Dr Apoorva Dafne-Joshi guides how to successfully overcome a frozen shoulder.
Persistently high blood glucose levels can cause damage to the blood vessels and the nerves of the heart and the limbs, and can cause or aggravate many orthopaedic problems. In this article we will talk about a common shoulder problem which occurs fairly commonly in diabetics. It is called adhesive capsulitis or frozen shoulder. It occurs in about two per cent of the general population and in 10 to 20 per cent of people with Diabetes. Women are affected more than men and in people in their 40’s and 50’s more often.
The shoulder joint is made up of the upper arm bone (Humerus), the shoulder blade (scapula) and the collar bone (clavicle).The upper end of the arm bone and the socket of the shoulder blade essentially make up the shoulder joint. There is a thick tissue called the capsule which holds the joint in place along with many ligaments around
the joint. When the soft tissue structures contract and become tight along with formation of bands of tissue called adhesions the shoulder joint becomes painful and its range of motion (ROM) is greatly reduced, this condition is called frozen shoulder.
Causes of frozen shoulder
Frozen shoulder is caused by Diabetes, thyroid disorders, Parkinson’s disease, cardiac problems and injuries which cause the shoulder joint to be immobilized for a long time.
How does frozen shoulder present?
Pain in the shoulder joint is common and it starts slowly and increases in a few weeks time. Patients typically are not able to sleep on the painful side and the movement of the shoulder becomes less and painful.
Raising the affected arm while reaching to open a overhead cupboard is very painful and difficult. Pain often comes down the arm. Women have difficulty in combing their hair and when that stage is reached a doctor is immediately consulted.
Doctor examination and investigations
Your specialist Orthopaedic surgeon will test for your range of motion and compare it with your normal side. S/he will also check your neck and other joints to confirm the clinical diagnosis. Inability to mimic a ‘salute’ and inability to bring the back of the wrist with the elbow bend to the lower back behind is often diagnostic.
X rays are often taken and helps indicate
any other problem like arthritis of the shoulder joint. Blood investigations conducted include sugar and thyroid levels and HbA1c. An electro cardiogram (ECG) is done as a cardiac problem can trigger a painful shoulder (remember, people with long term Diabetes have reduced sensation and chest pain is very rare). Vitamin D, calcium, B12 levels are also checked to see if they are reduced. HbA1c levels are often elevated and indicate that the trigger for the frozen shoulder was high sugar levels in the previous months.
Treatment
Mainstay of the treatment is non surgical. Anti inflammatory and pain killers are prescribed to control the pain. These medications need to be taken for a very long time as the pain in frozen shoulder takes a long time to resolve. Nowadays analgesic patches are available which are used when patients are already taking many medications for multiple aliments like high blood pressure and cholesterol.
Physiotherapy is essential to gain the lost range of motion. Exercises need to be taught and done under supervision as incorrect exercises can aggravate the problem and can cause complications like a muscle tear and in worst scenario a fracture. A note of caution is necessary as a severe frozen shoulder in which range of motion has considerably reduced may require months of dedicated supervised physiotherapy.
A dedicated team of physiotherapists who guide patients in their rehabilitation program is crucial. Exercises not only help in regaining range of motion but help in reducing joint swelling and stretching of the contracted ligaments and breaking of the adhesions. Manipulation under anaesthesia is done sometimes when due to obesity, there is lack of motivation. Long immobilization of the shoulder makes progress in recovery long and painful.
Manipulation is also one of the ways to manage frozen shoulder. Manipulation
Dr Apoorva Dafne-Joshi is a Consultant
