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The term “frozen shoulder” is often used injudiciously for any painful condition of the shoulder. However, there are two known entities which must be differentiated and a proper diagnosis should be made. These conditions are:
. Painful shoulder
. Adhesive Capsuilitis or Periarthritis shoulder
Codman introduced the term “frozen shoulder” in 1934 to describe patients who had a painful loss of shoulder motion with normal radiographic studies. In 1946 Neviaser named the condition “adhesive capsulitis” based on the radiographic appearance with arthrography, which suggested “adhesions” of the capsule of the Glenohumoral joint limiting overall joint space volume.
*Any condition, around the shoulder that cause pain and limitation of the movement.
*No true contracture of the capsule of the shoulder joint.
*Various conditions include tendinitis of the rotator cuff, sprain and tears of the rotator cuff, bicipital tenosynovitis of the shoulder.
*Limitation of movement which is more due to pain rather than due to capsular contracture.
Inflammation of the capsule and synovial membrane of shoulder joint leading to adhesion formation.
* Age between 40-60 years.
* Higher incidence in females.
* Exact cause is often not identifiable but may be associated with- . Prolonged immobilization
. Trauma (strain or contusion)
. Surgical trauma especially breast or chest wall procedure
. Associated with medical condition such as diabetes, hyperthyroidism, ischemic heart disease, inflammatory arthritis and cervical spondylosis.
*Inflammation changes take place in the capsule and synovial membrane.
*Accumulation of exudates within the capsule.
*Adhesion form within this exudates.
*Inflammatory changes may spread to other periarticular structures.
Adhesive capsulitis is classically characterized by 3 stages.
1. Freezing phase (3-6 months):
*Onset of an aching pain in the shoulder.
*Pain is usually more severe at night and with activities.
*A sense of discomfort radiates down the arm.
*Specific traumatic event is difficult for the patient to recall.
*As symptoms progress, most patient position the arm in adduction and internal rotation.
*Many of these patients are initially treated with immobilization which only worsens the freezing phase.
2. Progressive stiffness or frozen phase
*Pain at rest usually diminishes.
*Restricted motion in all planes.
*Activities of daily routine become severely restricted.
*Patient complains about their inability to reach into the back pocket, fasten the bra, comb or wash the hairs etc.
3. Resolution or thawing phase:
A slow recovery of motions.
*Careful history and physical examination.
*A global loss of active and passive range of motion.
*Loss of external rotation with arm at the patient’s side is hallmark of this condition.
Self-limiting process, can be severely disabling for months to years. Aggressive treatment requires once diagnosis is made.
1. Physical therapy:
Mobilization techniques, stretching and strengthening exercises.
2. Sujok therapy:
First of all we need to diagnose the affected meridian. In simple cases generally any one meridian among Lungs, Large intestine , Spinal cord and Small intestine is affected. In some cases more than one meridian is also affected. Generally we need to treat on the affected side .
Next we have to diagnose the excessive energy which is causing the problem. It can be humidity (heaviness), dryness( sever pain) or coldness(unbearable pain). Depending on the symptoms we have to harmonise the energy in that meridian.
We can combine the advance renting techniques to reach the affected joint and harmonies the energy. For example if Left shoulder joint is affected then treat on wind of ah wind .
Sometimes we need to combine triorigin treatment also.