Dr Navin Prakash Roy,
B.H.M.S, M.D (PGT.), National Institute Of Homoeopathy
Email: navin.bhms@gmail.com
Introduction: Frozen shoulder, also known as adhesive capsulitis, is a common condition in which the articular shoulder capsule (a sac of ligaments surrounding the joint) swells and stiffens, restricting its mobility. It typically affects only one shoulder, but one in five cases affect both.
The shoulder has a spheroidal joint (ball – and – socket joint), in which the round part of one bone fits into the concavity of anot her. The proximal humerus (round head of the upper arm bone) fits into socket of the scapula (shoulder blade). Frozen shoulder is thought to cause the formation of scar tissue in the shoulder, which makes the shoulder joint’s capsule (not to be confused with the rotator cuff) thicken and tighten, leaving less room for movement. Therefore, movement may be stiff and even painful.
Shoulder Anatomy: The shoulder has a spheroidal joint (ball – and – socket joint), in which the round part of one bone fits into the concavity of another. The proximal humerus (round head of the upper arm bone) fits into socket of the scapula (shoulder blade).
The flat blade of the scapula glides along the back of the chest allowing for extended movement of the arm. The coracoid process is a thick curved structure that projects from the scapula and is the attachment point of ligaments and muscles.
The shoulder is one of the most sophisticated and complicated joints of the body:
- It has the greatest range of motion of any joint in the body allowing complete global movement allowing you to position the hand anywhere in space.
- The coordinated activity of numerous muscles working together in set patterns is required to produce this motion
- It is made up of FOUR joints and FIVE linked bone groups which are related and work together.
- To allow so much movement the joints need to be ‘free’ to move, therefore the shoulder should be unstable; However a series of complex ligaments and muscle keep it in joint.
. Understanding how the different layers of the shoulder are built and connected can help you understand how the shoulder works and is affected by injury and overuse.
- The deepest layer includes the bones and the joints of the shoulder.
- The next layer is made up of the ligaments of the joints.
- The tendons and the muscles come next.
- The nerves supply all the structures above and make them work.
Causes of frozen shoulder
The cause of frozen shoulder is not fully understood and in some cases is unidentifiable. However, most people with frozen shoulder have suffered from immobility as a result of a recent injury or fracture. The condition is common in people with diabetes, thyroid disorder. Females are more prone to affected in there 5th decade.
Risk factors for frozen shoulder
- Age – being over 40 years of age.
- Gender – 70% of people with frozen shoulder are women.
- Recent surgery or arm fracture – immobility of recovery may cause the shoulder capsule to stiffen.
- Diabetes – two to four times more likely to develop frozen shoulder for unknown reasons; symptoms may be more severe.
- Having suffered a stroke.
- Hyperthyroidism (overactive thyroid).
- Hypothyroidism (underactive thyroid).
- Cardiovascular disease (heart disease).
- Parkinson’s disease.
Symptoms of frozen shoulder
The most pervasive sign or symptom of frozen shoulder is a persistently painful and stiff shoulder joint. Signs and symptoms of frozen shoulder develop gradually; usually in three stages in which signs and symptoms worsen gradually and resolve within a two – year period. Loss of external rotation is differential sing from rotator calf tear.
There are three stages of frozen shoulder:
- Painful stage – the shoulder becomes stiff and then very painful with movement. Movement becomes limited. Pain typically worsens at night.
- Frozen/adhesive stage – the shoulder becomes increasingly stiff, severely limiting range of motion. Pain may not diminish, but it does not usually worsen.
- Thawing stage – movement in the shoulder begins to improve. Pain may fade, but occasionally recur.
Clinical course :- it runs over period of 1 to 3 years and the conditions is usually resolve without any long term sequele.
Diagnosis of frozen shoulder
Diagnosis of frozen shoulder based on signs and symptoms and a physical exam; paying close attention to the arms and shoulders. Structural problems can only be identified with the help of imaging tests, such as an X – ray or MRI.
Treatment options for frozen shoulder
The aim of treatment for frozen shoulder is to alleviate pain and preserve mobility and flexibility in the shoulder. However, recovery may be slow, as symptoms tend to persist for several years.
Treatment options for frozen shoulder include:
- Painkillers – relieve symptoms of pain. Nonsteroidal anti – inflammatory drugs (NSAIDs).
- Exercise – frequent, gentle exercise can prevent and even reverse stiffness in the shoulder.
- Hot or cold compression packs – help to reduce pain and swelling. It is often helpful to alternate between 0the two.
- Corticosteroid injections – a type of steroid hormone that reduces pain and swelling. Corticosteroids may be injected into the shoulder joint to alleviate pain, especially in the ‘painful stage’ of symptoms. However, repeated corticosteroid injections are discouraged as they could cause damage to the shoulder.
- Transcutaneous electrical nerve stimulation (TENS) – numbs the nerve endings in the spinal cord that control pain and sends small pulses of electricity from the TENS machine to electrodes that are applied to the skin on the affected shoulder.
- Physical therapy: exercises to maintain as much mobility and flexibility as possible:without straining the shoulder or causing too much pain.
- Shoulder manipulation – the shoulder joint is gently moved while you are under a general anesthetic
- Shoulder arthroscopy – a minimally invasive type of surgery used in a small percentage of cases.
- HOMOEOPATHIC TREATMENT-
Homeopathy treats the person as a whole. It means that homeopathic treatment focuses on the patient as a person, as well as his pathological condition. The homeopathic medicines are selected after a full individualizing examination and case-analysis, which includes the medical history of the patient, physical and mental constitution etc. A miasmatic tendency (predisposition/susceptibility) is also often taken into account for the treatment of chronic conditions. The medicines given below indicate the therapeutic affinity but this is not a complete and definite guide to the treatment of this condition. The symptoms listed against each medicine may not be directly related to this disease because in homeopathy general symptoms and constitutional indications are also taken into account for selecting a remedy. To study any of the following remedies in more detail, please visit our Materia Medica section. None of these medicines should be taken without professional advice.
Calc phos : Rheumatic pains in shoulder and arm, also with swelling of the diseased part and febrile heat. Ulcerative pain especially in roots of finger nails of right hand, and in middle finger.For persons anaemic and dark complexioned, dark hair and eyes; thin spare subjects, instead of fat. Spine weak, disposed to curvatures, especially to the left; unable to support body; neck weak, unable to support head.
Ferrum met.Shootings and tearings in the joint of the shoulder, and in the arm, or pullings or paralytic weakness, and heaviness. Cracking in the shoulder-joint. Nightly tearing and stinging in the arm. Cramps and numbness in the fingers.
Persons of sanguine temperament; pettish, quarrelsome, disputative, easily excited, least contradiction angers; >. from mental exertion. Irritability:.Extreme paleness of the face, lips and mucous membranes which become red an flushed on the least pain, emotion or exertion. Worse in winter.
Ferrum phos.Violent drawing, tearing pain right shoulder and upper arm, worse violent motion of arm, better gentle motion, so that patient hardly kept it still at all, sensitive, deadness in right hand. Acute rheumatism of right deltoid, unable to wear cloak. In right shoulder-joint acute rheumatism, red, swollen, very sensitive..Ferrum is used in first stage of inflammation.
Ferrum acetate . Pain in right deltoid. Especially adapted to thin, pale weak children who grow rapidly and easily exhausted. Worse sitting still and lying.
Rhus. tox 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, and get better by constant motion.
Adapted to persons of rheumatic diathesis; bad effects of getting wet, especially after being over-heated. Ailments: from spraining or straining a single part, muscle or tendon; overlifting, particularly damp ground; too much summer bathing in lake or river. 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; as if bones were scraped with a knife; worse after midnight and in wet, rainy weather; affected parts sore to touch. Lameness, stiffness and pain on first moving after rest, or on getting up in the morning >. by walking or continued motion. Great restlessness, anxiety, apprehension; cannot remain in bed, must change position often to obtain relief from pain.
Ruta g.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 in forearms as well as in bones and joints of hands as if they had been beaten.Paralytic stiffness of wrist. 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. Pain in wrist (as from a sprain) on lifting a weight. Spasmodic contraction of fingers. Swollen veins on hands, after eating. Warts, with sore pains, flat, smooth, on palms of hands.
Sanguinaria can. Rheumatic pain in right arm and shoulder, worse at night in bed, cannot raise arm. Pain in top of right shoulder. Pain in right deltoid. R. arm hung helpless. Coldness in body. Burning of palms. Stiffness of finger-joints.
Thiosenaminum. Usefull in torn ligament especially in shoulder.
References:
1. Turek’s Orthopedics: Principles and their Application. 5th edn. Eds S Weinstein, J Buckwalter. Lippincott, 1994; ISBN 0-397-50692-9
2. Campbell’s Operative Orthopedics. 8th edn. Ed A H Crenshaw. Mosby/Year Book, 1992. ISBN 0-8016-1096-6
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4) Standard Orthopaedic Operations. 4th edn. J Crawford Adams. Churchill Livingstone, 1992. ISBN 0-443-03232-7
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6) Proving of Ferrum Metallicum, and Mercurius Iodatus Ruber (Philadelphia: C. Sherman and Son, 1856by American Provers’ Union (page images at HathiTrust)
7) The Twelve Healers and Other Remedies (1936), by Edward Bach (frame-dependent HTML at edwardbach.org)
8) Leaders in homœopathic therapeutics, (Philadelphia, Boericke & Tafel, 1913), by Eugene Beauharnais Nash (page images at HathiTrust)
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13) keynotes and charachteristics with comparitions of some of the leading remedies of the materia medica with bowel nosodes. By H.C. Allen, eigth edition, B.jain Publishers(P) Ltd. ISBN: 978-81-319-0124-3.
14) Lectures on homoeopathic materia medica. Together with kent’s ‘ New Remedies’ incorporated and arranged in alphabetical order. James Tyler KENT. B.jain Publishers(P) Ltd. ISBN:978-81-319-0259-2.
15) homoeopathic Drug Pictures. Dr. M.L.TYLER. . B.jain Publishers(P). ISBN:978-81-319-030-3.
Very informative artical