A sore, stiff shoulder
If crying is closer to you than laughing because of the pain in your shoulder and you can barely move your arm, you’re actually too late. At the first signs of a frozen shoulder, you should see a doctor as soon as possible.
Ouch! At night, the pain in your shoulder keeps you from sleeping. In the morning you can’t close your bra because your shoulder not only hurts a lot, it’s also stiff. Then you could very well have a frozen shoulder. It’s not dangerous, but it’s very annoying. It will go away on its own, but you have to be patient. With treatment you get rid of the pain faster and you recover better.
A collection of symptoms
Frozen shoulder is also known as adhesive capsulitis. You can no longer move your ‘frozen’ shoulder properly, not only because it hurts, but also because it has become ‘stuck’. The cause is unknown. Orthopedic surgeon Lieven De Wilde, head of the clinic at Ghent University Hospital, says: “That is why it is called a syndrome: it is a collection of symptoms. There are a number of abnormal substances in the blood of people who get it. You can get it again because of this, usually on the other arm. Usually it starts just like that, but it can also start after a fall, sometimes even months later.” The condition has three consecutive stages, each lasting about four months. So it will take at least a year for you to fully recover.
Freeze, frozen, thaw
In the first stage – freezing – you gradually get more and more pain in your shoulder. That pain can be severe. In the beginning it only hurts at night, but after a while you also hurt with the slightest movement of your arm and shoulder and eventually even if you don’t move your shoulder. At this stage, your shoulder also gradually becomes less mobile. In the second stage – frozen – you mainly suffer from stiffness. The pain will go away, but your shoulder is now completely stuck. You can no longer stretch your arm all the way up above your head, even if someone else grabs your arm and pushes it up. Combing your hair or putting on a seat belt becomes almost impossible. The third and final stage—thaw—is that of recovery. The pain will disappear completely and you can move your shoulder more freely.
Inflammation is the start
The cause of the pain is in the shoulder joint. It consists of a bulb at the top of the upper arm and a hollow in the top of the shoulder blade. An elastic joint capsule of connective tissue keeps both bones together, but also allows movement. Bursae secrete a substance that keeps the joint lubricated. A frozen shoulder starts with the inflammation of one of those bursae, the subscapular bursa. The joint capsule also becomes inflamed. As a result, it becomes thick and stiff, and starts to fuse with a tendon in the shoulder joint. There is also scar tissue. This reduces the mobility of the shoulder joint.
Immediately to the doctor
“That inflammation starts gradually, but that is precisely what is insidious,” says De Wilde. “Everyone thinks it will soon be over and is being fooled by that. People make do with painkillers, until things don’t go on like this and they have to get out of the car, for example, to put the ticket from the parking garage in the machine. Unfortunately, because it is very important not to delay a doctor’s visit, especially because the therapy works better if you are treated quickly. Your doctor must do a good physical examination to make the correct diagnosis. Raising the arm on the affected side clearly less far than on the other side, then the diagnosis is clear. You must lie on your back for the examination. If you are examined sitting down, the body compensates for this limitation of movement in a different way. An X-ray or another form of imaging is not necessary for diagnosis, but is used to rule out other causes for the painful shoulder, such as rheumatism.”
Move, but be careful
Treatment primarily consists of one or two injections of cortisone into the shoulder joint. This gets you out of the inflammatory phase and the pain decreases, but you still have to go through the three stages of the condition. In addition, it is important to keep moving your shoulder, but not to overdo it. De Wilde: “Not moving your shoulder at all makes the frozen shoulder even worse and delays healing. So you have to move, but listen to your shoulder and stay just below the pain threshold. Too much pain makes you afraid to move and so you can a vicious cycle of pain arises. Compare it with a scrape on your knee. If the wound has not yet healed and you immediately bend your knee a lot, the wound opens again, it rubs against your pants and it starts to bleed harder again This is why cyclists who have fallen are given an ointment and bandage on the abrasion, which keeps the healing skin moist and supple and allows them to continue cycling.The cortisone injection in your shoulder works like that ointment and the connection: it makes moving easier.”
Sometimes surgery is needed
If you are afraid to move, a physiotherapist can give you exercises that you should continue at home. A good coach who helps you with this and measures your progress encourages you to keep practicing. A heavy-handed therapy is out of the question, because it further increases your pain and therefore also your fear of movement. Most frozen shoulders heal completely, but some people have limited range of motion. If you are ultimately unable to lift your arm 90 degrees, you will need viewing tube surgery. Then the scar tissue – which limits your movements – is removed and all muscles and tendons are released again. You should also practice afterwards to regain your mobility.
Sources):
- Plus Healthy
