1][2]

Indian epidemiology then other

Causes of Frozen Shoulder

It’s not clear why some people develop it, but some groups are more at risk.

Frozen shoulder happens more often in women than men, and you’re more likely to get it if you’re between the ages of 40 and 60

Frozen shoulder is more common in diabetes mellitus, but may also be triggered by a rotator cuff tear, local trauma, myocardial infarction or hemiplegia. [4]

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Risk factors are things that make you more likely to develop a disease in the first place.

Risk factor of Frozen Shoulder

Age and sex

People 40 and older, particularly women, are more likely to have frozen shoulder.

Immobility or reduced mobility

People who’ve had prolonged immobility or reduced mobility of the shoulder are at higher risk of developing frozen shoulder. Immobility may be the result of many factors, including:

• Rotator cuff injury
• Broken arm
• Stroke
• Recovery from surgery

Systemic diseases

People who have certain diseases appear more likely to develop frozen shoulder.

Diseases that might increase risk include:

• Diabetes
• Overactive thyroid (hyperthyroidism)
• Underactive thyroid (hypothyroidism)
• Cardiovascular disease
• Tuberculosis
• Parkinson’s disease. [3]

Pathogenesis refers to the development of a disease. It’s the story of how a disease gets started and progresses.

Pathophysiology, on the other hand, focuses on the functional changes that occur in the body due to the disease. It explains how the disease disrupts normal physiological processes and how this disruption leads to the signs and symptoms we see.

Imagine a car accident. Pathogenesis would be like understanding how the accident happened – what caused it, the sequence of events (e.g., one car ran a red light, then hit another car). Pathophysiology would be like understanding the damage caused by the accident – the bent fenders, deployed airbags, and any injuries to the passengers.

In simpler terms, pathogenesis is about the "why" of a disease, while pathophysiology is about the "how" of the disease’s effects.

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Sign & Symptoms of Frozen Shoulder

The main symptoms of a frozen shoulder are pain and stiffness that make it difficult or impossible to move it.

If you have frozen shoulder, you’ll likely feel a dull or achy pain in one shoulder. You might also feel the pain in the shoulder muscles that wrap around the top of your arm. You might feel the same sensation in your upper arm. Your pain could get worse at night, which can make it hard to sleep.

You’ll typically go through three phases with a frozen shoulder. Each has its own unique symptoms and timeline.

Freezing stage:

• You develop a pain (sometimes severe) in your shoulder any time you move it.
• It slowly gets worse over time and may hurt more at night.
• This can last anywhere from 6 to 9 months.
• You’re limited in how far you can move your shoulder.

Frozen stage:

• Your pain might get better but your stiffness gets worse.
• Moving your shoulder becomes more difficult and it becomes harder to get through daily activities.
• This stage can last 4-12 months.

Thawing stage:

• Your range of motion starts to go back to normal.
• This can take anywhere from 6 months to 2 years.

Clinical / Physical Examination For Frozen Shoulder

• On examination, the shoulder is tender and there is loss of active and passive range of motion in all planes.[1]

Diagnosis of Frozen Shoulder

• The diagnosis is predominantly made on clinical grounds.
• Discuss your symptoms and review your medical history.
• Conduct a physical exam of your arms and shoulders
• X-rays of the shoulder
• Advanced imaging tests, such as magnetic resonance imaging(MRI) and ultrasound.[1]

Differential Diagnosis of Frozen Shoulder

• Acromioclavicular arthropathy
• Autoimmune disease
• Biceps tendinopathy
• Glenohumeral osteoarthritis
• Neoplasm
• Rotator cuff tendinopathy
• Cervical disk degeneration
• Sub acromial and subdeltoid bursitis [5]

Complications are what happen after you have a disease. They are the negative consequences of the disease process.

• X-rays of the shoulder
• Advanced imaging tests, such as magnetic resonance imaging(MRI) and ultrasound.[1]

Treatment of Frozen Shoulder

Most frozen shoulder treatment involves controlling shoulder pain and preserving as much range of motion in the shoulder as possible.

Medications

Over-the-counter pain relievers, such as aspirin and ibuprofen (Advil, Motrin IB, others), can help reduce pain and inflammation associated with frozen shoulder.

In some cases, your doctor may prescribe stronger pain-relieving and anti-inflammatory drugs.

Therapy

• A physical therapist can teach you range-of-motion exercises to help recover as much mobility in your shoulder as possible.
• Regular ‘pendulum’ exercises of the arm to prevent the capsule from over-tightening.
• Mobilizing and strengthening exercises are the sole treatment in the painless ‘frozen’ stage.

Surgical and other procedures

Most frozen shoulders get better on their own within 12 to 18 months. For persistent symptoms, your doctor may suggest:

• Steroid injections- Injecting corticosteroids into your shoulder joint may help decrease pain and improve shoulder mobility, especially in the early stages of the process.
• Joint distension- Injecting sterile water into the joint capsule can help stretch the tissue and make it easier to move the joint.
• Shoulder manipulation- In this procedure, you receive a general anesthetic, so you’ll be unconscious and feel no pain. Then the doctor moves your shoulder joint in different directions, to help loosen the tightened tissue.
• Surgery- Surgery for frozen shoulder is rare, but if nothing else has helped, your doctor may recommend surgery to remove scar tissue and adhesions from inside your shoulder joint. Doctors usually perform this surgery with lighted, tubular instruments inserted through small incisions around your joint (arthroscopically).[2][4]

Prevention of Frozen Shoulder

• Frozen shoulder usually starts from immobilization. Often, the shoulder starts to pain when progressing towards becoming stiff.
• This may cause someone to move the joint less and leading to further adhesions of the shoulder joint, preventing the movement of shoulder in full range.
• One should keep the shoulder in complete motion to avoid the occurrence of this condition.
• If one is having any injury which prohibits movement the shoulder joints a few exercises must be performed to maintain the range of motion in the shoulder joint on a daily basis.
• Management of the condition aims at restoring the joint movement and reducing the shoulder pain.
• Management can be done by performing physiotherapy, massages, stretching exercises. One must perform exercises which involve a range of motion of the shoulder joint so that the adhesions start to loosen up and shoulder can move freely.

Homeopathic Treatment of Frozen Shoulder

Homeopathy treats the person as a whole. It means that homeopathic treatment focuses on the patient as a person, as well as his pathological condition. The homeopathic medicines selected after a full individualizing examination and case-analysis.

which includes

• The medical history of the patient,
• Physical and mental constitution,
• Family history,
• Presenting symptoms,
• Underlying pathology,
• Possible causative factors etc.

A miasmatic tendency (predisposition/susceptibility) also often taken into account for the treatment of chronic conditions.

What Homoeopathic doctors do?

A homeopathy doctor tries to treat more than just the presenting symptoms. The focus is usually on what caused the disease condition? Why ‘this patient’ is sick ‘this way’?.

The disease diagnosis is important but in homeopathy, the cause of disease not just probed to the level of bacteria and viruses. Other factors like mental, emotional and physical stress that could predispose a person to illness also looked for. No a days, even modern medicine also considers a large number of diseases as psychosomatic. The correct homeopathy remedy tries to correct this disease predisposition.

The focus is not on curing the disease but to cure the person who is sick, to restore the health. If a disease pathology not very advanced, homeopathy remedies do give a hope for cure but even in incurable cases, the quality of life can greatly improved with homeopathic medicines.

Homeopathic Medicines for Frozen Shoulder

The homeopathic remedies (medicines) given below indicate the therapeutic affinity but this is not a complete and definite guide to the homeopathy treatment of this condition. The symptoms listed against each homeopathic remedy may not be directly related to this disease because in homeopathy general symptoms and constitutional indications also taken into account for selecting a remedy, potency and repetition of dose by Homeopathic doctor.

So, here we describe homeopathic medicine only for reference and education purpose. Do not take medicines without consulting registered homeopathic doctor (BHMS or M.D. Homeopath).

Medicines:

Rhus Toxicodendron: Top Grade Medicine for Frozen Shoulder

• In general, Rhus tox is a wonderful medicine that can help to relieve long-standing cases of marked stiffness in the shoulder joint.
• The shoulder is too stiff to move.
• The stiffness of shoulder gets usually better by warmth application.
• It can also be helpful in cases where motion also massages tend to offer relief in the stiffness.
• Moreover, there is severe tearing, shooting pain at the top of the shoulder.
• Pains get worse especially during cold and wet weather.
• Pains become severe during the rest especially in night preventing the patient to fall asleep.
• Besides this, there is a constant feeling of pressure on shoulders like a heavyweight is placed upon them.
• Pains getting better by movement of the shoulder.

Sanguinaria Canadensis: For Right Sided Frozen Shoulder

• Sanguinaria Can is a great remedy which shows an affinity towards the pains occurring in the right shoulder.
• Pains are present in the top of right shoulder.
• Pains usually get worse during the night also while attempting to turn in bed.
• The patient feels great difficulty to raise the arm on account of distressing pains.
• Right shoulder is affected.
• There is nightly aggravation of the pain.
• Difficulty in raising the arm.

Ferrum Metallicum: For Left Sided Frozen Shoulder

• Ferrum met is an amazing remedy for treating a complaint of left-sided frozen shoulder.
• There is a pain in the left shoulder which is constantly present. Pain is of drawing, shooting, tearing also laming character.
• Pains are usually shooting downward and travel down the arm also patient may feel it impossible to raise the arm.
• In detail, the person requiring this remedy feels extreme heaviness in the shoulder joint.
• Slow movement of the shoulder gradually improves the condition. Warmth can be given to relieve the pains.
• All in all; Pain gets aggravated in bed; the patient has to get up and move about slowly to get some relief.

Bryonia Alba: For Pains getting Worse from Least Motion

• Bryonia is an excellent remedy in cases where the pain in the shoulder gets worse especially from least motion.
• Pains are sharp and tearing in character which usually gets worse upon touch also by pressure.
• Relief of the pains takes place after the patient has complete rest.
• Application of the warmth can also be helpful in relieving the pains in the shoulder.
• There is painful pressure on the top of the shoulder. Stiffness is present in the shoulder joints.

Causticum: For Pains in Morning

• Generally, Causticum is a good remedy in treating the cases of frozen shoulder where pains in the shoulder are worse in the morning.
• The patient may experience great discomfort and difficulty in moving the shoulder.
• There is a constant feeling of pressure and heaviness on shoulders.
• Pain which is dull, aching in character is present in the shoulder usually getting worse on motion.

Phytolacca: For Right Sided Frozen Shoulder

• Phytolacca can be given in cases of frozen shoulder where the pain is present in the right shoulder.
• Pains in the shoulder also arms feel like electric shocks.
• Pains are shooting in character also travel from one part to the other.
• Pains usually worsen during the night and in damp weather.
• Patient experiences stiffness in the shoulder that usually makes him unable to raise the arm.

Ledum Palustre: For Pains on Raising the Arm

• Ledum Pal suits well in the cases where the patient experiences severe pain in the shoulder while raising the arm.
• The pains are stitching and throbbing in nature.
• There is pain and pressure in both the shoulder joints which gets worse from motion.

Calcarea Phosphorica: For Pains getting Worse During Change of Weather

• Calcarea Phos can be given without a doubt in cases of frozen shoulder where pain gets worse from any change of weather.
• There is pain and stiffness in shoulders and shoulder-blades.
• Pains are dull, sore aching, bruised type in the shoulder and down the arm.
• Pains start from left then travel to the right and can travel downward to the arm as well.

Rhododendron: For Shoulder Pains Worse during a Thunderstorm

• Rhododendron can be of extreme help in cases where there is marked pain in shoulder also gets during a thunderstorm.
• In addition, The patient usually feels pains which get worse while lying upon it and getting relieved by turning to the other side.
• Lastly, Violent, tearing also boring type of pains occur in the shoulder which can worsen from motion.

 Guaiacum Officinale: For Marked Stiffness

• Guaiacum can act wonders in cases where there is immovable stiffness of the joints taking place.
• There is a sharp stitching type of pains in the top of the shoulder.
• Pains are of drawing and lacerating nature which can travel down the arm.

Syphilinum: Where Pains get Worse especially on Raising the Arms

• Syphilinum acts well on the patients of frozen shoulder well where the pain in the shoulder worsens on raising the arm.
• The patient is able to raise the arm only up to the level of the shoulder with difficulty. [7]

Diet & Regimen of Frozen Shoulder

Foods to be taken i.e.

• Increase intake of anti-inflammatory foods e.g. fruits and vegetables, oily fish (which contain high levels of omega-3 fatty acids), nuts, seeds, also certain spices, such as ginger, garlic, turmeric.
• Furthermore, Vegetables like cauliflower, broccoli, Brussel sprouts, cabbage, cress, sweet potatoes are all loaded with antioxidants that can help rid the body of harmful compounds.
• Besides this; Fruits like berries, pineapples, red grapes are well regarded for their anti-inflammatory properties.

Foods to be avoided i.e.

• Simple carbohydrates and fats, e.g. saturated fats and trans fats.

Yoga and Exercise i.e.

Stretching exercises for frozen shoulder e.g.

• Pendulum stretch
• Towel stretch
• Finger walk
• Cross-body reach
• Armpit stretch

Strengthening exercises e.g.

• Outward rotation
• Inward rotation

Asanas which help for frozen shoulder e.g.:

• Gomukhasana
• Pranayama in sukasana
• Parvatasana

Music and Meditation

Home Remedies i.e.

• Gently move the affected joint within the limits of your pain also range-of-motion
• Massage the affected joint to increase blood circulation to the area
• Apply a warm/cold compress to the area which can help a great deal in alleviating pain
• Be aware of proper posture
• Sleep with two pillows- One pillow is for your head, as usual, the other is to go between your elbow also your body (on your affected side) so that your arm is held slightly away from your body.[6]

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References use for Article Frozen Shoulder

1] Clev_Cli_-_Cur_Clini_Med_2nd_ed_2010.pdf

2] https://www.mayoclinic.org/diseases-conditions/frozen-shoulder

3] Textbook of Medicine, 5th Edition

4[ Davidson’s Principles and Practice of Medicine

5] https://www.aafp.org/pubs/afp/issues/2011/0215/p417.html#:~:tex

6] https://www.mtatva.com/en/disease/frozen-shoulder-treatment-diet-and-home-remedies/

7] https://www.drhomeo.com/joint/homeopathic-remedies-for-frozen-shoulder-treatment/

Frequently Asked Questions

What is Frozen Shoulder?

Frozen shoulder also known as Adhesive capsulitis, is characterized by pain and global restriction of both active and passive Glenohumeral joint motion.

Homeopathic Medicines used by Homeopathic Doctors in treatment of Frozen Shoulder?

• Rhus Tox
• Sanguinaria
• Ferrum Met
• Bryonia Alba
• Causticum
• Phytolacca
• Ledum Pal

What causes Frozen Shoulder?

• Diabetes mellitus
• Rotator cuff tear
• Local trauma
• Myocardial infarction
• Hemiplegia

What are the symptoms of Frozen Shoulder?

• You develop a pain in your shoulder any time you move it.
• It slowly gets worse over time and may hurt more at night.
• This can last anywhere from 6 to 9 months.
• You’re limited in how far you can move your shoulder.