Does your shoulder feel ‘stuck’? Is your shoulder pain so great you can barely lift your arm? Does your shoulder make even getting dressed difficult? If so, you could be suffering from adhesive capsulitis, also known as frozen shoulder.
What is Frozen Shoulder?
Frozen shoulder, also called adhesive capsulitis, is the creation of adhesions and fibrosis of the capsule of the shoulder. The capsule is the soft tissue envelope that surrounds the shoulder joint. Flexibility of the capsule is required in order for normal shoulder motion to occur. In frozen shoulder, the capsule begins to thicken and in a way, becomes vacuum sealed around the shoulder joint. This change most noticeably occurs in the inferior or bottom aspect of the capsule.
Although the creation of adhesions and fibrosis has a strong inflammatory component, there is also evidence of an autoimmune or systemic cause. People with a history of thyroid conditions and diabetes are more likely to have frozen shoulder. Adhesive capsulitis most commonly occurs between the ages of 45 and 60 and occurs more frequently in women than in men. The onset of this condition may, but generally does not, occur secondary to a trauma.
The most common signs and symptoms of adhesive capsulitis are shoulder joint pain and decreased mobility in the shoulder. The amount of pain and loss of shoulder mobility depends on the stage. There are three general stages to frozen shoulder: freezing, frozen, and thawing.
Freezing stage: generally characterized by significant joint pain and decreasing shoulder mobility. During the freezing stage, pain is the primary issue. The freezing stage can last 3 to 9 months. Pain is significant both at rest and with movement. Pain is specifically noted at night and can greatly interrupt sleep. Because the pain is so great, use of the arm becomes less for daily activities such as eating, dressing, and reaching.
Frozen stage: generally characterized by much less joint pain but significant restriction in mobility. During the frozen stage, a lack of mobility is the primary issue. This stage can last 3 to 6 months. If pain occurs during this stage it is generally not at rest but occurs with active motion. The shoulder does not feel as painful but it simply does not want to move.
Thawing stage: generally characterized by a gradual return of normal shoulder mobility. Duration of this phase is variable. Generally frozen shoulders will improve over a total of 24 months (from freezing to thawing). Minimal pain is present during this stage and over time, shoulder range of motion returns to near normal.
The emphasis for treatment is directly affected by the specific stage of the frozen shoulder.
In the freezing stage, pain reduction is of primary importance. The use of anti-inflammatory medication (consult your doctor regarding medication) as well as the use of ice therapy can help reduce the pain and inflammation. During this stage, cortisone injections can also be helpful to reduce pain and inflammation. Although performing shoulder range of motion exercises can be helpful in minimizing the loss of mobility, pain often significantly limits stretching tolerance.
During the frozen and thawing stages, stretching and mobilization of the shoulder can be beneficial in regaining shoulder mobility. Physical therapy can be helpful to manually mobilize the shoulder joint. It is important to note that the shoulder must be stretched past the point of resistance. Unfortunately this means the stretches can be rather uncomfortable. In addition, there is some evidence that longer, lower intensity stretches are more effective then short intense stretches. Because stretching can be uncomfortable and irritating, utilizing ice after stretching is recommended.
In some cases, your doctor may recommend a manipulation. With a manipulation, the shoulder joint is forcibly moved through the range of motion while you are under anesthesia. The goal is to stretch, and in some cases, tear the joint capsule. A risk to this procedure is that the capsule may not be the only tissue stretched or torn. In some cases, manipulation is a reasonable treatment option. However, recovery from a manipulation is painful and will require dedication to post-operative physical therapy stretching.
The typical physical therapy protocol for frozen shoulder will include modalities, joint mobilization, and stretching. Modalities such as ice, ultrasound, TENS, and iontophoresis can all be helpful in reducing pain. Joint mobilizations performed by the physical therapist are the means of improving mobility of the joint capsule. Although mobilizations can be uncomfortable they are vital to improving shoulder range of motion. Finally, self stretching is vitally important to regaining normal shoulder mobility. Again, because of the nature of the condition, stretching exercises will be very uncomfortable. Consistency will pay off as range of motion and functional use of your shoulder improves..
Knee joint pain due to arthritis or any other disease or infection is treated along with the major problem while knee joint pain due to any injury can be treated by hot and cold compresses, massages with warm oil, light exercises like walking and cycling, yoga and aerobics. Knee replacement surgery is the last option to treat a completely immobile and painful knee.
Knee joint is the junction of two large bones of leg in which pain can be caused due to many reasons. The exact location of the pain helps medical experts to diagnose the problem better and quickly for treatment. Like any other joint of the body knee too is prone to the injuries, infections and disorders, in fact in older people complaints for knee pain is more common than compared to any other joint of the body.
The knee joint is formed by two bones femur and tibia supported by four ligaments and a patella also popularly known as knee cap. This whole joint is covered by synovium and is filled with synovial fluid which provides nourishment to the cartilages and keeps them elastic. Synovial fluid inside synovium also keeps cartilages smooth and slippery to ensure friction free and pain free movement of the knee. The knee joint joins thigh and shin bones to make normal activity like walking possible. This joint can bend up to 135 degrees and extend to 0 degrees. It is a weight bearing joint and complex in design which makes it most commonly injured joint of the body.
Injuries can promote pain in the knee. Any traumatic event can cause damage to ligaments attached to the knee joint. As knee has four ligaments attached to it exact area of pain can help the doctor to find out the particular ligament that has been damaged. Pain occurs when weight is transferred on the joint. Swelling of tendons also referred as tendinitis or jumper’s knee, injuries caused to meniscus by sharp and quick movements can cause mild to severe pain in the knee joint. The pain due to tearing of meniscus is felt with a popping sensation and locking or feeling of unstable knee. Swelling of tendons causes pain below the knee cap or at the back of the knee joint. All of these knee pains may also occur due to old age or overuse of the knee joint like in sports and other activities.
Osteoarthritis and rheumatic arthritis are other common causes of pain in the knees. Osteoarthritis causes damage to cartilages which eventually exposes ends of the bones to rub each other to cause severe pain and inflammation and also can cause complete immobility of the joint. Rheumatic arthritis makes immunity system attack its own healthy tissues which causes damage to the tissues present in the knee joint causing inflammation, redness, pain and infection in the synovial fluid. Arthritis also promotes secretion of fluid in the joint which gets accumulated in the form of a cyst at the back of the knee joint also known as baker’s cyst.
Knee joint pain due to arthritis or any other disease, infection or disorder is treated along with the major problem while joint pain in the knee due to any injury can be treated by hot and cold compresses, massages with warm oil or pain relieving ointments and creams, light exercises like walking and cycling , yoga and aerobics. Knee replacement surgery is the last option medically available to treat a completely immobile and painful knee..
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