If you’re reading this, chances are you are in pain and have probably already seen a doctor or therapist who hasn’t helped you much. You’ve probably even had injections… even surgery with little or no improvement!

A Frozen Shoulder is an extremely painful and debilitating condition characterised by intense pain and stiffness of the shoulder and has the medical profession stumped.  There’s lots of theories about the cause and pain killers are prescribed by the bucket load, but from my experience, nothing works. If there was a medicinal cure for Frozen Shoulders, the chemist shops would have walls covered with the stuff.

Some doctors say “Leave a Frozen Shoulder alone for 18 months or so and it will get better on its own”. I’ve heard of others saying “You have what’s called a Frozen Shoulder.  Get used to it, because you’ll have it for two years.”
It will eventually get better on it’s own… but never completely.  In reality, a Frozen Shoulder will take a bit longer than that to heal itself.
X-rays can’t reveal the cause of shoulder stiffness in most cases of primary adhesive capsulitis, and an MRI (Magnetic Resonance Image) shows soft tissue and may be used in cases in which another disorder is suspected, such as a torn Rotator Cuff.   So when nothing shows up, it’s frustrating to be told there’s nothing wrong with your shoulder when it’s really hurting like blazes.

At this point, let me say that I was sent for a MRI when I had the condition.  I listened to the technicians discussing their findings and heard the boss say “Write your report and say muscles appear to be normal, and leave it at that.”
The technician then went on to say he did find a thickening in the Synovial Fluid around the Gleno-Humeral Joint.
The response?  An off-handed  “So what?”
That told me everything I needed to hear… that’s what.  I was then sure of what I was dealing with!

Signs and symptoms of Frozen Shoulder.

The pain of a Frozen Shoulder can be horrendous. Ask a sufferer what the pain would be on a scale between 1 and 10 and you’ll often hear 20.

The major symptoms of Frozen Shoulder are:

• Pain and loss of motion:

• Night pain and especially when trying to lay on the affected side.

• Severe sharp catching pain at the front of the shoulder when you inadvertently extend the arm and lasting up to a minute or so. (You have to protectively hold the shoulder tightly.)

• Pain reaching for the hip pocket, (not necessarily a bad thing if it’s your shout), putting on or taking off a coat, brushing the hair and inability to do up a bra.

• Pain down the outer upper side of the arm.

• Inability to drive.

• Swelling of tendons causes severe limitation in movement, especially reaching up behind the back.

Immobility / Stiffness

This is the key diagnosis of a Frozen Shoulder. You can’t move the arm and neither can anyone else if they attempt to lift the arm for you. If they do try, it’s very painful and you want to kill them for their effort.

From when you first notice the pain, the shoulder becomes stiff or stuck for a period that could be between 48 hours to a month and it’s all downhill from there. If your shoulder is not ‘stuck’ you may not have a true Frozen Shoulder. Many people are forced to give up work as a result of the pain and stiffness that commonly persist for many years.

The inability to work and the constant pain and stiffness can have a considerable impact on you psychologically as well as financially, and you can become extremely depressed and anxious as a result.

Frozen Shoulder Facts:

• 2-5% of the population suffer from it. This doesn’t mean 98-95% enjoy it.

• It is more common in women (60%)

• It is five times more common in diabetics

• It is common, but not limited to people with Dupuytren’s contracture (an uncommon hand condition where the connective tissue under the skin of the palm contracts and hardens over time.

• It may be genetic. i.e it can run in the family.

• It seems to affect 40-70 year olds.

• About 15% of people get it on both sides.

There are three phases to Frozen Shoulder, (which lasts an average of 30 months. Some say longer).

1.    Freezing (1 – 8 months) You notice some things you normally do are starting to hurt.
2.    Frozen (9 – 16 months) It’s full on! Any movement using the arm is incredibly painful.
3.    Thawing (12 – 24 months) Slowly gets back to normal and pain free use of the arm.

Not much to look forward to, is it.

The pain and loss of function associated with this condition can become so severe that it can significantly affect the quality of life, and prevent some people from sleeping well or working.

What causes a Frozen Shoulder?

There’s no explanation for the development of Frozen Shoulder in most patients. The majority of cases seem to be more prevalent in women. Some who develop Frozen Shoulder have sustained an injury and developed stiffness as a result. The trauma can be quite mild or severe, and the body’s response to the event is probably more important than the event itself.

What is happens inside a Frozen Shoulder?

The shoulder joint is a ball and socket (Gleno-humeral) joint. The ball is at the top of the Humerus (arm bone), and the socket is a shallow cup on the end of the Scapula (shoulder blade).

Surrounding the Gleno-Humeral joint (shoulder joint) is a bag called the Capsule. When the arm is raised above the head, this Capsule is fully stretched. When the arm is lowered to the side, the capsule hangs down like a small pouch.

To improve the stability of the shoulder a group of four muscles called the Rotator Cuff braces the joint as well as an elaborate bunch internal ligaments.

Inflammation.
In a Frozen Shoulder Syndrome the Lax Capsular Sack and the Synovial Fluid it contains becomes sticky and thick and can sometimes form adhesions. The stickiness is brought on through inflammation. This can occur after a small injury, but often you may not remember anything about it. Once established, this inflammation spreads into other shoulder soft-tissues and can cause swelling in other shoulder sacks (bursae).
Stiffness.
The stiffness is an ‘overreaction’, or the shoulders attempt to counteract the inflammation within the Biceps groove. The body seems to ‘switch off’ muscles in a coordinated sequence. This sequence is the same for everyone.  Arm movements start to diminish, and within a few weeks the arm literally becomes frozen and for many, cannot be raised more than 40° in any direction. The muscles of the Rotator Cuff become weak and start slowly to waste away, leaving the arm to hang stiff and immobile.

The shoulder may not be completely stiff for several months and both active and passive movements are stiff and neither you nor anyone else can lift it because it’s too painful!

At this point, you’re probably saying “He’s talking about me!”

Traditional treatments may include:

Cortisone Injections:
Cortisone injections are often tried during both the freezing and frozen phases. It is usual to have up to four injections. Cortisone injections may give brief periods of pain relief, but mostly, they seem to give only a few days or weeks of symbolic respite. Cortisone, which is a steroid, is a crystalline substance and is injected into the joint capsule.

Suprascapular Nerve Block:
The suprascapular nerve is the major sensory supply to the shoulder joint and motor supply to the Supraspinatus and infraspinatus muscles.

A Suprascapular Nerve Block has been used in patients with severe pain associated with Frozen Shoulder syndrome. This injection technique is usually performed 3 times over as many weeks. It has given some relief for pain, but has no effect on the stiffness in the shoulder.  This injection consists of a local anesthetic and steroid, and is done with x-ray guidance and involves inserting a needle through skin and deeper tissues.

The procedure is not without pain.  However, the skin and deeper tissues are numbed with a local anesthetic. Most of the patients also receive intravenous sedation which makes the procedure easier to tolerate.

Manipulation:
Under anesthetic, manipulation can be performed in the freezing phase (after about 6 months).  It is performed under general anaesthetic and followed up by several months of physiotherapy. Complications arising from this include fractures and dislocations of the Humerus, Rotator Cuff tears, increased inflammation and scarring. Nerve damage can also occur, especially to the Radial Nerve.

Physiotherapy:
Physiotherapy is commonly advised  by doctors during the ‘Frozen’ stage and is mainly aimed at keeping the shoulder mobile through stretching and pushing the joint.  However, it rarely seems to hasten the recovery of the condition.

Halleujah.
The good news is that even very severe types of Frozen Shoulder syndrome can be treated effectively. Treating Frozen Shoulders is massage based and naturally utilises the body’s own healing mechanisms. No drugs, no surgery. It utilises a specific sequence of manipulations to the shoulder joints and soft-tissues.

In a Frozen Shoulder there are masses of inflammation and on top of this the brain starts to recruit the ‘wrong’ muscles to move the shoulder.

The body and the brain is tricked into healing itself by addressing the two main components of the problem … pain and stiffness. Initially the aim is to significantly reduce the pain by treating the swelling around various shoulder tendons, especially the biceps tendon.

Following this, the technique moves on to rapidly ‘thaw’ and improve the range of shoulder motion by stimulating a unique sequence of reflexes hidden within the muscles. One reflex is triggered against another in sequence and the arm is not forced. Instead it’s kept still whilst applying the pressure.

Patients treated in this massage based technique will notice a definite improvement with each treatment session. These should be twice a week for twenty to thirty minutes a session and complete relief should be within twelve weeks.

There is a couple of testimonials regarding Frozen Shoulders you might care to visit, and if you believe you might be displaying the symptoms of this condition… call me to talk about it.

Frozen Shoulders CAN be fixed… but it won’t happen with medication.