Frozen shoulder. Frozen shoulder...

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1 Frzen shulder Frzen shulder... 1

2 Frzen shulder, r adhesive capsulitis, is a cnditin that causes restrictin f mtin in the shulder jint. The cause f a frzen shulder is nt well understd, but it ften ccurs fr n knwn reasn. Frzen shulder causes the capsule surrunding the shulder jint t cntract and frm scar tissue. What causes frzen shulder? Mst ften, frzen shulder ccurs with n assciated injury r discernible cause. There are patients wh develp a frzen shulder after a traumatic injury t the shulder, but this is nt the usual cause. Sme risk factrs fr develping a frzen shulder include: Age & Gender Frzen shulder mst cmmnly affects patients between the ages f 40 t 60 years ld, and it is twice as cmmn in wmen than in men. Endcrine Disrders Patients with diabetes are at particular risk fr develping a frzen shulder. Other endcrine abnrmalities, such as thyrid prblems, can als lead t this cnditin. Shulder Trauma r Surgery Patients wh sustain a shulder injury, r underg surgery n the shulder can develp a frzen shulder jint. When injury r surgery is fllwed by prlnged jint immbilizatin, the risk f develping a frzen shulder is highest. Other Systemic Cnditins Several systemic cnditins such as heart disease and Parkinsn's disease have als been assciated with an increased risk fr develping a frzen shulder. What happens with a frzen shulder? N ne really understands why sme peple develp a frzen shulder. Fr sme reasn, the shulder jint becmes stiff and scarred. The shulder jint is a ball and scket jint. The ball is the tp f the arm bne (the humeral head), and the scket is part f the shulder blade (the glenid). Surrunding this ball-and-scket jint is a capsule f tissue that envelps the jint. Nrmally, the shulder jint allws mre mtin than any ther jint in the bdy. When a patient develps a frzen shulder, the capsule that surrunds the shulder jint becmes cntracted. The patients frm bands f scar tissue called adhesins. The cntractin f the capsule and the frmatin f the adhesins cause the frzen shulder t becme stiff and cause mvement t becme painful. 2

3 frzen shulder causes a typical set f symptms that can be identified by yur dctr. The mst imprtant finding is restricted mvement. Other shulder cnditins can cause difficulty with mvement f the shulder, such as a rtatr cuff tear; therefre it is imprtant t have an examiner familiar with this cnditin fr a prper diagnsis. What are the typical symptms f a frzen shulder? Shulder pain; usually a dull, aching pain Limited mvement f the shulder Difficulty with activities such as brushing hair, putting n shirts/bras Pain when trying t sleep n the affected shulder What are the stages f a frzen shulder? Painful/Freezing Stage This is the mst painful stage f a frzen shulder. Mtin is restricted, but the shulder is nt as stiff as the frzen stage. This painful stage typically lasts 6-12 weeks. Frzen Stage During the frzen stage, the pain usually eases up, but the stiffness wrsens. The frzen stage can last 4-6 mnths. Thawing Stage The thawing stage is gradual, and mtin steadily imprves ver a lengthy perid f time. The thawing stage can last mre than a year. What tests are needed t diagnse a frzen shulder? Mst ften, a frzen shulder can be diagnsed n examinatin, and n special tests are needed. An x-ray is usually btained t ensure the shulder jint appears nrmal, and there is nt evidence f traumatic injury r arthritic changes t the jint. An MRI is smetimes perfrmed if the diagnsis is in questin, but this test is better at lking fr ther prblems, rather than lking fr frzen shulder. If an MRI is dne, it is best perfrmed with an injectin f cntrast fluid int the shulder jint prir t the MRI. This will help shw if the capsule f the shulder is scarred dwn, as wuld be expected in patients with a frzen shulder. Frzen shulder treatment primarily cnsists f pain relief and physical therapy. Mst patients find relief with these simple steps, althugh the entire treatment prcess can take several mnths r lnger. Exercises and Stretching Stretching exercises fr frzen shulder serves tw functins: 3

4 First, t increase the mtin in the jint Secnd, t minimize the lss f muscle n the affected arm (muscle atrphy) The imprtance f stretching and exercises cannt be veremphasized as these are the key t successful frzen shulder treatment. Patients cannt expect t have successful frzen shulder treatment if they perfrm exercises nly when wrking with a therapist. These exercises and stretches must be perfrmed several times daily. Mist Heat Applicatins f mist heat t the shulder can help t lsen the jint and prvide relief f pain. Patients can apply mist heat t the shulder, then perfrm their stretching exercises--this shuld be dne at least three times daily. Mist heat can be applied by using a ht-saked washclth n the jint fr 10 minutes befre stretching. Physical Therapy Physical therapists can help a patient develp a stretching and exercise prgram, and als incrprate ultrasund, ice, heat, and ther mdalities int the rehabilitatin fr frzen shulder. As said previusly, it is imprtant that patients perfrm their stretches and exercise several times daily--nt nly when wrking with the therapist. Anti-inflammatry inflammatry Medicatins Anti-inflammatry medicatins have nt been shwn t significantly alter the curse f a frzen shulder, but these medicatins can be helpful in ffering relief frm the painful symptms. Crtisne Injectins Crtisne injectins are als cmmnly used t decrease the inflammatin in the frzen shulder jint. It is unclear the extent f the benefit f a crtisne injectin, but it can help t decrease pain, and in turn allw fr mre stretching and physical therapy. What is knwn, is the crtisne is nly effective when used in cnjunctin with physical therapy fr the management f a frzen shulder. Will I need surgery fr frzen shulder? If the abve treatments d nt reslve the frzen shulder, ccasinally a patient will need t have surgery. If this is the case, the surgen may perfrm a manipulatin under anesthesia. A manipulatin is perfrmed with the patient sedated under anesthesia, and the dctr mves the arm t break up adhesins caused by frzen shulder. There is n actual surgery invlved, meaning incisins are nt made when a manipulatin is perfrmed. 4

5 Alternatively, r in cnjunctin with a manipulatin, an arthrscpe can be inserted int the jint t cut thrugh adhesins. This prcedure is called an arthrscpic capsular release. Surgical capsular release f a frzen shulder is rarely necessary, but it is extremely useful in cases f frzen shulder that d nt respnd t therapy and rehab. If surgery is perfrmed, immediate physical therapy fllwing the capsular release is f utmst imprtance. If rehab des nt begin sn after capsular release, the chance f the frzen shulder returning is quite high. Will my shulder mtin return t nrmal? Mst patients wh have a frzen shulder will have slight limitatins in shulder mtin, even years after the cnditin reslves. Hwever, this limit in mtin is minimal, and ften nly nticed when perfrming a careful physical examinatin. The vast majrity f patients wh develp a frzen shulder will recver their functinal mtin with therapy and stretching aln Band exercises Flexin: Stand upright and hld a stick in bth hands, palms dwn. Stretch yur arms by lifting them ver yur head, keeping yur elbws straight. Hld fr 5 secnds and return t the starting psitin. Repeat 10 times. Extensin: Stand upright and hld a stick in bth hands behind yur back. Mve the stick away frm yur back. Hld the end psitin fr 5 secnds. Relax and return t the starting psitin. Repeat 10 times. External rtatin: Lie n yur back and hld a stick in bth hands, palms up. Yur upper arms shuld be resting n the flr, yur elbws at yur sides and bent 90. Using yur gd arm, push yur injured arm ut away frm yur bdy while keeping the elbw f the injured arm at yur side. Hld the stretch fr 5 secnds. Repeat 10 times. Internal rtatin: Stand upright hlding a stick with bth hands behind yur back. Place the hand n yur uninjured side behind yur head grasping the stick, and the hand n yur injured side behind yur back at yur waist. Mve the stick up and dwn yur back by bending yur elbws. Hld the bent psitin fr 5 secnds and then return t the starting psitin. Repeat 10 times. Shulder abductin and adductin: Stand upright and hld a stick with bth hands, palms dwn. Rest the stick against the frnt f yur thighs. While keeping yur elbws straight, use yur gd arm t push yur 5

6 injured arm ut t the side and up as high as pssible. Hld fr 5 secnds. Repeat 10 times. Scapular range f mtin: Stand and shrug yur shulders up and hld fr 5 secnds. Then squeeze yur shulder blades back and tgether and hld 5 secnds. Next, pull yur shulder blades dwnward as if putting them in yur back pcket. Relax. Repeat this sequence 10 times. Pectralis stretch: Stand in a drway r crner with bth arms n the wall slightly abve yur head. Slwly lean frward until yu feel a stretch in the frnt f yur shulders. Hld 15 t 30 secnds. Repeat 3 times. Biceps stretch: Stand facing a wall (abut 6 inches away frm the wall). Raise yur arm ut t yur side and place the thumb side f yur hand against the wall (palm dwn). Keep yur elbw straight. Rtate yur bdy in the ppsite directin f the raised arm until yu feel a stretch in yur biceps. Hld 15 secnds, repeat 3 times The Best Exercise fr Frzen Shulder: Hw t Treat and Prevent it. ANATOMY OF THE SHOULDER It's gd t knw the best exercise fr frzen shulder because f the anatmy and the extensive range f mtin in the shulder jint. The shulder jint is highly vulnerable t injury and needs t be dealt with in a timely fashin. A frzen shulder is different than ther shulder injuries in that it affects the shulder jint capsule. When the rtatr cuff is trn r there is tendnitis in the jint, the muscles and tendns that supprt the jint becme inflamed frm the injury. WHAT CAUSES FROZEN SHOULDER? In the jint where the head f the humerus (upper arm) fits int the shulder scket the ligaments that supprt the capsule becme inflamed and cause pain, stiffness, and limited mtin. 6

7 This may be referred t as the freezing phase that can last frm 1-3 mnths. There is usually mild pain that seems t wrsen at night. The frzen shulder may ccur after a rtatr cuff tear, which generally causes immbilizatin f the arm and jint. Yu may develp a frzen shulder frm veruse, r pr psture that results in a shrtening and tightening f the muscles and ligaments arund the shulder jint. Having a frzen shulder seems t be mre cmmn in wmen and diabetics. Starting at arund age 40. Generally because f veruse (carrying purses, cleaning with that arm) r frm underuse (nt strengthening the muscles that surrund and supprt the shulder capsule). The secnd phase is the actual frzen shulder. There is nt as much pain but it can be very stiff and with limited range f mtin. This phase can last anywhere frm 4-12 mnths. The third and final phase is the thawing where the range f mtin begins t return. This can g n fr 3-8 mnths. This is where yu will begin t fcus n exercise fr frzen shulder. TREATMENT AND PREVENTION OF FROZEN SHOULDER T begin treatment f the frzen shulder yu may start with anti-inflammatry medicines and begin heat and massage t increase bld flw t the area. The massage is als gd at breaking up scar tissue that can restrict mvement later. The best exercise fr frzen shulder includes range f mtin and shulder stretching exercises t help alleviate and prevent frzen shulder. 7

8 It is imprtant t stretch bth the psterir and anterir muscles f the shulder. A gd psterir shulder stretch is: Place ne arm acrss yur bdy under yur chin just parallel t the grund. Using the ther hand gently press it twards yur bdy. Hld fr abut 10 secnds fr 3 t 4 repetitins. A gd anterir shulder and chest stretch is: Standing upright, clasp yur hands behind yur back and gently pull away frm yur bdy while lifting them up. Keep gd psture and hld fr abut 10 secnds fr 3 repetitins. A gd exercise fr frzen shulder and t imprve range f mtin is: Sitting in a chair with arms at yur side circle yur trs a full range fr 5 rtatins each directin. Just let the arms dangle ding n wrk. Once yur range f mtin has returned yu can begin t strengthen the area with this exercise. Dumbbell circle Fr this exercise fr frzen shulder yu will kneel with the gd side knee and hand n a bench while the frzen shulder hand dangles hlding a 3 r 5 pund dumbbell. Circle the arm clckwise and then cunterclckwise abut 10 repetitins each making the circles larger as yu are able. 6-way shulder exercise 8

9 Physical Therapy Diagnsis: Shulder Stabilizatin Treating Frzen Shulder with Acupressure acupressure, Frzen Shulder Frzen Shulder is a cnditin in which mvement f the arms gets restricted. Patient is unable t lift the hands perfrm varius rutine tasks. This cnditin is very uncmfrtable but can be treated with the help f Acupressure. Acupressure is s effective in treating frzen shulder that even after first sitting r treatment imprvement can be nticed. Fr treating left shulder pints n the left hand and feet shuld be treated and similarly fr right shulder press the pints n the right side. treatment itself. I have reflexlgy chart Pints fr Treating Frzen Shulder Belw the little finger n the palm. This pint is lcated apprximately 1 inche frm the line where little finger ends n the palm. This pint is fr the shulder and is lcated n bth the palm and feet. Press this pint fr arund 1 minute. See the pint number 8 n the reflexlgy chart. 9

10 1. On the entire f the thumb. Especially the uter and inner edges f the thumb and the back f the thumb. See pint Press these fr 2 minutes. See the pint number 9 n the reflexlgy chart. 2. Edge f the base f the thumb. This regin is lcated belw the thumb and uter edge f the palm. Press it fr 1 minute. See the pint number 2 n the reflexlgy chart. 3. Press the pint which is lcated at the center pint f the back f the wrist fr half a minute. 4. Press n the channel between the bnes n the back f the palm, starting frm tp till the wrists. Press each channel fr half a minute. Acupressure Pints fr Frzen Shulder There are a number f pints n the bdy that yu can press r massage, that speed the healing f frzen shulder. Generally it is best t use the pint n the ppsite side f the bdy frm the frzen shulder. TH3 is n the back f the hand, between the last tw bnes f the hand, just abve the fingers. The pint shuld be tender. 10

11 ST38 is n the shin, just utside f the crest f the shin bne, half way between the knee cap and the ankle. GB39 is ne hands width abve the uter ankle bne, just in frnt f the leg bne that runs dwn t the ankle. Press r massage each f these pints fr abut ne minute, tw r three times a day. D it immediately befre massaging liniment int the shuld Cmpiled by cnu.pne 11