Tag Archive for: Frozen shoulder

Frozen Shoulder

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Frozen shoulder is a condition that causes severe, painful restriction of motion in the shoulder joint. The pain, swelling, and stiffness make everyday activities more difficult. This gradually worsens over time and even affects your ability to sleep a restful night. Frozen shoulders can last for years without proper treatment. If you begin to feel shoulder pain, you shouldn’t wait to see the orthopedic specialists at the Colorado Center of Orthopaedic Excellence in Colorado Springs, Colorado. There is no reason to suffer from pain and stiffness that can seriously interfere with your ability to do everyday tasks such as dress and bathe, wash your hair and even work.

Overview

In the medical community, a frozen shoulder is also called “adhesive capsulitis,” “painful, stiff shoulder,” and “periarthritis.” Nearly 3-5% of adults between 40-60 years old might encounter a frozen shoulder condition at some time in their lifetime. It occurs in over 20% of people with diabetes. The condition is called a “frozen” shoulder because the more pain that is felt, the less likely the shoulder will be used. Lack of use causes the shoulder capsule to thicken and becomes tight, making the shoulder even more difficult to move — it is “frozen” in its position. It’s unusual for a frozen shoulder to recur in the same shoulder, but some people can develop it in the other shoulder, usually within five years.

About The Shoulder

The shoulder is made up of three bones that form a ball-and-socket joint. Along with the tissues that hold everything together, the three bones that form the shoulder capsule are the humerus (upper arm), scapula (shoulder blade), and clavicle (collarbone). The head of the upper arm bone fits into a shallow socket in your shoulder blade. Strong connective tissue, called the shoulder capsule, surrounds the joint. To help the shoulder move more easily, synovial fluid lubricates the shoulder capsule and the joint. Normally the shoulder joint is one of the most mobile joints in the body.

What Is Frozen Shoulder?

The contraction of the capsule and the formation of the adhesions cause the frozen shoulder to become stiff and cause movement to become extremely painful. Frozen shoulder typically progresses through three different stages: freezing, frozen, and thawing.

Freezing Stage: most sufferers first become aware of the conditions by experiencing a dull, aching pain in the shoulder. In this first stage of frozen shoulder – which can last anywhere from two to nine months – the shoulder becomes painful, and stiffness slowly builds up, limiting a person’s overall movement.

Frozen Stage: the pain begins to subside in the upper arm and shoulder, but the stiffness and limitation to the range of motion in the joint capsule will increase. Patients may have sharp, acute nerve pain when making sudden movements or forceful movements beyond their normal limitations. The stage can last anywhere from four months to over a year.

Thawing Stage: During the third and final stage, the shoulder eventually begins to thaw, and the range of motion will return to normal. The thawing stages take anywhere from two to three years in 90% of cases.

Frozen Shoulder Causes

Doctors are not certain about the exact cause of frozen shoulder in some people, but some of the potential causes and those at risk include:

  • Reduced immobility due to conditions such as fractures, rotator cuff injuries, and broken arms
  • Inflammation of the muscles and/or tendons, as with rotator tendinitis or bursitis
  • Medical ailments and hormonal imbalances include diabetes, hyperthyroidism, hyperthyroidism, adrenal stress, menopause, testosterone imbalance, cardiovascular disease, Parkinson’s disease, stroke, and tuberculosis
  • Nerve compression in patients with lower neck disc conditions or muscle contraction conditions
  • Chronic inflammatory arthritis in the shoulder
  • After vaccinations
  • Age-people between the ages of 40 and 60
  • Gender–women are twice as likely to develop frozen shoulders than men

Non-surgical Treatment For Frozen Shoulder

The two main goals of treatment for a frozen shoulder are to increase motion and decrease pain. To increase motion, physical therapy is usually prescribed. Supervised physical therapy usually lasts from one to six weeks, with the frequency of visits ranging from one to three times per week. The patient should engage in home exercises and stretching throughout the healing process. The stretching exercises should be done at home at least once or twice daily, as noted above. Generally, a frozen shoulder will resolve almost completely with time and consistent compliance with the prescribed treatment program. This process can take up to six to nine months for some patients, although it may take only a few months for others. Internal rotation (moving the hand to the back pocket or up the middle of your back) is usually the motion that takes the longest to regain. To decrease pain, physicians frequently recommend anti-inflammatory medications such as aspirin, Motrin, Advil, Naprosyn, or Aleve. Occasionally, steroid injections of the joint or bursa may be indicated. Steroids like prednisone may be given to help decrease inflammation.

When Is Surgery Indicated?

If the symptoms don’t resolve in 6 to 12 months and the above program does not improve the range of motion or decrease the pain, surgery may be an option. After the patient has had a general or regional anesthetic, the physician may manipulate the shoulder in the operating room to break down the scarring. Occasionally, an arthroscope (a small instrument with an attached camera placed into the shoulder through a small puncture-type incision) is used to directly cut or release the capsular adhesions.

Other operations, such as the removal of spurs, may also be indicated or required at the time of the manipulation. These operations can sometimes be done with the arthroscope but may require one or two larger incisions around the shoulder (open surgery).

Getting The Right Diagnosis

The first step is to have a complete history and physical examination by your physician. Experienced doctors can usually diagnose a frozen shoulder based on the symptoms it causes and how it limits movement. They will move your shoulder in all directions to see the range of motion and see if there is pain with movement. This type of exam, in which your doctor is moving your arm and not you, is called determining your “passive range of motion.” The doctor will also watch you move your shoulder to see your “active range of motion.” People with frozen shoulders have a limited range of both.

People with suspected frozen shoulders very rarely need imaging tests such as x-rays, magnetic resonance images (MRIs), or ultrasounds. Still, healthcare providers do sometimes order them to make sure other problems are not causing the symptoms. It is important to note that 10% of cases of frozen shoulder will not disappear without medical intervention. More than half of those who go without proper treatment will experience permanent damage as the body secretes enzymes into the synovial fluids of the joint, which eventually eats away the cartilage. In addition to deterioration of the joint, muscular atrophy (muscle waste) can also prolong recovery and make for a quite difficult recovery. This can be avoided by seeing one of the orthopedic shoulder specialists at CCOE in Colorado Springs, Colorado. They understand the complexities of a frozen shoulder and have years of experience treating it correctly. The goal of these experts is to do everything necessary to get you out of pain and on with life. Call (719) 623-1050 to schedule an appointment.

Frozen Shoulder: Why It Happens and How to Treat It

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You’ve probably heard of frozen shoulder, but what is it and how can you recover? Shoulders are the most mobile joint in the human body, and this mobility is essential to get full use of your hands and arms. There are many causes of shoulder pain, but when your mobility is limited by pain, tightness, or stiffness, it could be a sign you are suffering from frozen shoulder.

Let’s learn about why people get frozen shoulder and how to treat it.

What is Frozen Shoulder?

The shoulder is made up of three bones, surrounded by ligaments, tendons, and nerves. A joint capsule holds all of those parts together and keeps them in place. Frozen shoulder happens when that shoulder joint capsule thickens and tightens, causing pain when a person tries to move their shoulder. Some patients with frozen shoulder report increased pain at night, sometimes strong enough to interrupt their sleep.

It typically comes on gradually in most people. It has three stages that can each last several months:

  • Freezing Stage: the shoulder’s range of motion typically becomes more limited and using the shoulder becomes more painful
  • Frozen Stage: Pain might decrease, but range of motion and stiffness increase
  • Thawing Stage: Range of motion and ability to use the shoulder start to improve

How Can You Get It?

Frozen shoulder occurs for a variety of reasons, and there’s no one definitive reason why it happens to some people and not others. However, it does tend to be more prevalent in patients who have one or more of the following:

  • Over 40-years-old
  • Female
  • Rotator cuff injury
  • Broken arm
  • Stroke
  • Recovering from shoulder surgery – especially when patients do not follow their physical therapy plan.
  • Diabetes
  • Other diseases, including heart disease, thyroid disease, tuberculosis, and Parkinson’s

How Is Frozen Shoulder Diagnosed?
The doctors at the Colorado Center for Orthopaedic Excellence will determine whether you have frozen shoulder by discussing your symptoms and performing a physical examination. This can include asking you to move your shoulder and then gently manipulating it to determine your range of motion. Other tests may include an X-ray or MRI, but are not typically required to diagnose frozen shoulder.

How Is It Treated?

Treatment for most frozen shoulder sufferers involves stretching and physical therapy to help loosen and strengthen the joint. This typically helps increase range of motion and reduce stiffness. Regularly performing specific exercises recommended by a doctor or physical therapist is generally an effective treatment, although it can still take as long as three years to fully resolve.

Over-the-counter pain relievers, like aspirin or ibuprofen, can help decrease pain. But if the pain is more severe, your doctor might recommend a steroid injection or numbing medication.

If you don’t start feeling better over time or the condition does not improve, there are additional treatments. Some physicians may perform joint distention – injecting sterile water into the joint capsule to help stretch it out. Surgery is another course of treatment, but it is rarely necessary to treat frozen shoulder.

It is uncommon for frozen shoulder to return if the patient follows their treatment plan. However, contributing conditions like diabetes can make a recurrence more likely.

One of the most common causes of frozen shoulder is immobility, often after injury, surgery, or a stroke. If you are having a hard time moving your shoulder, talk to one of our specialists about diagnosis and treatment, including exercises to help maintain your range of motion and reduce your likelihood of getting it:

Dr. Doner

Dr. Kobayashi

Dr. Henderson

Dr. Martyak

Dr. Larsen

Dr. Purcell

To make an appointment or learn more, click here.

How to Deal with an Orthopedic Emergency While at Work

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Just because you sit at a desk all day doesn’t mean you can’t experience an orthopedic emergency on the job. Hazards are everywhere! Slipping over spilled coffee; straining your back while lifting a box of printer paper; suddenly experiencing frozen shoulder. So just because you aren’t a lumberjack or longshoreman doesn’t mean that you are immune from experiencing an orthopedic while at work. Here’s how you can deal with it should it happen to you.

Triage Yourself

The first thing to do is assess the severity of your condition. Is it an orthopedic emergency? In other words, might you need to go to urgent care or the emergency room, or can it wait to for an appointment with your orthopedist? Here are a few examples of what may be considered an orthopedic emergency.

·      Following an orthopedic procedure such as a hip replacement knee surgery, you are experiencing shortness of breath, chest pain, and coughing – all of which may indicate a blood clot in the lungs.

·      Following surgery on a lower extremity, pain and swelling in the calf. This could indicate thrombosis that might become a deadly embolus in the lung.

·      A post-operative wound that starts to drain spontaneously.

·      Following joint replacement surgery, a painfully swollen joint that accompanied by fever and/or chills, which could indicate an infection.

·      If you are in a solid cast, pain, swelling and numbness in the fingers or toes. This is known as cast compression syndrome.

·      Following lumbar spine surgery or an epidural spinal injection, severe back pain along with weakness in the legs and difficulty empting your bladder. This could indicate internal bleeding around the spinal cord.

·      Following orthopedic surgery, an accidental fall or twist of a post-operative limb followed by a noticeable increase in pain. This could indicate several things, to include a change in the fixation of a fracture, a new fracture, or – if you’ve recently had a total hip replacement – a dislocation of the hip joint.

·      Groin or thigh pain followed by an inability to walk. This could indicate an osteoporotic fracture of the hip.

Emergencies that are not post-operative

Other orthopedic emergencies that could happen at work include a broken or fractured arm or leg, a dislocated shoulder, or a sprain or strain. If you are able to move, seek medical attention right away. If you can’t move, have emergency medical attention come to you. Many offices have emergency medical personnel on standby; if you don’t be sure to clear a path so responders can come. Bring your purse and cell phone with or have a colleague accompany you as you may be laid up for a while.

If your orthopedic emergency happens on the job and is work-related, be sure to capture all the data – place, witnesses, photographs – in case you need to file a workman’s compensation claim.

If you experience any sort of head trauma such as a concussion, see a medical professional immediately.

In the event of an orthopedic emergency, don’t hesitate to visit – or have someone transport you – to an orthopedic urgent care facility. There, you can receive immediate care, as opposed to a hospital emergency room where it may take time to see an orthopedic specialist.

Colorado Center of Orthopaedic Excellence in Colorado Springs provides its patients with optimal comprehensive orthopedic care and primary care (non-operative) sports medicine on an urgent care basis. Whether you have an orthopedic emergency at work, home or in the field, our specialists are readily available to provide you with world-class care and service. Our board-certified orthopedic surgeons will diagnose the condition and explain your treatment options. Call us at (719) 623-1050 today for an appointment.