Dr Baghya Hugar
Life is all about movement and activities. Shoulder is the most flexible joint in the body, and given the number of everyday activities it is involved in from-brushing our- hair to reaching up into the cupboard. It is difficult for anyone to lift heavy objects even to do simple works like opening the door, eating, walking, climbing strains, typing, turning doorknobs and lifting things all of which require shoulder mobility. Among many conditions of the shoulder joint “Adhesive Capsulitis” is one of the most common cause for the patients suffering.
The frozen shoulder was first described as periarthritis involving the peri-articular soft tissues of the shoulder by Duplay in 1872. Codman coined the term “Frozen shoulder” in 1934.He described the frozen shoulder as “difficult to define, difficult to treat, difficult to explain”. J. S. Naviaser coined the term “Adhesive capsulitis” in 1945.2
“Frozen shoulder” Adhesive capsulitis is characterised by pain and restricted movements of the shoulder usually in the absence of intrinsic shoulder disease. Adhesive capsulitis may follow bursitis or tendinitis of the shoulder or to be associated with systematic disorder such as chronic pulmonary disease, myocardial infarction and diabetes mellitus.4
PREVALENCE AND AGE OF ONSET:
Prevalence for frozen shoulder is seen in 3% to 5% in the general population with a significantly increased incidence amongst diabetes on the order of 10% to 20%. It appears to be most common in adults between the ages of 40 to 70 years. Women appear to be at a slightly increased risk 4:1. Diabetes also has a tendency to develop bilateral shoulder involvement.5
AETIOLOGY AND PATHOLOGY:
Cause for adhesive capsulitis is unknown. There is no evidence of infection. Injury is an inconstant factor and its significance is doubtful.
Pathology is not fully understood. It is believed that there is a loss of resilience of the joint capsule, with adhesion between the synovial folds. 6
A recent study with, arthroscopic biopsy material from the rotator interval in patients with frozen shoulder revealed immunocytochemical evidence of both chronic inﬂammation and proliferative ﬁbrosis, supporting the theory that this is both a chronic inﬂammatory and a ﬁbrotic condition. together with the presence of high vascularity and nerve tissue, this inﬂammation and ﬁbrosis explain why frozen shoulder is such a painful and stiff condition. The presence of T and B cells suggests that the pathology maybe immune-modulated. Mast cells, which are known to be involved in regulating ﬁbroblast proliferation, may be the cellular intermediary between the chronic inﬂammation and ﬁbrosis.7
Three stages for frozen shoulder are
- Painful or freezing phase:
This phase lasts 10 to 36 weeks. The patient has Spontaneous onset of shoulder pain, with severely disrupts sleep. The patient often rests the arm, noting an abatement of pain and contributing to increased stiffness. At the end of the painful phase, the glenohumeral capsule volume is greatly reduced.
- Stiffening or frozen phase:
This phase lasts to 4 to 12 months. The painful phase is often followed by a stiffening phase. The patient has restricted range of movement (ROM) in a charistiactercs pattern of loss of external rotation, internal rotation and abduction.
- Thawing phase:
The final phase is described as thawing and is characterized by the gradual recovery of range of movement (ROM). The thawing phase will lasts an average of 5 to 26 months and is reportedly directly related to the length of duration of the painful phase.
Primary frozen shoulder:
Primary frozen shoulder refers to the idiopathic form of a painful, stiff shoulder. Possible causes include
- Biochemical and
- Endocrine alterations.
Secondary frozen shoulder:
Secondary frozen shoulder can be indicated by a precipitating event or trauma, which can be identified to explain the loss of motion. Possible causes include
- Limitations following surgery
- Soft tissue trauma or fracture8
Diagnosis of the Adhesive capsulitis is based on the clinical signs and symptoms of the patients.
- Dr. Samuel Hahnemann Says: In the chronic disease as affected by psora. The pain is pressive between the shoulder-blades.
-Sensation of pressure upon the shoulders.
In the limbs, drawing (tearing), tensive pains, partly in the muscles and partly in the joints(Rheumatism).
-The joints, as it were, stiff, with painful, difficult motion, the ligaments seem too short.9
- Dr. J Henry Allen Says: In the chronic miasm: As psora joint pains often is worse by motion and better by rest and warmth.
The sycotic pain are worse by rest and the patient is relieved by moving, by rubbing, stretching, and better in dry, fair weather; worse at the approach of a storm or damp, humid atmosphere and a falling barometer or becoming cold; heat does not always relieve a sycotic patient; stiffness and soreness, especially lameness, is very characteristic of sycosis.12
- Swelling, stiffness, and paralysed sensations in joints, from sprains, over-lifting, or over-stretching.
- Lameness, stiffness, and pain on first moving after rest, or on getting up in morning, better by constant motion.
- Excessively cold hands and feet all day.
- Affects the fibrous tissue, especially; the right side more than the left.
- Pains: as if sprained; as if a muscle or tendon was torn from its attachment.
- Worse after midnight and in wet, rainy weather.
- Affected parts sore to touch.
- Lameness, stiffness and pain on Craving for smoked meat.
- First moving after rest, or on getting up in the morning better by walking or continued motion.
- Great restlessness, anxiety, apprehension; cannot remain in bed, must change position often to obtain relief from pain.
- Shootings and tearings in the joint of the shoulder, and in the arm.
- paralytic weakness, and heaviness.
- Cracking in the shoulder-joint.
- Nightly tearing and stinging in the arms.
- Uneasiness in the arms.
- Swelling and desquamative of the skin of the hands.
- Cramps and numbness in the fingers.
- Irritability: slight noises like crackling of paper drive him to despair.
- Women who are weak, delicate, chlorotic, yet have a fiery red face.
- Extreme paleness of the face, lips and mucous membranes which become red an flushed on the least pain, emotion or exertion.
- Worse in winter.
- Persons is pettish, quarrelsome, disputative, easily excited, least contradiction angers.
- Violent tearing pain right shoulder and upper arm.
- Worse from violent motion of arm, better gentle motion, so that patient hardly kept it still at all.
- Somewhat sensitive, deadness in right hand.
- Acute rheumatism of right deltoid, unable to wear cloak.
- Right shoulder-joint red, swollen, very sensitive.
- Stiffness and pain in joint.
- Sensation of numbness and coldness in affected area.
- Complaint worse in weather change.
- Joint complaints after bone injury.
- Numbness and crawling sensation are the characteristics of the remedy.
- Patient has great desire for travelling.
- Wrenching pain in the shoulder-joint, especially when permitting arms to hang down or when resting on them.
- Dull tearings in bones of the arm and joints of elbow.
- Pain as from contusion in joint of elbow.
- Pain in forearms as well as in bones and joints of hands as if they had been beaten.
- Pressive and spasmodic drawing and tearing in forearms, hands, and fingers.
- Sensation as from a sprain and stiffness in wrist.
- Bones of wrist and back of hand painful as if bruised when at rest and when moving.
- Numbness and tingling in hands after exertion.
- Pain worse lying down, from cold and wet weather.
- Rheumatic pain in right arm and shoulder
- worse at night in bed, cannot raise arm, motion, turning in bed cause excessive pain.
- Pain in top of right shoulder.
- Pain in right deltoid.
- Coldness in body and right arm.
- Stiffness of finger-joints.
- Burning in soles and palms.9
List of references:
- D’Amato, K., and M. Rogers. “‘Frozen Shoulder’—A Difficult Clinical Problem”. Osteopathic Family Physician, Vol. 4, no. 3, 1, pp. 72-80,
- Kasper ,Fauci,Hauser,Longo,Jameson,Loseaczo;Harrison’s Principles of Internal Medicine 19thedition;volume 2;page:2249.Accessed on: 30/1/2019
- Research In Pharmacy And Health Sciences; Volume 4;Issue4;oct-dec2018 Accessed on:30/1/2019
- John.Crawford.adams DavidL. Hamblen; Outline Of Orthopedics;13thedition; Published by, Churchill Livingstone 2001,page:226
- The Journal Of Bone And Joint Surgery; Volume 89; no.7;March 2007; Accessed on : 4/2/19
- Robert.A.Donatelli; The Physical Therapy Of The Shoulder;4thEdition;Published by, Elsevier; page: 320, & 321
- Samuel Hahnemann; The Chronic Diseases Their Peculiar Nature And Their Homoeopathic Cure;Volume1;Reprint Edition July 2009;Published by, Indian Books And Periodical Publishers New Delhi; Page 78,79.
- J.H. Allen; The Chronic Miasma Psora PseudoPsora And Sycosis; Reprint Edition1994; Volume 1and 2; Published by, B. Jain publishers PVT Ltd; New Delhi; page 250,251.
- William Boericke, MD. Pocket Manual Of HOMOEOPATHIC Materia Medics And Repertory
Avery helpful article. Thanks for sharing.