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Frozen Shoulder

And How You Can Survive It

Frozen Shoulder And How You Can Survive It Don’t let frozen shoulder pain beat you An

Don’t let frozen shoulder pain beat you

An electronic book by

Doctor Gordon Cameron

Frozen Shoulder and How to Survive It

Frozen Shoulder and How to Survive It Legal Stuff Doctor Cameron has made every effort to

Legal Stuff

Doctor Cameron has made every effort to provide authoritative information on the subject of Shoulder Pain and Frozen Shoulder

No promises are made about the results you will obtain using this material.

This book is offered with the understanding that it is not intended to substitute for face to face advice on medical issues.

If you feel that such assistance is needed, then please seek early assessment from a local doctor.

You are solely responsible for any consequences arising from your use of this information. It is unsafe to attempt to diagnose your own medical symptoms and Doctor Cameron strongly recommends that you do not attempt to do so.

Doctor Cameron strongly recommends that you do not attempt to do so. An electronic book by
Doctor Cameron strongly recommends that you do not attempt to do so. An electronic book by

Frozen Shoulder and How to Survive It

Frozen Shoulder and How to Survive It A message from Doctor Cameron “ If you are

A message from Doctor Cameron

If you are reading this then I guess that either you or someone close to you is suffering from the pain of a frozen shoulder.

Life is tough if you have a frozen shoulder and there’s no getting away from the fact that day to day existence can be a bit of a struggle.

We rarely realise how much we depend on our shoulder functioning normally until something goes wrong with it – a loss in the normal range of shoulder movements is at best an indignity and at worst a disaster when it comes to dealing with the normal day to day chores of life. The pain can be bad enough to bring normal life temporarily to a halt.

I’ve written this book to give you the power to beat your shoulder symptoms – let’s get your life back to normal and let’s get started NOW !”

About Me

I live and work in Edinburgh, Scotland and specialise in treating pain from the spine, joints and muscles. I am fascinated by the condition that has come to be known as Frozen Shoulder and I’ve treated thousands of patients who have suffered from it.

Having knowledge can be very powerful and truly knowing the facts about frozen shoulder can give you the strength you need to deal with your condition and the problems it causes. I can’t promise you a miracle but I can promise you that this book will make your life a lot easier.

Stay well and be happy

Doctor Gordon Cameron

P.S. – you can read a lot more about me and my qualifications by visiting my Shoulder Pain website at www.jointenterprise.co.uk

You’ll find details of my background and experience – as well as a lot more information about other aspects of shoulder pain and neck pain

more information about other aspects of shoulder pain and neck pain An electronic book by Doctor
more information about other aspects of shoulder pain and neck pain An electronic book by Doctor

Frozen Shoulder and How to Survive It

Frozen Shoulder and How to Survive It About this book I’ve tried very hard to make

About this book

I’ve tried very hard to make this book easy to read. The style is best described as “comfortable” and “relaxed” – chatty almost, and I’ve done that quite deliberately. There is nothing complicated about how your shoulder works and I want you to be able to understand it for yourself.

I’ve avoided using medical language or big words and I’ll try to use pictures whenever I can. My aim is to have you understand your own shoulder in as much depth as I do. I want you to “become your own shoulder expert” because only then will you really take charge of your life again. Only then will you start the process of breaking free from your pain.

A word of caution

This book can never be a replacement for your own doctor or for a qualified therapist. You should not rely on this book as your only source of medical advice. If you haven’t already done so then you should see an experienced physician or therapist so that a proper diagnosis can be made for your condition – and investigations carried out if need be.

In general, frozen shoulder is not difficult to diagnose but there are other conditions which can mimic it.

It’s important to ensure that other conditions have been ruled out – either by having the appropriate examinations or tests, or by your doctor’s clinical examination.

Please don’t be foolish. Seek help and guidance and make sure you have your condition properly diagnosed before starting or seeking treatment.

condition properly diagnosed before starting or seeking treatment. An electronic book by Doctor Gordon Cameron Page
condition properly diagnosed before starting or seeking treatment. An electronic book by Doctor Gordon Cameron Page

Frozen Shoulder and How to Survive It

Frozen Shoulder and How to Survive It Part One How your shoulder works – understanding shoulder

Part One

How your shoulder works – understanding shoulder anatomy

Let’s begin the process of getting to grips with the workings of your shoulder.

The shoulder is the most mobile joint in the body and is often affected by painful problems which limit movement. What most people call the shoulder is really several joints that combine with tendons and muscles to allow a wide range of motion to the arm.

Some terms to remember before we begin delving deeper.

The arm bone is called the humerus.

The shoulder blade is called the scapula but different parts of the scapula have different names.

The bit of the scapula where the arm bone joins is called the glenoid fossa – so the joint where the humerus joins it is called the gleno-humeral joint, and it’s this joint that most people mean when they talk about the shoulder joint

The bone bump we can feel at the top of our shoulder is part of the shoulder blade and is called the acromion

The collar bone comes across the front of our upper chest to form a joint with the acromion. The anatomy name for the collar bone is the clavicle – so the joint formed between it and the shoulder blade is called the acromio- clavicular joint. This is sometimes shortened just to “AC joint.”

This picture shows the main parts of the shoulder

to “AC joint.” This picture shows the main parts of the shoulder An electronic book by
to “AC joint.” This picture shows the main parts of the shoulder An electronic book by
to “AC joint.” This picture shows the main parts of the shoulder An electronic book by

Frozen Shoulder and How to Survive It

Frozen Shoulder and How to Survive It The movements of the shoulder mostly take place at

The movements of the shoulder mostly take place at the gleno-humeral joint – the ball in the socket in other words. This is true for movements of the arm around and away from the body – but in most of these movements there is also a bit of movement of the shoulder blade or scapula, which has the ability to rotate around on the chest wall.

Most but not all of the shoulder movements involve a degree of rotation. Even movements where the arm seems to be simply moving forward or back have a rotation element to them. The group of muscles that surround the shoulder and do most of these movements are called the Rotator Cuff muscles.

The rotator cuff muscles act partly to move the shoulder – and partly to stabilise and support it when it’s moving. Problems with the rotator cuff muscles can cause several painful conditions such as tendonitis, impingement and rotator cuff tears.

You can see the bones of the shoulder in the picture here:

You can see the bones of the shoulder in the picture here: The shoulder joint is

The shoulder joint is called a Ball and Socket Joint – and if you look at the picture you’ll be able to see why. The ball shaped upper part of the humerus sits snugly in the socket on the scapula – an arrangement that allows movement freely in all sorts of directions.

But hang on a minute – you don’t need to be an engineer or a surgeon to realise that simply sitting the ball end of the humerus into the socket on the shoulder blade is not going to be a very stable arrangement. The socket needs to be deeper to give the humerus head a snug fit and nature achieves this by putting a donut shaped ring of gristle around the socket – making it deeper and better able to support the joint.

the socket – making it deeper and better able to support the joint. An electronic book
the socket – making it deeper and better able to support the joint. An electronic book

Frozen Shoulder and How to Survive It

Frozen Shoulder and How to Survive It This donut shaped ring is called the glenoid labrum

This donut shaped ring is called the glenoid labrum – and you can see it illustrated in the picture below. Injuries to the glenoid labrum are not unusual in sports people and in athletes and are often referred to as a “labral tear” or “SLAP lesion”.

referred to as a “labral tear” or “SLAP lesion”. The shoulder joint capsule The glenoid labrum

The shoulder joint capsule

The glenoid labrum

OK – I guess by now that you are starting to understand how the bits of the shoulder fit together. Let’s add in another important bit of anatomy for you to understand, in fact, probably the most important bit when it comes to considering frozen shoulder.

The capsule is simply the name given to a tough bag of gristle that completely surrounds the glenohumeral joint and helps to support the joint as it moves. It also contains the synovial fluid that the joint needs for friction free movement. Synovial fluid is like oil for joints – it lubricates and allows movement without friction or roughness.

– it lubricates and allows movement without friction or roughness. An electronic book by Doctor Gordon
– it lubricates and allows movement without friction or roughness. An electronic book by Doctor Gordon
– it lubricates and allows movement without friction or roughness. An electronic book by Doctor Gordon

Frozen Shoulder and How to Survive It

Frozen Shoulder and How to Survive It The picture above shows you the joint capsule and

The picture above shows you the joint capsule and – although this particular illustration doesn’t show it very clearly – there is a small fold or pouch of the capsule that hangs downwards into the armpit or axilla. It’s this pouch or fold that forms the key to understanding much of what goes on inside a frozen shoulder.

This little fold of shoulder capsule is important in normal life because it’s what allows us the flexibility to move our shoulder in all the directions that it travels – particularly when we try to move the arm upwards. If we lose the use of this pouch then our

shoulder flexibility is dramatically reduced

but, more of this later.

A bit about Synovial Fluid and Synovial Joints

Nearly all the moving joints of the body are what is known as “Synovial joints” – they need oily fluid to bathe the joint surfaces and keep them moving freely – just like the joints in a machine really.

The shoulder is a synovial joint and it needs the bag of gristle or capsule that surrounds it to stop the synovial fluid from escaping away from the joint. Synovial fluid is produced inside our shoulder by a layer of slippy, spongy cells that cover the inside of the capsule in the same way that the inside of your mouth is covered by a slippy spongy layer of cheek cells. The oil producing cells inside a joint are called the synovium.

The shoulder joint muscles

For the last bit of our shoulder anatomy jigsaw we need to look at the muscles around the shoulder.

Muscles create and control movements and the engineers and scientists who construct artificial joints have found that the shoulder is one of the “busiest” joints in our body. The shoulder moves thousands of times every day and we need a complicated and synchronised group of muscles to work in close coordination for us to achieve that.

This picture shows the main muscles around the shoulder:

that. This picture shows the main muscles around the shoulder: An electronic book by Doctor Gordon
that. This picture shows the main muscles around the shoulder: An electronic book by Doctor Gordon

Frozen Shoulder and How to Survive It

Frozen Shoulder and How to Survive It We are looking side on at a shoulder with
Frozen Shoulder and How to Survive It We are looking side on at a shoulder with

We are looking side on at a shoulder with the back of the shoulder towards the right margin of the page and the front of the shoulder facing towards the left margin.

You can see the large beef steak muscle of subscapularis in front of the glenohumeral joint, the supraspinatus muscle above and two additional muscles – called infraspinatus and teres minor behind. Together these four muscles make up what’s called the rotator cuff group of muscles. They are not the only muscles that move or control the shoulder, but they are certainly the most important. The rotator cuff functions to give the shoulder stability as it moves – often very rapidly – through the tasks of day to day life.

Another thing to notice in this picture is the arch like shape that the acromion and clavicle make above the shoulder joint. It’s this arch, or problems with it, that lead to impingement problems at the shoulder.

The Rotator Cuff

The Rotator cuff group of muscles consists of the following four muscles:

Supraspinatus above the joint and mostly responsible for movements of the arm upwards and away from the body

Infraspinatus and Teres Minor behind the joint and responsible for allowing the joint to rotate the arm outwards away from the body

Subscapularis in front of the joint and organising movement of the joint as it rotates inwards across the body.

Together these muscles work as an incredibly well organised team – stabilising and strengthening the shoulder joint.

organised team – stabilising and strengthening the shoulder joint. An electronic book by Doctor Gordon Cameron
organised team – stabilising and strengthening the shoulder joint. An electronic book by Doctor Gordon Cameron

Frozen Shoulder and How to Survive It

Frozen Shoulder and How to Survive It Shoulder joint stability Fundamentally, the shoulder is an unstable

Shoulder joint stability

Fundamentally, the shoulder is an unstable joint. In normal life it pulls off quite a remarkable balancing act between extreme mobility and extreme potential instability on a daily basis. It’s a joint that needs to cope with huge forces on a regular basis if it is to fulfil the tasks we ask of it.

To remain stable the shoulder relies on a fascinating interplay between many of the structures you have just been reading about.

If any of the following things go wrong with the shoulder then the end result is often a sense of the joint being unstable – with associated pain on day to day function.

These fairly common injuries can trigger shoulder instability:

A tear in the glenoid labrum

A tear in a rotator cuff muscle

A tear in the capsule – particularly at the front of the shoulder

More gross and more immediate instability will follow after a complete dislocation of the shoulder. This usually occurs only in situations of trauma.

The conditions above can usually be picked up fairly readily by using modern imaging techniques such as MRI scan or scans with additional contrast medium injected into the joint – usually called an MRI Arthrogram.

The shoulder bursa – a spongy bag of fluid

Nature is the most amazing thing. Engineers spend lifetimes trying to design moving systems and then stand back in amazement and dismay when they realise that nature has beaten them to it by many thousands of years.

Think again about the muscles of the rotator cuff. What did I say they did thousands of times each day? That’s correct – they move, and move, and move, and move

And what do moving parts need – lubrication of course. The joint is lubricated by the synovial fluid held inside the joint capsule – the muscles are lubricated by synovial fluid held inside a spongy bag of fluid called the bursa.

We have these small spongy bags of lubrication all over our body. Where muscles lie over the top of other muscles, or where muscles lie close to bones or joints, the body builds in a bursa. Their purpose is to allow movement without friction.

in a bursa. Their purpose is to allow movement without friction. An electronic book by Doctor
in a bursa. Their purpose is to allow movement without friction. An electronic book by Doctor

Frozen Shoulder and How to Survive It

Frozen Shoulder and How to Survive It There are several bursae around the shoulder. The largest

There are several bursae around the shoulder. The largest one - and the commonest one to cause a problem is called the sub deltoid bursa or the subacromial bursa (two names for the same bursa).

Sub means beneath and the bursa lies beneath the deltoid muscle and beneath the Acromion bone which is part of the shoulder blade.

The muscles of the rotator cuff around the shoulder are called subscapularis, supraspinatus, infraspinatus and teres minor are small muscles that stabilise the shoulder. Collectively, these four muscles are known as the rotator cuff.

Within the shoulder, bones and ligaments form an arch over the top of these rotator cuff muscles. In between the rotator cuff muscles and the arch is the Subacromial space, which is filled by the Subacromial bursa, a sac of fluid that is designed to prevent any friction at the shoulder.

that is designed to prevent any friction at the shoulder. The bursa at the shoulder is

The bursa at the shoulder is often triggered into inflammation by something as simple as lifting a bag of groceries into the car.

Bursitis around the shoulder usually arises after an injury such as a fall or as a result of unaccustomed overuse of the shoulder joint or shoulder muscles.

Sometimes the sufferer will not be able to recall a specific trigger and it can seem as if the pain just starts out of nowhere.

Bursitis can exist on its own or in association with inflammation of the shoulder tendons. Shoulder tendon inflammation is called tendonitis

shoulder tendons. Shoulder tendon inflammation is called tendonitis An electronic book by Doctor Gordon Cameron Page
shoulder tendons. Shoulder tendon inflammation is called tendonitis An electronic book by Doctor Gordon Cameron Page

Frozen Shoulder and How to Survive It

Frozen Shoulder and How to Survive It Part Two – Where Does Shoulder Pain Come From?

Part Two – Where Does Shoulder Pain Come From?

It’s just not possible to discuss pain at the shoulder or frozen shoulder without looking a bit more widely at the ways that your shoulder can become painful. We also need to consider how other joints near the shoulder can also cause pain in the same region.

Referred Pain

Please don’t forget that not every pain felt in the shoulder region is actually caused by a problem in the shoulder joint. The pain you feel can sometimes be coming from somewhere else in the body – but the pain centre in the brain gets muddled and blames the pain on the shoulder muscles.

This phenomenon is common and is called Referred Pain.

Common sources for pain being referred to the shoulder include the neck, the heart or lungs and the organs in the upper abdomen like the liver, gall bladder or diaphragm muscle. The picture below shows you how internal body organs can cause a pattern of referred pain to areas of skin or areas near joints.

For example – you can see that the liver and gall bladder shaded orange will typically cause pain in the upper right abdomen but also around the right side of the neck and the shoulder.

Likewise, the heart (shaded pink) will cause chest pain, pain down the left arm and through to the back. It can also cause shoulder and jaw pain at times.

to the back. It can also cause shoulder and jaw pain at times. An electronic book
to the back. It can also cause shoulder and jaw pain at times. An electronic book
to the back. It can also cause shoulder and jaw pain at times. An electronic book

Frozen Shoulder and How to Survive It

Frozen Shoulder and How to Survive It When the problem really is starting in the shoulder

When the problem really is starting in the shoulder joint or in the shoulder muscles then the pain is felt over the front of the shoulder or in the upper part of the arm. This area of the upper and outer arm is called the “deltoid area” – named after the large deltoid muscle that lies beneath it.

This kind of shoulder pain can appear to spread down the arm towards the elbow and this is another example of referred pain.

However, if your pain spreads further down into the hand itself or if you have tingling or pins and needles in your hand or fingers then your pain is probably arising from a problem in the neck.

Neck and shoulder pain

For the purposes of educating you about frozen shoulder and the pain it causes, we need to keep two things in mind about the neck and how it can trigger shoulder area pain.

Firstly – the main large nerves that exit the neck to run down the arm pass very close to the shoulder joint.

Secondly – if the joints, or muscles or gristle of the neck become inflamed then they can send a pain message to the brain in such a way that the brain becomes confused and blames the pain message on the shoulder. This means that the brain thinks there is a pain in the shoulder, even when the shoulder joint itself is healthy and the problem lies in the neck. This again is called Referred Pain.

Referred pain from the neck into the shoulder region is very common and pain specialists have mapped out the areas of skin and muscle that neck problems send their pain to. Take a look at this diagram:

that neck problems send their pain to. Take a look at this diagram: An electronic book
that neck problems send their pain to. Take a look at this diagram: An electronic book
that neck problems send their pain to. Take a look at this diagram: An electronic book

Frozen Shoulder and How to Survive It

Frozen Shoulder and How to Survive It The numbers and letters in the picture above relate

The numbers and letters in the picture above relate to the cervical (or neck) vertebrae. So C3 is the third vertebra of the neck. C6 is the sixth and so on. C3-4 means the segment of the neck consisting of the third vertebra, the fourth vertebra and all the muscle and gristle that surrounds them.

The picture shows you that if something is inflamed in the C5 -6 area of the neck then the patient feels pain over the red area in the picture – over the shoulder in other words. Likewise, if the structures around C6-7 are inflamed then the pain spreads over the shoulder and down the inner part of the shoulder blade.

All of this means that it’s very important to think about possible problems in the neck when assessing someone who has pain in or around their shoulder.

Shoulder tip pain

Pain at the very tip of the shoulder may come from the small joint at the end of the collarbone – called the acromio-clavicular joint or the AC Joint. The bony bump at the tip of your shoulder blade is called the acromion and the collar bone is called the clavicle so the joint where they meet is called the acromio-clavicular joint.

where they meet is called the acromio-clavicular joint. But if you have a pain at the

But if you have a pain at the tip of the shoulder that seems to spread up towards the neck or then there’s a fair chance that this is actually originating in the neck and not the shoulder. Don’t forget too, that pain in and around the shoulder tip can come from the internal organs in the chest or the abdomen.

tip can come from the internal organs in the chest or the abdomen. An electronic book
tip can come from the internal organs in the chest or the abdomen. An electronic book

Frozen Shoulder and How to Survive It

Frozen Shoulder and How to Survive It Pain Patterns at the Shoulder One of the most

Pain Patterns at the Shoulder

One of the most confusing things about the pain from a frozen shoulder is that the pain can often seem as if it isn’t coming from the shoulder at all.

Frozen shoulder pain can often spread all the way down the arm as far as the hand. In my experience people are often confused by this but the explanation lies in what’s called referred pain. You’ve heard a bit about referred pain in general above but now we’ll look at the specifics of referred pain from the shoulder.

In simple terms referred pain is what happens when the brain gets a signal of pain from a part of our body but interprets the signal as coming from somewhere else. Many of us will have had this experience with toothache. A pain from a tooth can be blamed by the brain on the ear or the jaw or the cheek or even up around the eye. This system of pain referral applies throughout your body and it often comes into play with shoulder pain conditions – sending the pain down towards the hand from the brains view point.

Referred pain patterns are usually based on the nerve pathways that arise when we are still an embryo in the womb. All of the parts of the shoulder, the joint, the bursa, the ligaments and the muscles are part of the same embryonic segment. The fifth neck vertebra is part of the same segment and for this reason it’s often referred to as the “C5 segment.” What this means in practice is that the brain feels pain from these body parts in the same area. Inflammation from any of the body parts that originated in the fifth cervical segment of the embryo will be felt as pain in the same area. The picture below shows where this segment is on the skin. I’m sure the pattern of pain distribution will be familiar to those of you with frozen shoulder.

will be familiar to those of you with frozen shoulder. Frozen shoulder pain is always felt

Frozen shoulder pain is always felt in the C5 segment distribution – most commonly over the upper part of the arm as seen in the picture above.

over the upper part of the arm as seen in the picture above. An electronic book
over the upper part of the arm as seen in the picture above. An electronic book

Frozen Shoulder and How to Survive It

Frozen Shoulder and How to Survive It It often seems to spread down towards the wrist

It often seems to spread down towards the wrist but stops short of the hand. Normally the distance down the arm that the pain spreads is governed by how inflamed your shoulder is – the angrier the inflammation in your shoulder, the further the pain will spread.

Part Three – Frozen Shoulder

What is a frozen shoulder?

Pain is the major issue for most people.

Frozen shoulder is also known as adhesive capsulitis and the two terms are used almost interchangeably. The problem can either start quite quickly after an injury – or it can arise very slowly as if out of nowhere and with no obvious trigger involved.

Doctors first recognised the condition about two hundred years ago when it was first described as being a different condition from arthritis of the shoulder. Let’s repeat and rephrase that for emphasis. Frozen shoulder is not the same as arthritis and it does not develop into arthritis.

Frozen shoulder can cause severe pain. Even when sufferers are frustrated by the stiffness in the joint, pain relief is the real priority for most of them. Almost without exception people with frozen shoulder say that they could put up with the stiffness – if only they could get rid of the pain.

One of the earliest modern doctors to devote attention to frozen shoulder was an American orthopaedic expert called Codman. When he wrote a large textbook devoted to frozen shoulder in 1934 he gave only a few pages to the subject of frozen shoulder – saying that frozen shoulder was common but only a little was known about the subject of how it started and what caused it. Sad to say that now nearly eighty years later we are still in pretty much the same situation. There are still more questions than answers available when it comes to understanding frozen shoulder.

A brief medical history lesson

About twenty years after Codman wrote his first textbook a surgeon called Nevasier tried to perform surgical operations on the shoulders of people with frozen shoulder. He planned to explore the joint to see what was going on inside. During his attempts to operate he found that the joint capsule was stuck fast to the bone surface inside the joint. He had to peel it away like a Band-Aid or an Elastoplast strip. Because of this he coined the name “Adhesive Capsulitis” and the term has been in use ever

the name “Adhesive Capsulitis” and the term has been in use ever An electronic book by
the name “Adhesive Capsulitis” and the term has been in use ever An electronic book by

Frozen Shoulder and How to Survive It

Frozen Shoulder and How to Survive It since. Adhesive because of the stickiness he found and

since. Adhesive because of the stickiness he found and Capsulitis because the capsule was inflamed.

Some Extra Information – All about “- Itis”

The suffix “ –itis” crops up a lot in medicine and it simply means “inflamed.”

So tonsillitis is inflamed tonsils, dermatitis is inflamed skin, sinusitis is inflamed sinuses and so on. The capsule – as you now know – is the bag of gristle that surrounds the joint capsule so capsulitis is simply another way of saying an inflamed joint capsule.

What is a frozen shoulder?

Inflammation anywhere in the body causes stickiness.

The cells that control the inflammation process trigger a reaction in the tissues of the body and tend to create a sticky fluid to form in the inflamed area. This causes adjacent bits of the body to stick to each other – not normally on a permanent basis but certainly for weeks or months at a time.

Now – if you think back to what you read above about the little bag or pouch of capsule that hangs down into your armpit so that your shoulder can move freely upwards – you’ll begin to develop an idea of why the frozen shoulder pattern develops in the way that it does. If this little pouch were to fill up with inflammation fluid then the sides would stick together and make it very difficult for you to lift your arm above your head.

If the front of your shoulder joint capsule stuck itself to the bone at the front of your upper arm then you would find it very nearly impossible to rotate your arm properly – especially if you were trying to reach your arm round behind your back in the way most women do when trying to fasten their bra or when wiping yourself after using the toilet.

If you add in some general stickiness in the bursa area and around the muscles then you can surely now see why the shoulder seems to freeze up and stiffen. It’s quite literally stuck with a kind of natural glue – adhesive capsulitis indeed.

stuck with a kind of natural glue – adhesive capsulitis indeed. An electronic book by Doctor
stuck with a kind of natural glue – adhesive capsulitis indeed. An electronic book by Doctor

Frozen Shoulder and How to Survive It

Frozen Shoulder and How to Survive It The end result of the above process is that

The end result of the above process is that the capsule shrinks and tightens around the joint and stays that way for many months before it gradually begins to recover again.

Still a mystery

Although in recent years we are getting closer to understanding what goes on inside a shoulder with adhesive capsulitis there are still a lot of questions to be answered.

New research is beginning to hint that there might be a connection to genetics or to the way our individual immune systems work. Other scientists have found changes in nerve function in the capsule of frozen shoulders – perhaps again hinting at some of the underlying triggers. The connection between frozen shoulder and diabetes is also provoking a lot of interest. No doubt a lot of this will become clearer in years to come but for the time being it seems more important to focus on what we can do to treat the condition than to worry too much about the finer points of what causes it.

than to worry too much about the finer points of what causes it. An electronic book
than to worry too much about the finer points of what causes it. An electronic book

Frozen Shoulder and How to Survive It

Frozen Shoulder and How to Survive It The Story So Far Let’s pause and review what

The Story So Far

Let’s pause and review what you now know about frozen shoulder

The shoulder is a ball and socket joint

Its formal name is the glenohumeral joint

The joint is surrounded by a tough bag of gristle called the capsule

The rotator cuff muscles control movements around the shoulder and keep the joint stable and strong

A spongy bag of fluid called the bursa sits between the joint and the muscles that lie over it

Nerves from the neck run near to the front of the shoulder joint

Certain pain patterns called referred pain explain why shoulder pain behaves the way it does

An inflammation reaction can cause sticky fluid to build up inside the shoulder capsule

This fluid can stick the capsule to itself and also to the underlying bone – causing pain, stiffness and loss of movement.

Who gets frozen shoulder?

On a page below, I’m going to show you a box listing all the so called causes of frozen shoulder or adhesive capsulitis – I’ve put the words in inverted commas because in truth it’s better to think of most of them as conditions that are associated with frozen shoulder rather than conditions that cause it. Nobody yet fully understands the triggers in the body that lead to frozen shoulder starting.

the triggers in the body that lead to frozen shoulder starting. An electronic book by Doctor
the triggers in the body that lead to frozen shoulder starting. An electronic book by Doctor

Frozen Shoulder and How to Survive It

Frozen Shoulder and How to Survive It Please remember however that most cases of frozen shoulder

Please remember however that most cases of frozen shoulder have none of these things associated to them – they just simply seem to arise from nowhere and are called “idiopathic cases” or “idiopathic frozen shoulder” – idiopathic is just a medical word meaning “cause not known.”

Idiopathic Frozen Shoulder

This group of patients are by far the most common group that I see with frozen shoulder pain.

I think it’s also true that many people who remember an injury at the start of their frozen shoulder episode only do so with the benefit of hindsight. Some research doctors believe that the problem was already brewing up in these people – just sitting quietly waiting for a minor tweak to come along and unmask the symptoms and signs. They think that the minor injury is probably unrelated to the cause of the condition and only serves to draw the sufferer’s attention to their shoulder and the fact that it is quietly becoming sorer and stiffer.

It might even be true that a joint already beginning to stiffen with frozen shoulder could actually be more vulnerable to a minor tweak in the first place – leading to another version of the famous old “chicken or egg” question.

The Facts about Idiopathic Frozen Shoulder

OK – here are the facts about the commonest type of frozen shoulder.

It happens mostly to people in their 50’s, 60’s and 70’s.

Women get it more often than men – in my patients it’s by a ratio of about four women for every man. Some researchers think this might be related to the menopause.

There’s no connection obvious connection to right and left handedness

It can rarely affect both shoulders at once – or one and then the other months or years later

How common is frozen shoulder in our communities?

It’s hard to get a real idea of how common frozen shoulder really is. The research studies that have looked at this have not been very successful and part of this ties in to the fact that not all family doctors are skilled at making the diagnosis – you might already have experienced this in your own case.

– you might already have experienced this in your own case. An electronic book by Doctor
– you might already have experienced this in your own case. An electronic book by Doctor

Frozen Shoulder and How to Survive It

Frozen Shoulder and How to Survive It We know some details about shoulder pain in general

We know some details about shoulder pain in general but not about frozen shoulder in particular.

Out in the real world about a quarter of us experience shoulder pain of some kind every year. Only about one in every twenty of those who have pain will bother to see

their family doctor about it – and from that small number only about one in every ten

will be seen by a specialist. Now

can you see where the problem is? Any research being done is being conducted on a very small select group of shoulder pain patients – a group whose problems are likely to be more severe and quite different in nature to those of the rest of the population.

research is only really done by specialists, so

Primary and Secondary Frozen Shoulder

Some authors divide frozen shoulder cases into Primary and Secondary cases. I must say that I don’t always find this separation helpful in day to day practice when faced with a patient who has a sore shoulder – but it might help you to understand a bit more about the condition.

Primary Frozen Shoulder patients have no clues in their history about what might have triggered their condition. They have normal investigations and nothing in the pattern suggests any other underlying condition as a trigger for the frozen shoulder.

Secondary Frozen Shoulder cases are always able to identify an injury or other medical condition that acted as the trigger for the start of their shoulder problems.

that acted as the trigger for the start of their shoulder problems. An electronic book by
that acted as the trigger for the start of their shoulder problems. An electronic book by

Frozen Shoulder and How to Survive It

Frozen Shoulder and How to Survive It Diabetes and Frozen Shoulder Diabetic patients are much more

Diabetes and Frozen Shoulder

Diabetic patients are much more likely to suffer from frozen shoulder than the rest of those in the population – by about seven to one for those who have insulin dependent diabetes.

Diabetic frozen shoulder is a major problem. The pain and limited function that it causes can seriously limit the normal activities of day-to-day life. Frozen shoulder is much more common in diabetic patients and this section of the book aims to explore the nature of the Frozen Shoulder – Diabetes connection.

the nature of the Frozen Shoulder – Diabetes connection. There are many ways that diabetes can

There are many ways that diabetes can affect the muscles and joints. Sugar sticks to the collagen in cells and affects its ability to function. Diabetes can damage blood vessels and a poor blood supply results in scarring and damage in the body's elastic tissues.

We know that some diabetic patients can have problems with changes in the gristle of their hands - and in men, the penis. Most experts think that diabetic frozen shoulder arises for the same reasons

Diabetes is known to affect the shoulder in several ways. Diabetic frozen shoulder seems to be the commonest - with up to 20% of diabetic patients developing frozen shoulder at some time or other.

Calcium spots in the tendons and muscle around the shoulder are also seen more commonly in diabetic patients - this probably relates to the fact that high blood sugars can impair blood flow through small vessels. Tendons are particularly vulnerable to this and respond by depositing calcium. These calcium deposits can sometimes be painless but often cause severe discomfort or limited movement. They usually show up on x-rays.

Slow healing and impaired nerve function are also common in diabetic patients and contribute to the fact that the frozen shoulder pain takes longer to settle than it does in other, non diabetic, patients.

Diabetic patients are much more likely to have problems with their shoulders than others. Insulin dependent diabetics are particularly at risk - with some studies showing that they are six times more likely to develop diabetic frozen shoulder than the rest of the population.

to develop diabetic frozen shoulder than the rest of the population. An electronic book by Doctor
to develop diabetic frozen shoulder than the rest of the population. An electronic book by Doctor

Frozen Shoulder and How to Survive It

Frozen Shoulder and How to Survive It We don’t yet really know why diabetic frozen shoulder

We don’t yet really know why diabetic frozen shoulder problems arise but it seems to relate in part to how well each individual controls their blood sugar levels.

Textbooks tell you that all shoulder complaints are more common in diabetes but in my experience diabetic frozen shoulder is the most troublesome and most frequent. Diabetics not only get frozen shoulder more often than others but it lasts longer and is more painful for them when they do.

Some experts think that shoulder problems in diabetics are so common that they should be regarded as a complication of diabetes and not a coincidental event.

There has been a lot of research recently into the frozen shoulder – diabetes link but it is still rather unclear why diabetic patients get such problems with their shoulders. It seems to relate to the effect that diabetes and a high blood sugar has on the collagen containing cells in the body. Collagen is a protein that is involved in making ligaments, tendons and - of course - joint capsules.

Diabetic frozen shoulder eventually resolves itself in most cases but can cause a major problem with day to day function for those unlucky enough to suffer from it.

One of the most recent bits of research shows that there is a genetic connection in some way between frozen shoulder and diabetes. The same genes that leave people predisposed to diabetes might also make them vulnerable to getting frozen shoulder. The alterations in these genes and chromosomes lead to a distorted response to wound healing and scar tissue formation.

For those who have these genes, their body forms more scar tissue than it needs to in response to trauma and it takes longer to reshape and soften scar tissue once it starts. If the capsule of the shoulder sustains a minor injury then it is provoked into forming scar tissue – if too much is formed then pain and reduced movements follow quickly thereafter and a frozen shoulder starts. Diabetics also develop nodules in their palms and feet, another evidence of the exaggerated healing process.

Slow healing and impaired nerve function are also common in diabetic patients – all contributing to the severity and duration of frozen shoulder symptoms.

to the severity and duration of frozen shoulder symptoms. An electronic book by Doctor Gordon Cameron
to the severity and duration of frozen shoulder symptoms. An electronic book by Doctor Gordon Cameron

Frozen Shoulder and How to Survive It

Frozen Shoulder and How to Survive It Frozen Shoulder Diagnosis Is my shoulder frozen? How to

Frozen Shoulder Diagnosis

Is my shoulder frozen? How to diagnose adhesive capsulitis and frozen shoulder

It’s not hard for an experienced doctor to diagnose frozen shoulder – the story that the patient tells and the findings on examination are very typical and tend to be very consistent from one sufferer to another.

Family doctors can find it difficult because they are not familiar with the patterns of pain and symptoms that occur at the shoulder joint. Diagnosing frozen shoulder is all about recognising the movement limitation pattern that develops.

Remember that C5 dermatome

Refresh your memory and take a look back earlier in this book when we spoke about dermatomes and the way that pain spread down embryo segments of our body. Remember that all of the tissues that make up your shoulder come from the same development area of the growing embryo – the fifth segment of the neck. This means that pain from any of these shoulder bits is felt in the same part of the arm – and sometimes all the way to the wrist.

part of the arm – and sometimes all the way to the wrist. What this means

What this means in practice is that it’s not possible to work out which part of the shoulder is inflamed just by asking someone to describe where their pain is. The pain is always in that C5 segment area – it doesn’t matter if it’s being caused by frozen shoulder, arthritis, tendonitis or bursitis.

Even the neck gets in on the act sometimes. If the actual nerve from the fifth part of the neck is inflamed or trapped then it too will send pain all the way down that C5 segment of skin.

Frozen Shoulder Symptoms – Pain is the problem for most people

There is absolutely no doubt that pain is the cardinal and most important symptom in cases of frozen shoulder. Great numbers of patients have told me that, if it wasn’t for the pain, they would be able to get on with their lives even though their shoulder felt stiff or tight.

on with their lives even though their shoulder felt stiff or tight. An electronic book by
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Frozen Shoulder and How to Survive It

Frozen Shoulder and How to Survive It Frozen shoulder pain is felt in the C5 dermatome

Frozen shoulder pain is felt in the C5 dermatome area – and as it becomes more severe it seems to spread all the way down the arm towards the wrist. You can usually tell when recovery is starting because the pain seems to spread back up the arm towards the shoulder – almost as if it was retracing its steps.

The nature of frozen shoulder pain is that it follows a pattern of getting worse and worse for several months until a plateau level is reached. The pain often then remains severe at the plateau level for six or nine months before it settles down again and eventually goes away completely. This pattern corresponds to what are called the “freezing up stage” – the “frozen stage” and the “thawing out stage” of the problem.

Frozen shoulder pain is typically dull and felt like toothache. Sudden movements of the arm can trigger more severe stabs of pain which can be bad enough to make you feel nauseated, sweaty or even faint at times. These sudden severe pains can shoot all the way down towards the wrist or hand.

The pain is often made worse if you try to move your arm or your hand above your head or if you lie on the affected side at night. This inability to use the arm behind your back can make getting dressed and undressed very difficult and can also cause problems with even basic hygiene after using the toilet.

As a general rule, the distance the pain spreads down the arm can be used to judge how irritated the shoulder joint is. Mild inflammation in the capsule causes tolerable pain around the upper arm or shoulder. A badly inflamed capsule will trigger severe, almost unbearable pain, spreading all the way to the wrist.

STIFF – STIFF – STIFF

Pain is only one feature of frozen shoulder – major problems with stiffness is the other and these two terrible twins often follow one another hand in hand. In most cases the more painful your shoulder is – the stiffer it will be – and the more problems you’ll find if you try to move it or lie on it at night.

The stiffness shows itself most prominently when you try to use the arm above your head or if you try to rotate it around behind your back – and it’s this that causes most problems for women trying to dress or undress.

this that causes most problems for women trying to dress or undress. An electronic book by
this that causes most problems for women trying to dress or undress. An electronic book by

Frozen Shoulder and How to Survive It

Frozen Shoulder and How to Survive It Stage One Frozen Shoulder – The Freezing up Stage

Stage One Frozen Shoulder – The Freezing up Stage

The pain and stiffness of a frozen shoulder often just start in a gradual manner. To begin with the pain can be no more than a vague niggle that you might hardly even be aware of. It gradually worsens but there is often very little stiffness to start with and you might not even be aware of anything significantly wrong.

This phase is called Stage One Capsulitis – or “the freezing stage” of the condition. It can last anything from two weeks to two months – it’s a very individual thing for each sufferer.

Pain is the key feature in stage one frozen shoulder. You might be aware of the developing stiffness but it’s not usually enough to limit day to day activity or movement. Many sufferers get all the way to the end of stage one without needing to seek help from a doctor or a physical therapist.

Stage Two Frozen Shoulder – The Frozen Stage

Stage two of the capsulitis picture arrives as the pain reaches its peak intensity and is more or less constantly present. By now it might well be spreading all the way to the wrist and you will be having significant problems sleeping because of the pain. Day to day function is becoming more and more limited as the stiffness worsens and the pain drags you down.

This is true “frozen shoulder” and is absolutely no fun at all when you are struggling along with it.

This second stage of frozen shoulder can last between six and nine months – longer if you have diabetes.

Stage Three Frozen Shoulder – Thawing Out At Last

At last now, we’re heading for home. After many months of suffering the pain begins to ease and movement slowly returns to the stiff joint.

This third phase is very variable in its duration.

Most people with frozen shoulder will go from onset to a full recovery in a period of between twelve and eighteen months – but it’s the length of the thawing out phase

eighteen months – but it’s the length of the thawing out phase An electronic book by
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Frozen Shoulder and How to Survive It

Frozen Shoulder and How to Survive It that often is most unpredictable. A few people find

that often is most unpredictable. A few people find that the pain goes fairly quickly but their shoulder continues to feel stiff for many months longer before it finally gets better.

Medical textbooks nearly always quote a period of about eighteen months from start to end of the condition – but I suppose this is best thought of as an average figure. Some people have fully recovered after only about nine months – others take two years or longer – particularly so in diabetic patients. You can read more about what can be done to help diabetic frozen shoulder recover more quickly elsewhere in this book.

frozen shoulder recover more quickly elsewhere in this book. An electronic book by Doctor Gordon Cameron
frozen shoulder recover more quickly elsewhere in this book. An electronic book by Doctor Gordon Cameron

Frozen Shoulder and How to Survive It

Frozen Shoulder and How to Survive It How does your doctor assess frozen shoulder? These are

How does your doctor assess frozen shoulder?

These are the steps a doctor will normally take when examining your shoulder:

a doctor will normally take when examining your shoulder: Listen to your story This is called

Listen to your story

This is called “taking the history” and it lets your doctor gather the information needed to begin making a diagnosis.

Your doctor needs to know how and when the pain started, where it is now and where it spreads to.

Did you injure yourself or have you been overusing the arm?

Could there be symptoms or patterns that might point to the neck as the source of your problems?

What activities make your pain worse – and what do you do to relieve it?

How is your general health? Would you feel entirely well if it wasn’t for your shoulder pain? How about your health in the past? Are you on any regular medications or treatments? Do any other joints apart from the shoulder give you problems?

Look at the shoulder

A careful doctor will ask you to undress down to your underwear and examine your shoulder for signs of muscle wasting or swelling.

Check out the neck

You know by now of course that your neck can send pain down the arm in the distribution of the C5 neck segment – the same area as pain from your shoulder. Your doctor needs to assess if your pain could be arising from your neck – either completely or partly because both are possible.

Assessing the shoulder

The shoulder joint and the muscles around it need to be checked in a methodical manner. Your doctor will start by examining the joints and then move on in turn to the

will start by examining the joints and then move on in turn to the An electronic
will start by examining the joints and then move on in turn to the An electronic

Frozen Shoulder and How to Survive It

Frozen Shoulder and How to Survive It muscles and the bursa. With practice it’s usually easy

muscles and the bursa. With practice it’s usually easy for an experienced doctor to work out where the problem lies.

If you have a frozen shoulder then your doctor will find the “capsular pattern” of movement loss – and this is described in the box below. It’s a very typical finding in cases of frozen shoulder.

If the problem is coming from the muscles or the bursa then you might well have a full and normal range of movement in the shoulder. In these cases the pain is provoked when your doctor asks you to move your arm in a certain direction while he or she resists your attempts to do this. These so called “resisted movements” test the strength and function of your shoulder muscles. Your attempts to push against the doctor’s hand will reveal either pain or weakness (or both) in the problem muscle.

The Capsular Pattern

Your shoulder can move in many directions but there are only three that are important when it comes to deciding if you have a frozen shoulder or not.

A very typical pattern of restricted movement develops when frozen shoulder is present and this is called the capsular pattern. Its presence helps the doctor to make the diagnosis.

The picture below shows the movement called external rotation of the shoulder. It’s the most important movement when testing for frozen shoulder and it’s the one that is most limited when a capsular pattern is present.

movement when testing for frozen shoulder and it’s the one that is most limited when a
the one that is most limited when a capsular pattern is present. An electronic book by
the one that is most limited when a capsular pattern is present. An electronic book by

Frozen Shoulder and How to Survive It

Frozen Shoulder and How to Survive It Conditions Associated With Frozen Shoulder • Recent Injury Many

Conditions Associated With Frozen Shoulder

Recent Injury Many cases of frozen shoulder seem to follow after an injury to the shoulder joint or to the rotator cuff muscles. The injury can be major or it may seem minor at the time, only for frozen shoulder to develop in the days that follow

Problems in other joints nearby Frozen shoulder can develop in association with arthritis in the neck or in the acromio-clavicular joint.

Prolonged immobility Conditions that lead to the limb being held immobile can trigger a frozen shoulder. These conditions include stroke or brain injury, spinal injury or long immobilisation in a sling after a fracture or dislocation

Heart or lung problems Heart disease or cardiac surgery have sometimes lead to frozen shoulder, as have illnesses like tuberculosis (TB) or cancer

Diabetes Mellitus People with diabetes are much more likely to get frozen shoulder than anyone else. This is discussed in the next chapter of the book.

Other ailments previously shown to be associated with frozen shoulder Parkinson’s disease, high cholesterol or underactive thyroid.

Parkinson’s disease, high cholesterol or underactive thyroid. An electronic book by Doctor Gordon Cameron Page 30
Parkinson’s disease, high cholesterol or underactive thyroid. An electronic book by Doctor Gordon Cameron Page 30

Frozen Shoulder and How to Survive It

Frozen Shoulder and How to Survive It Investigations for Frozen Shoulder Do you need further investigations

Investigations for Frozen Shoulder

Do you need further investigations for a frozen shoulder?

There are no investigations that are needed or essential for the diagnosis of frozen shoulder as such – but your doctor might want to arrange further tests to rule out other conditions that can sometimes mimic the frozen shoulder pattern.

These conditions include arthritis of the shoulder, severe bursitis, a tear in the rotator cuff muscles – and very rarely, serious underlying disease like infection or tumour in the bones. These last two are incredibly rare but a good doctor will always keep issues like that in the back of his or her mind when assessing your problems.

Some commonly used investigations are:

Blood tests

problems. Some commonly used investigations are: Blood tests problems. These are used to help your doctor

problems.

These are used to help your doctor look for other conditions like inflammation or infection, and to rule out diabetes or thyroid

X-ray – standard x-ray pictures can be useful on some occasions. Your doctor might take an x-ray of your neck to check for arthritis or spondylosis in the neck joints. This can cause pain spreading from the neck to the shoulder. A shoulder x-ray can sometimes show calcium in the tendons or muscles of the rotator cuff, or wear and tear arthritis in the shoulder joint itself.

Ultrasound scan or sonogram – this is a useful and quick test for assessing a patient with shoulder pain. These scans are excellent at examining the muscles and tendons around the shoulder and will quickly and clearly reveal the presence of a torn or damaged muscle.

MRI Scan – MRI (magnetic resonance imaging) scanning is a very powerful technology. These scans are complex and relatively expensive but they do provide your doctor with a clear picture of the inner workings of your shoulder. With frozen shoulder, I would normally only arrange an MRI scan if the pattern of pain and stiffness was unusual or if there was a failure to improve or respond to treatment. MRI is a good way of looking for the presence of alternative causes for the patients’ pains. For a very complete look inside the shoulder it’s possible to inject a special die into the joint before doing the MRI test – this is called an MRI Arthrogram.

before doing the MRI test – this is called an MRI Arthrogram. An electronic book by
before doing the MRI test – this is called an MRI Arthrogram. An electronic book by

Frozen Shoulder and How to Survive It

Frozen Shoulder and How to Survive It M R I o f t h e s
Frozen Shoulder and How to Survive It M R I o f t h e s

MRI of the shoulder

It M R I o f t h e s h o u l d e

Shoulder X-ray

h o u l d e r S h o u l d e r X

Shoulder Ultrasound

How long does it take for Frozen Shoulder to get better?

People often ask me how long it will take for their frozen shoulder to get better and the answer is I suppose – “it depends on how you define better”

The textbook view – still often quoted in books, magazines and pamphlets is that full recovery can be expected within eighteen months to two years of onset for most patients. As a kind of rough average, then I suppose that this is a reasonable guide time but do keep in mind what an average means.

If 18 to 24 months is average then by definition there must be a group of people who are better long before eighteen months – and another group who still have symptoms long after two years. You also need to remember that good quality appropriate treatment at an early stage can dramatically shorten the duration of the problem for many people.

Modern research about frozen shoulder recovery times is interesting.

When research teams in Europe looked at frozen shoulder and adhesive capsulitis cases recently they found that in terms of “getting back to normal function” the traditional textbook view is pretty accurate and by the end of two years more than ninety five percent of people had fully returned to the level of function they enjoyed before.

But when the scientists looked at pain levels the results were different. Even after two years a significant number of people still had low level pains on certain shoulder movements. Fifty percent of those the researchers spoke to still had some discomfort at the very end of range of the external rotation movement – although not bad enough to need any painkillers.

movement – although not bad enough to need any painkillers. An electronic book by Doctor Gordon
movement – although not bad enough to need any painkillers. An electronic book by Doctor Gordon

Frozen Shoulder and How to Survive It

Frozen Shoulder and How to Survive It The same is true when the range of shoulder

The same is true when the range of shoulder movement is looked at using a machine called a goniometer. Fifty percent of people still had some loss of range two years down the line – although most were completely unaware of this until the machine pointed it out to them.

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completely unaware of this until the machine pointed it out to them. An electronic book by

Frozen Shoulder and How to Survive It

Frozen Shoulder and How to Survive It Frozen shoulder treatments An Important Message from Doctor Cameron

Frozen shoulder treatments

An Important Message from Doctor Cameron

It’s not my intention that this book should act as a substitute for you seeking attention or help from a doctor or a therapist.

In the sections that follow I will discuss treatment options in

general terms with the aim of allowing you an overview of the big picture. Each of us is an individual and as such any treatment plan needs to be tailored to our specific needs – no book or website can do this for you properly. Please consult a doctor or therapist before beginning any type of treatment.

A large number of other conditions can present with symptoms

and signs that seem similar to frozen shoulder. Some of these

conditions are serious and your health could be at risk if you fail

to obtain a proper diagnosis from a doctor. Please don’t try to

diagnose and treat yourself – it’s just not worth the risk.

to diagnose and treat yourself – it’s just not worth the risk. An electronic book by
to diagnose and treat yourself – it’s just not worth the risk. An electronic book by

Frozen Shoulder and How to Survive It

Frozen Shoulder and How to Survive It General points about frozen shoulder treatment One of the

General points about frozen shoulder treatment

One of the great problems about frozen shoulder is that there is no one standardised way of treating it. Leaving aside the problems mentioned above about diagnosis, it’s clear that even if you are lucky enough to be diagnosed correctly, you still face a bewildering set of choices for treatment.

Lots of different treatment variations have been tried and an internet search will reveal dozens of different approaches open to you. You should be aware that there are only a very few high quality research studies on the subject of frozen shoulder and even then they only focus on a few specific treatment areas. Many of the treatments in common use simply have not been properly tested. This does not mean that they don’t work – just that we don’t have the science to back up any claims made for them.

It’s my plan in this book to give you an overview of the treatments for frozen shoulder based on my own years of extensive experience. Others might quibble with some of the suggestions but at the end of the day I have no particular axe to grind – no unique treatment to sell or promote – only an interest in giving you the best advice I can in an easy to read format.

When you try and assess the claims made for a treatment you need to remember what we call the “natural history” of the condition. The natural history is what happens as time passes, even if no treatment is applied. In frozen shoulder of course, the natural history is for spontaneous improvement and eventual recovery – so take the claims of some therapists or product sales pitches with a pinch of salt at times.

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Frozen Shoulder and How to Survive It

Frozen Shoulder and How to Survive It The aim of frozen shoulder treatment should be either

The aim of frozen shoulder treatment should be either

To relieve pain and make you more comfortable while nature gets on with resolving the underlying problem

or

To speed up the recovery process

You should keep those two bullet points in mind as you read the chapters that follow.

Remember too – that you always have the option with frozen shoulder to simply opt to have no treatment at all.

Now – you’ll have guessed that I’m not just saying that to be flippant or to create a controversy. The “keep it until it gets better approach” is an option that some people really do choose to take.

Frozen shoulder affects us all in different ways and some sufferers seek only an explanation of what is going on in their shoulder before opting to largely ignore it, taking an occasional painkiller, or using a bit of local heat from time to time.

For most people frozen shoulder gets better in a timescale of between twelve and eighteen months from when it started. Sufferers are often about seven or eight months down their path before the diagnosis is made and some find that they can cope with the level of pain and dysfunction. They are reassured to discover that there is no serious disease present and just choose to get on with things.

Many of those with frozen shoulder – possibly you too if you are reading this book – find the pain too severe and the immobility too troublesome not to want to try to do something about it.

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Frozen Shoulder and How to Survive It

Frozen Shoulder and How to Survive It Tips for Living With Shoulder Pain Are you finding

Tips for Living With Shoulder Pain

Are you finding it hard to deal with day to life because of shoulder pain?

If you've been browsing or scouring the internet for information about shoulder pain

then I’m sure you now know a great deal about the condition and how it can be diagnosed or treated. You might already be finding your new knowledge helpful – but

what if you haven't - or if you've gained only partial pain relief?

Read on and discover how to cope more easily with shoulder pain on a day by day basis

Recent Onset Shoulder Pain

If your shoulder pain started only recently – perhaps after a strain or a minor injury or

a fall then you should start by applying the basic principles below. They nearly always help.

Minor injuries that have only slight pain can be treated at home but if you have any doubt about what caused the problem to start – or if things are not showing signs of improving in the first twenty four hours – then you should seek help from a doctor to make a proper diagnosis.

Here are the main ways to deal with a recent shoulder injury:

Rest your arm. Use the injured area as little as possible for the first 2-3 days, and then slowly begin to exercise the injured area. This speeds recovery.

Use Ice:

You can place some ice in a plastic bag, wrap the bag with a towel, and then apply to the injured area for 15-20 minutes every hour. I often tell my patients to buy a cheap bag of frozen vegetables from their local supermarket and use that instead of ice cubes. Again – rap it in a small towel or cloth because directly applying ice can damage the skin. I find that the ice cubes melt whilst the bag of frozen vegetables can be used over and over again. You can also buy reusable cold packs from sports goods shops or online.

Elevate the arm:

Prop the arm up on pillows on the arm of your chair or sofa. Elevation of the injured area above your heart helps prevent and then reduce any swelling or

area above your heart helps prevent and then reduce any swelling or An electronic book by
area above your heart helps prevent and then reduce any swelling or An electronic book by

Frozen Shoulder and How to Survive It

Frozen Shoulder and How to Survive It bruising in the muscles and tissues. This reduces your

bruising in the muscles and tissues. This reduces your pain and will lead to a quicker recover.

Take Pain Killers:

Paracetamol (Tylenol) or Ibuprofen (Nurofen, Advil, Motrin) can help control swelling and pain. Don’t take painkillers for more than a few days without reassessing the situation. If things are not improving or if you find you need more and more painkillers then see your doctor for a check up and a diagnosis.

Will Heat Help?:

Most textbooks say that you should not use heat in the first week because in theory it can increase the swelling in the injured area and worsen your pain. I have to say that I am unsure that this is true for most patients. Of course, if you have a shoulder that feels hot to the touch and is obviously swollen then heat may make it feel worse. In my experience however, this is rarely the case, and you might want to experiment for yourself to see if heat or ice work best for you.

Top tips for chronic shoulder pain relief

Chronic pain occurs when the pain of an acute injury fails to settle – or when the underlying condition is not one that will simply vanish or heal in a few days or weeks.

Frozen shoulder is a good example of this kind of condition.

What follows are my best "top tips" for surviving the chronic shoulder pain ordeal or on dealing with your symptoms until either nature works her magic or a specialist steps in to help you out.

I’ve put these tips together for you based on my own twenty year experience in the field – and I know you will find them a real boost to morale.

Remember to stay positive – you’ll get through this soon and before you know it you’ll be back to full normal function without pain or discomfort.

So – how do you live with chronic shoulder pain?

or discomfort. So – how do you live with chronic shoulder pain? An electronic book by
or discomfort. So – how do you live with chronic shoulder pain? An electronic book by

Frozen Shoulder and How to Survive It

Frozen Shoulder and How to Survive It Tip One: Keep your shoulder warm I know that

Tip One:

Keep your shoulder warm

I know that it almost sounds too obvious but it works! Unlike a recent injury, where ice is the treatment of choice for many patients, gentle warmth is much better for chronic shoulder pain.

Use warm or hot compresses (or buy a heating pad) and use it over your shoulder four or five times a day for fifteen minutes at a time. It also works well applied in your armpit - the warmth travels up into the shoulder.

Many of my shoulder pain patients have also found great relief - particularly at night - by using a heated pad or thermal blanket.

I keep a list of products that other shoulder patients have found helpful on my website.

You can check it out here:

www.jointenterprise.co.uk/gallery-UK.htm

I’m often asked if ice or heat is the best options for chronic shoulder pain.

As above, my answer is that heat is almost always best in the chronic situation, although for a few conditions like gout or rheumatoid arthritis -where inflammation is the main issue - ice can also be effective and quick at giving relief.

Tip Two:

Sleep with an extra pillow

No - not for your head, but place the pillow under your shoulder on the affected side.

Loss of sleep at night makes it much harder to cope with pain during the day and if you roll onto the painful shoulder when asleep you will wake up in pain.

Sleep on your back with the extra pillow under your sore shoulder.

Try an adjustable wedge pillow or a water filled pillow which will conform to your body shape and contour - this is particularly good if you have both neck and shoulder pain.

- this is particularly good if you have both neck and shoulder pain. An electronic book
- this is particularly good if you have both neck and shoulder pain. An electronic book

Frozen Shoulder and How to Survive It

Frozen Shoulder and How to Survive It Neck and shoulder pain often go together and you

Neck and shoulder pain often go together and you can read more about this unpleasant combination in

Tip Three:

Massage helps a painful shoulder

In many cases the pain of shoulder problems does not only come from the joint because the surrounding muscles which become very tired and tense are also a very potent source of pain.

Nature makes the muscles hold themselves very tight in response to the pain and they become tender and knotted up very quickly.

Massage of these muscles can produce good short term relief of pain.

A family member, a friend or professional masseur could help with this.

Shoulder massage has been proven to improve range of motion and ease the pain associated with shoulder problems. However, not only does shoulder massage help you get pain relief, this therapy treatment also help the body in many other amazing ways.

Shoulder massage – even if done at home with a simple device can:

improve blood circulation to tense and strained muscles

provide deep relaxation and improved flexibility to the massaged muscle

stimulate your lymph system – bringing repair cells to the damaged and tender region

stimulate the release of endorphins, the body’s natural painkillers

speed up the elimination of your body waste

block pain signals’ pathways to your brain and provide a natural sense of well being

Here’s a simple home massage technique for shoulder pain:

Start by squeezing your injured shoulder with the opposite hand.

Then, kneed the shoulder repeatedly.

with the opposite hand. Then, kneed the shoulder repeatedly. An electronic book by Doctor Gordon Cameron
with the opposite hand. Then, kneed the shoulder repeatedly. An electronic book by Doctor Gordon Cameron

Frozen Shoulder and How to Survive It

Frozen Shoulder and How to Survive It You can also make circular pressure with your fingertips

You can also make circular pressure with your fingertips on both sides of your spine. Try applying penetrating massage oil to the shoulder to ensure smooth movements.

You can also incorporate heat and cold into your shoulder massage. Applying ice to your sore shoulder will reduce both inflammation and pain, while heat relaxes your tense muscles for additional pain relief.

Read more about shoulder massage in the chapter below.

Tip Four:

Use dietary supplements for your shoulder pain

Natural products like glucosamine or fish oils have been shown to ease joint pains and stiffness. Some herbal remedies have pain relieving properties. In my experience this approach does not always work for everyone but it might be worth a try for your shoulder pain – patients with chronic problems like frozen shoulder seem to gain particular benefit from diet supplements.

Glucosamine helps many people. Our body requires glucosamine for the synthesis of important building block proteins for our joints and muscles. Glucosamine sulphate is the dietary supplement most frequently used by patients who suffer from osteoarthritis and joint pains.

Lots of research now shows that glucosamine can reduce shoulder and joint pain symptoms. The recommended daily dosage of this supplement is one capsule of 1500mg per day or three capsules of 500mg a day.

Chondroitin also helps – particularly if taken at the same time as glucosamine. The recommended dosage of Chondroitin is 200mg to 400mg taken two to three times every day.

Other supplements to consider for your joint pain include Turmeric, magnesium and fish oils. Cod liver oil by mouth – although sometimes seen as rather old fashioned these days – is often very effective.

Did you know that turmeric has been used since ancient times to reduce joint inflammation? Turmeric contains the active ingredient curcumin, which exerts its anti-inflammatory effect by inhibiting COX-2, prostaglandins and leukotrienes, thereby improving symptoms of joint pains. Though there is no typical dosage and there is insufficient scientific evidence to support its efficacy in alleviating joint pains, turmeric can be safely consumed when added to food as a spice.

turmeric can be safely consumed when added to food as a spice. An electronic book by
turmeric can be safely consumed when added to food as a spice. An electronic book by

Frozen Shoulder and How to Survive It

Frozen Shoulder and How to Survive It Eastern medical traditions like Ayurvedic medicine include turmeric in

Eastern medical traditions like Ayurvedic medicine include turmeric in many healing remedies.

Bee Happy - A shoulder pain buzz !

I’ve had particular success recently with products based on honey bee venom. The use of honey bee venom is based on the long-known fact that bee keepers (who often get stung) very rarely develop arthritis or problems with their joints and muscles.

develop arthritis or problems with their joints and muscles. Now - the braver amongst you (not

Now - the braver amongst you (not including me I hasten to add) might volunteer for traditional "bee sting therapy" where you are subjected to repeated stings from a succession of bees held in tweezers! Personally I think I would just keep my shoulder pain thanks …. But there is a good and viable alternative way of doing it.

Most of us would feel more comfortable simply applying the bee sting venom in the form of a balm to be rubbed into the painful or stiff area and you can now purchase bee venom balm online at a very reasonable price.

I’ve included a link to purchase Bee Venom Balm in my page of recommended shoulder products. Do try it – it really does help many people and it’s relatively inexpensive.

In truth, I was a bit sceptical about all of this at first, but a large number of my patients have had great benefit from its use and I recommend you give it a try if you are interested. It's certainly a very natural way to obtain pain relief.

Tip Five:

Buy or borrow a TENS machine

TENS - or trans-cutaneous electrical nerve stimulation is a good and safe way to induce pain relief and some muscle relaxation.

It works by stimulating the skin nerves and thus encourages the brain to pay less attention to the incoming pain signals from the joint.

to pay less attention to the incoming pain signals from the joint. An electronic book by
to pay less attention to the incoming pain signals from the joint. An electronic book by

Frozen Shoulder and How to Survive It

Frozen Shoulder and How to Survive It A TENS machine works by sending small electrical pulses

A TENS machine works by sending small electrical pulses through the body via

electrodes placed on the skin. It is thought that TENS machine affects the ways that pain signals are sent to the brain.

All pain signals that the brain receives are sent via the nerves and the spine of a person’s body and therefore if the pain signals can be blocked then the brain is likely to receive fewer signals from where the pain source originates from, which results in the patient feeling less pain.

A TENS machine probably works in two ways. Firstly, when the machine is set on a

high pulse rate of 90-130Hz it will trigger the “pain gate” to close and this in turn is

thought to block the pain nerve path to the brain.

However, if the machine was set on a low pulse rate say 2-5Hz it will stimulate the patient’s body into making its own pain easing chemicals called endorphins. They act

in a similar way to morphine by blocking the pain signals to the brain. This combined

action often provides good and rapid pain relief. TENS machines are very portable

and you can wear it discretely without anyone realising.

and you can wear it discretely without anyone realising. Now – you’ll realise of course that

Now – you’ll realise of course that TENS does not seem to work for everyone but may be well worth a try – I find it is particularly good when there is a lot of muscle tenderness around the shoulder. If you can feel a lot of tender trigger spots in your muscles then you should seriously think about giving TENS a try.

There are a range of TENS machines available on the market and, if you are interested, then I suggest that you go for a mid- priced model such as the Meditens XP (shown above) which I’ve included on my products recommendation page. It will offer you good reliability and flexibility at a reasonable price.

Tip Six:

Strap or support the arm from time to time

If your shoulder is painful then support from a simple strap or shoulder support wrap

can be of great value. Be careful of strapping too much – or for too long at a time - because you may simply encourage the shoulder to stay stiff for longer.

A number of strapping products are available

stay stiff for longer. A number of strapping products are available An electronic book by Doctor
stay stiff for longer. A number of strapping products are available An electronic book by Doctor

Frozen Shoulder and How to Survive It

Frozen Shoulder and How to Survive It Tip Seven: Consider short term medication to improve sleep

Tip Seven:

Consider short term medication to improve sleep

People are naturally concerned about becoming dependent on sleeping medication - justifiably so. But for short term use there is no risk of dependency or addiction.

Consider asking your doctor for a sedative medication if your shoulder pain is stopping you from sleeping well.

You should also take analgesic medication if your pain is interfering with work or your normal daily life. There’s always a balance to be found between pain relief and the side effects that medications can bring but in my experience of shoulder pain the short term use of moderately strong pain relieving tablets is nearly always useful.

Tip Eight:

An injection might help your pain

Many of us are wary of having injections – fearing that the injection will either be more painful than the condition, or that the drug injected might cause us some kind of harm.

Neither of these two fears is justified in respect of shoulder steroid injections.

An injection done by an experienced doctor will nearly always be tolerable and no more than mildly uncomfortable during the procedure. The drug injected is simply an anti-inflammatory agent designed to ease pain and relief inflammation in the local area.

You can read a great deal more about injections for shoulder pain relief below.

a great deal more about injections for shoulder pain relief below. An electronic book by Doctor
a great deal more about injections for shoulder pain relief below. An electronic book by Doctor

Frozen Shoulder and How to Survive It

Frozen Shoulder and How to Survive It Medications to Treat Frozen Shoulder There are several approaches

Medications to Treat Frozen Shoulder

There are several approaches to taking oral medication as a treatment for frozen shoulder. Some are aimed at simply easing the pain while nature gets on with the cure inside. Other medications are trying to modify the inflammation process inside the shoulder and by doing this to shorten the duration of symptoms and make the pain and stiffness better.

For the most part the intention behind taking medication for frozen shoulder is to relieve the pain.

Oral medication does work for many people – but only up to a point. If your frozen shoulder is in stage one or stage three (the freezing up or the thawing out stages) then you might well be able to find a decent level of pain relief and function from relatively mild analgesia. If you are unlucky enough to be in stage two then the pain is often more severe and the painkiller needed is likely to cause you side effects like drowsiness, nausea or constipation – to name only a few of the possible problems you can experience.

Simple Painkillers

Simple oral painkillers that you can purchase without a doctor’s prescription can sometimes help take the edge off frozen shoulder pain. Drugs like paracetamol (Tylenol) or ibuprofen (Advil) may allow enough pain relief for the frozen shoulder victim to cope during the day. This type of medication is simply trying to mask the pain or to take the edge off the worst pain episodes. It will have no effect on the longer term aspects of the condition.

As a general rule you should aim for the level and dose of painkiller that gives you decent pain relief and function without producing intolerable side effects. In my experience there is always a trade off between taking strong enough medication to ease the pain but not so strong that you feel unwell with it. This balance is not always easy to achieve.

Oral anti-inflammatory tablets

These medications are intended to reduce the inflammation inside the joint capsule. Drugs in this category might include diclofenac (voltarol or voltarin), celecoxib (celebrex) and piroxicam (feldene).

or voltarin), celecoxib (celebrex) and piroxicam (feldene). An electronic book by Doctor Gordon Cameron Page 45
or voltarin), celecoxib (celebrex) and piroxicam (feldene). An electronic book by Doctor Gordon Cameron Page 45

Frozen Shoulder and How to Survive It

Frozen Shoulder and How to Survive It The research that has been published shows that they

The research that has been published shows that they are often relative ineffective for frozen shoulder pain. Many of them cause significant side effects elsewhere in the body and in general I don’t often use them for frozen shoulder treatment.

Oral steroid tablets

Giving frozen shoulder patients steroid tablets by mouth is an interesting new development for the treatment of frozen shoulder. The research that has been done seems to show a very good outcome – particularly if the steroid tablets are given in the early months of the freezing up stage.

Steroid tablets are good at switching off inflammation pathways and doctors think that they can reduce the inflammation and reduce the stickiness inside the joint capsule – leading to less stiffness, less pain and a quicker recovery time.

Steroid tablets too are not without side effects elsewhere in the body and can only be given under the supervision of an experienced doctor – but having said that – they do seem to work well for many patients.

having said that – they do seem to work well for many patients. An electronic book
having said that – they do seem to work well for many patients. An electronic book

Frozen Shoulder and How to Survive It

Frozen Shoulder and How to Survive It Natural Treatments for Frozen Shoulder Many of us nowadays

Natural Treatments for Frozen Shoulder

Many of us nowadays have become jaded and in truth a bit suspicious of the way’s that modern medicine approaches the topic of pain relief and healing. We are drawn towards what seems to be the more balanced approach offered by alternative therapists or complementary therapists who try to see our pain in a more holistic framework – they try to treat the “whole person” in other words – not just the body part that is complaining at the time.

Complementary and natural treatments tend to be practiced outside the normal medical settings and by people who are not trained as doctors. As time goes by some of these treatments – like acupuncture for example – are being adopted into hospitals to work alongside traditional medical treatments. Other techniques like reflexology or shiatsu are still on “the outside” as it were, waiting in the wings.

I’m not trained in any particular complimentary treatment approach so the only real advice I can give you is based on what my patients have told me or on the published scientific evidence.

So – what evidence is there for using complementary treatments for frozen shoulder treatment?

Well, and I don’t mean to sound at all negative about this, it depends who you ask. Those who practice these techniques often make great and heartfelt claims for them and what they can do for pain relief, but my problem is that the evidence just isn’t there from a scientific point of view. This is not saying that alternative treatments don’t work because many of them do seem to help people - but unlike conventional medicine there is no research that allows us to judge which treatment will help which patient.

I am certainly not against the idea of you trying a complementary treatment for your frozen shoulder pain and the sections below outline some of the options. But go cautiously and don’t spend too much money unless you really know for sure that you are getting benefit.

So

is the right approach for you? And secondly – how can you figure out which alternative therapy to try.

if you have shoulder pain, how do you first of all decide if an alternative therapy

pain, how do you first of all decide if an alternative therapy An electronic book by
pain, how do you first of all decide if an alternative therapy An electronic book by

Frozen Shoulder and How to Survive It

Frozen Shoulder and How to Survive It Herbal Medicine for Pain Relief Nowadays, a lot of

Herbal Medicine for Pain Relief

Nowadays, a lot of people are going back to their roots, quite literally. Herbal medicines are not fad products but are actually seen as scientifically based natural pain relief alternatives. These alternative pain killers are considered as “back ups” or the next best option after the use conventional medicines. Herbal medicines have become an attractive option since Western medicines are relatively costlier than natural pain relief products. A great many people now also see herbal medicines as more natural and therefore safer than traditional medicines for pain control. This is true up to a point but – like all other therapies – it’s best not to try to self medicate and you should seek help from a qualified herbalist before you consider this kind of treatment.

One of the problems with herbal treatments is that they often take some time to achieve good results for pain relief. This has made it difficult to design research to prove that they work. Many pain conditions either get better on their own as time passes or wax and wane in severity. This can make it hard to know if improvement in pain levels has been due to the herbal medicine or simply to the passage of time.

While you can be pretty much assured of having little or no side effects from herbal treatment, most doctors would like to see more research done to determine the curative value of many herbal products out in the market today.

If you do want to try herbal pain relief then ideally you should seek a consultation with a qualified herbalist but the following are products in common use.

White Willow

A popular herbal pain relief remedy is white willow (Salix alba). The bark of the

willow contains a product called salicin that is effective for both acute and chronic pain. This product has been used in ancient Chinese and Ayurvedic medicine, as

well as by Native American Indians. It is sometimes called 'nature's aspirin' because

of the similarity of the ingredients. Aspirin’s chemical name is salicylic acid and like

many other mainstream medicines it was originally derived from plants.

Fish Oils

If your pain is mostly due to inflammation then you could find relief from using fish oil supplements. Fish oils have helped those suffering from a wide range of conditions including various types of arthritis and back pain. Chronic shoulder pain often

types of arthritis and back pain. Chronic shoulder pain often An electronic book by Doctor Gordon
types of arthritis and back pain. Chronic shoulder pain often An electronic book by Doctor Gordon

Frozen Shoulder and How to Survive It

Frozen Shoulder and How to Survive It responds very well to this treatment. Fish oil products

responds very well to this treatment. Fish oil products contain omega-3 fatty acids, which are known to have natural anti-inflammatory properties.

Comfrey Another popular herbal remedy for pain is comfrey. Comfrey is also called by the

traditional name 'boneknit' – because in years gone by it was used by natural healers

to treat the pain and problems associated with fractures or broken bones. It is also

useful for wounds and lacerations when applied as a poultice or pack. The root of this product can be made into a tea or you may find it available in tablet form in herbal or health food shops.

Barberry Root Taken in tea form, barberry root is best for those who have rheumatoid arthritis. The practice of using barberry roots also came from the Native Americans who used it for back pain, arthritis and even cancer. This root also has no negative side effects, though some may regard it as out of date.

Black Cohosh

A Native Indian remedy, black cohosh is used often for dysmenorrhoeal pain during

menstruation. This herb's composition is deemed to have anti-inflammatory properties. This will help in the soreness of joints due to arthritis. It will also help in the relief of pain experienced by the patient. This is often mixed with other herbs like willow bark and guaiacum for arthritis relief.

Cider Vinegar This is recommended for patients who suffer from rheumatoid arthritis. It is also a well-known remedy for those who want to lose weight. The sour taste often repulses those who take it. But if you don't mind the taste, this may help you.

Alfalfa Alfalfa can be eaten or boiled like tea. This is believed to have bone strengthening properties. This type of herb also contains high concentrations of Vitamin K. It also contains protein, Vitamin D, Iron and calcium that may help build stronger bones

Celery The seed of this popular vegetable is ingested to improve symptoms of arthritis. Considered primarily for its medical value before it found its way to our tables as a vegetable, celery is known a good diuretic which is the main reason for its healing

is known a good diuretic which is the main reason for its healing An electronic book
is known a good diuretic which is the main reason for its healing An electronic book

Frozen Shoulder and How to Survive It

Frozen Shoulder and How to Survive It property. Potassium deficiency is often identified with rheumatoid arthritis

property. Potassium deficiency is often identified with rheumatoid arthritis and celery's abundance of this mineral may help with this problem.

Menthol Because of its cooling property, menthol is used for quick pain relief on muscles and joints. Another herb with analgesic, menthol is known for its soothing capabilities. This natural pain reliever is commonly added to creams to produce another example of natural arthritis treatments.

Camphor Liquid concentrations of camphor are massaged to the aching area afflicted with arthritis. This oil is natural analgesic and anti-inflammatory and could be used for dealing with arthritic pain. Use of this oil should be limited as it may be toxic when taken improperly

Emu Oil From the emu bird common to the Australian outback, the oil extracted from the animal is an Aboriginal remedy for curing arthritis. Unlike other medications, emu oil has no side effects that make it a safer choice among arthritic patients. This is not commonly known among Americans but its popularity is increasingly catching up. Australian studies show that there is significant pain relief among arthritic patients who use emu oil.

pain relief among arthritic patients who use emu oil. Dandelion Also known for its pain relieving

Dandelion Also known for its pain relieving properties, dandelion is claimed to be rich in potassium like celery. It contains high concentrations of Vitamin A. This is also a diuretic and helps the liver in straining the wastes out of our system.

Although herbal remedies are based on natural products, that does not mean to say that they are totally free of any adverse effects. Many of them are benign, but people react in different ways. What may be totally harmless to a thousand people may affect the next person. If you are planning on using them, you should always be aware of this fact. Don’t use herbal remedies to treat long term shoulder pain without seeking advice from a herbalist or a pharmacist.

pain without seeking advice from a herbalist or a pharmacist. An electronic book by Doctor Gordon
pain without seeking advice from a herbalist or a pharmacist. An electronic book by Doctor Gordon

Frozen Shoulder and How to Survive It

Frozen Shoulder and How to Survive It You also need to remember that herbal treatments can

You also need to remember that herbal treatments can react very badly with medicines you might be taking for other reasons.

Diet Supplements

The most common nutritional supplements physicians recommend for joint pain relief are glucosamine and chondroitin. These two molecules occur naturally in the joints of all humans and are the foundation of healthy bones and joints. In a damaged joint, glucosamine and chondroitin are in short supply and the body doesn't have the raw materials necessary to build new cartilage. With regular supplementation, however, the body has an advantage and can actually repair the damage caused by osteoarthritis.

This is in sharp contrast to commonly prescribed non-steroidal anti-inflammatory drugs that only reduce inflammation temporarily and do nothing to improve the condition of the damaged joint.

and do nothing to improve the condition of the damaged joint. An electronic book by Doctor
and do nothing to improve the condition of the damaged joint. An electronic book by Doctor

Frozen Shoulder and How to Survive It

Frozen Shoulder and How to Survive It Acupuncture for Pain Relief Another method of natural pain

Acupuncture for Pain Relief

Another method of natural pain relief is Acupuncture. It is an important branch of traditional Oriental medicine that dates back more than 2,000 years ago. This involves piercing the skin with needles in specific points of the body.

Many people believe that Acupuncture prevents and cures illnesses but the western type research on this is limited. When it comes to pain treatment however there is now a great deal of science type research backing up acupunctures claims as an effective method for pain relief – so much so in fact that many hospital pain clinics now routinely include an acupuncture specialist on their staff.

Acupuncture treatment can be applied in the style of traditional Chinese medicine when a whole body or whole person diagnosis will be made before treatment starts – or in a Western medicine style when the acupuncture needles are inserted near to the painful area.

Modern research shows that nerve pathways are stimulated and the brain is provoked into releasing pain killing chemicals when acupuncture needles are inserted. Anti-inflammation chemicals are also released near to the point that the needles are inserted.

The needles themselves are tiny and are inserted at certain points of the body – some near to the pain and some further away at so called “distal points”. In traditional terms these needles disperse built up energy (or CHI) and bring it back to the normal level. In western terms the needles provoke the release of local and brain centre chemicals that trigger pain relief. The acupuncturist will twist and turn the needles slightly after they are in place and will also sometimes use electrical currents, as well as pressure, heat, and cold.

Chinese herbs may be used in combination with the acupuncture for joint therapy treatment.

Most modern acupuncture needles are made in sterile containers and used only once before being disposed of. Some traditional Chinese practitioners use needles more than once and sterilise them between patients. You should take care to ask about this and to reassure yourself that the sterile precautions are adequate before you have treatment.

Most acupuncturists or traditional medical practitioners also work with prevention in mind. Certainly, they focus on the pain you have but they will also try to attempt to correct the slightest imperfections in our bodies before they become dangerous health problems.

in our bodies before they become dangerous health problems. An electronic book by Doctor Gordon Cameron
in our bodies before they become dangerous health problems. An electronic book by Doctor Gordon Cameron

Frozen Shoulder and How to Survive It

Frozen Shoulder and How to Survive It An acupuncturist should take a complete history from you

An acupuncturist should take a complete history from you and be prepared to look beyond your shoulder symptoms – trying to understand your overall health and lifestyle.

symptoms – trying to understand your overall health and lifestyle. An electronic book by Doctor Gordon
symptoms – trying to understand your overall health and lifestyle. An electronic book by Doctor Gordon

Frozen Shoulder and How to Survive It

Frozen Shoulder and How to Survive It Physical therapy and exercises There is always some debate

Physical therapy and exercises

There is always some debate about the place of physical therapy or home exercises in the treatment of frozen shoulder.

Some research studies suggest that physiotherapy like exercises, or stretches either do no good at all – or may even aggravate and prolong the condition. Other research suggests that the opposite is true. Like all these medical issues, the truth probably lies somewhere in between.

In my own experience of treating thousands of people with frozen shoulder the key to exercises or physical therapy is to work out which stage of frozen shoulder you are in.

If you are in the freezing up stage then your joint will be very inflamed inside and any attempts to move it, exercise or stretch is likely to make your pain worse and the inflammation more severe. Physical therapy or exercises are probably not a good idea in the first stage (the freezing up stage) of frozen shoulder.

In the second stage of frozen shoulder, the joint is so stuck and frozen that no real stretching or exercising is possible – so there is no sense in wasting time and money getting physical therapy. It just simply isn’t going to help. Once you are in the frozen solid phase of the condition, it’s often a matter of just sitting tight until nature begins the thawing out.

It is my view that physical therapy, stretches and exercises really come into their own in the thawing out phase or third phase of a frozen shoulder. The joint is not any longer inflamed. The pain is decreasing naturally day by day and there is a bit of stretchy elasticity coming back into the tight capsule. This is the time and the phase to work with a physical therapist. Good quality and supervised exercises and stretches can really make a difference and will see you over the final hump before full recovery begins.

and will see you over the final hump before full recovery begins. An electronic book by
and will see you over the final hump before full recovery begins. An electronic book by

Frozen Shoulder and How to Survive It

Frozen Shoulder and How to Survive It Steroid Injections for Frozen Shoulder Steroid injections do work

Steroid Injections for Frozen Shoulder

Steroid injections do work for frozen shoulder – that’s the first and most important point to make in this section – but as with exercises, you need to choose your timing well to get the best effect.

The key points about injections for frozen shoulder are these:

In a real sense, an injection into or around the shoulder is just another way of delivering anti-inflammatory medication. The concept is almost identical to the description of taking oral steroid treatment by mouth described above. The injection simply is targeting the drug directly to where it is needed.

Injections, like medication described above, provide pain relief. In my experience injections work effectively in all stages of frozen shoulder, but are particularly effective in the stage two or the true frozen phase of the condition.

The injection for frozen shoulder is usually a mixture of local anaesthetic (such as your dentist would use) and a steroid anti-inflammatory drug that works where it is placed but without much effect elsewhere in the body. Different doctors might use slightly different techniques but the end result is the same.

There is always the chance of a small amount of the steroid drug having an effect elsewhere in the body so I always warn diabetics that their blood sugar might run higher than normal for a few days. Occasional patients also get short lived sweats or flushes for up to forty eight hours.

Injections do indeed work for many patients - but again - only as effective means of obtaining pain relief. They don't alter the course of the condition.

Some patients do gain a slight easing of the stiffness after an injection but this is not a consistent outcome.

Most patients who have an injection get substantial or full pain relief that can last for many weeks or months. It depends a bit on the stage of the frozen shoulder but one injection is often sufficient to obtain lasting relief. Some people need a second or even a third injection if they wish to remain pain free.

a second or even a third injection if they wish to remain pain free. An electronic
a second or even a third injection if they wish to remain pain free. An electronic

Frozen Shoulder and How to Survive It

Frozen Shoulder and How to Survive It The next few pages go into much more detail

The next few pages go into much more detail about injections for frozen shoulder treatment

into much more detail about injections for frozen shoulder treatment An electronic book by Doctor Gordon
into much more detail about injections for frozen shoulder treatment An electronic book by Doctor Gordon

Frozen Shoulder and How to Survive It

Frozen Shoulder and How to Survive It Steroid Injections for Frozen Shoulder Steroid Injections Should you

Steroid Injections for Frozen Shoulder

Steroid Injections

Should you have a steroid injection for your shoulder pain?

The information in this report is written about having a steroid injection into the shoulder or into the soft tissues or gristle around the shoulder. The basic facts here also apply to steroid injections into and around the joints in elsewhere in the body.

You should keep in mind that the end result success of a steroid injection will depend first of all on an accurate diagnosis and secondly on the doctor treating you

being skilled enough to deliver the injection into the part of the shoulder that is at fault. This seems self evident but some doctors who do shoulder injections have only

a limited range of techniques available to them. This can lead to an apparent failure

to respond to an injection when the real issue is that the injection may not have been

given into the correct place.

Injections of steroids can help many shoulder problems. The injections work by reducing the inflammation and allowing you to move your shoulder more comfortably.

If you do have an injection into or around the shoulder then you should try not to use

your shoulder for anything too strenuous in the first 2 weeks afterwards. I tell people

that they should do “active rest” – and by that I mean that they can wash, clothe and feed themselves, but should avoid anything more active than that until the injection has had a chance to take effect.

Some people find that their pain can seem worse the night after an injection but this does not mean that the injection has gone wrong. You only need to see your doctor or to look for more medical advice if this “after pain” continues for more than twenty four hours. This initial worsening is sometimes called the post injection flare.

For many people an injection is all that is needed to allow recovery, but for some people the problem can come back and in this case you may need more investigations. You can read more about this below.

There are usually very few side-effects from steroid injections and the injections can be repeated if necessary – again, details of side effects are explained in more depth below.

again, details of side effects are explained in more depth below. An electronic book by Doctor
again, details of side effects are explained in more depth below. An electronic book by Doctor

Frozen Shoulder and How to Survive It

Frozen Shoulder and How to Survive It What shoulder conditions might benefit from a steroid injection?

What shoulder conditions might benefit from a steroid injection?

The following list is not exhaustive but gives you a good idea of the kind of conditions that injection can help with.

Injection into the shoulder joint:

helps with osteoarthritis, frozen shoulder or adhesive capsulitis, rheumatoid arthritis and rotator cuff tendon or muscle problems.

Injection into the acromio-clavicular joint:

good for acromio-clavicular joint problems and pain – for example osteoarthritis of the AC joint which is quite a common cause of shoulder pain in people over 50 years.

Subacromial injections:

works well for subacromial bursitis (bursitis often arises out of the blue but may also rarely occur in gout, trauma or rheumatoid arthritis), impingement syndrome and rotator cuff tendinosis.

Subacromial injections are often effective for improvement for rotator cuff tendinitis for up to 9-months. The research shows that they are more effective and have less side effects than oral anti-inflammatory medication.

Bicipital groove injections:

injection is the best treatment for biceps tendonitis

What can a steroid injection around the shoulder achieve?

A steroid injection is usually tried after other therapeutic interventions such as non- steroidal anti-inflammatory drugs, physical therapy, and activity-modification have not resulted in good pain relief. Some doctors will offer you an injection almost as the first treatment but normally patients will work their way towards an injection by trying other options first.

In a real sense, an injection into or around the shoulder is just another way of delivering medication - targeting it directly to where it is needed. Injections, like other oral medications, provide pain relief.

In my experience a steroid injection will work effectively in many different shoulder conditions including frozen shoulder. With some of the stages of frozen shoulder a well placed injection is probably the only way to get relief from the pain that many patients experience.

only way to get relief from the pain that many patients experience. An electronic book by
only way to get relief from the pain that many patients experience. An electronic book by

Frozen Shoulder and How to Survive It

Frozen Shoulder and How to Survive It Research studies have shown that an injection for rotator

Research studies have shown that an injection for rotator cuff problems like impingement or a joint injection for frozen shoulder or arthritis are often helpful although some research shows that the effect may not be one hundred percent relief of pain and sometimes the problems can come back after the injection wears off.

What's injected for shoulder pain treatment?

Injections for shoulder pain are usually a mixture of local anesthetic (like your dentist would use) and an anti-inflammatory drug that works where it is placed but without much effect elsewhere in the body. Scientists have found that a small amount of the injected steroid works its way into your blood stream but the amount is not large and the effect quickly passes.

Technically the anti-inflammation drug is from the steroid family but does not carry the same adverse effects as the body building type of steroid we often read about in the press.

Commonly used steroid drugs for shoulder injections include triamcinolone, depomedrone and, less often, hydrocortisone. These are very different in their action from other dangerous steroids.

Do shoulder injections work?

Shoulder injections do indeed work for many patients - but again - only as effective means of obtaining pain relief. They don't usually alter the course of the condition.

With frozen shoulder, some patients do gain a slight easing of the stiffness after an injection but this is not a consistent outcome.

Most patients who have an injection get substantial or full pain relief that can last for many weeks or months. It depends a bit on the stage of the frozen shoulder or on how inflamed the tendons or bursa are but one injection is often sufficient to obtain lasting relief. Some people need a second or even a third injection if they wish to remain pain free. Most shoulder specialists would want to arrange further investigation if the first or second injection does not result in a significant benefit.

If injections fail to work it is usually for one of these two reasons:

the doctor doing the injection is inexperienced and has not managed to get the injection into exactly the correct spot

has not managed to get the injection into exactly the correct spot An electronic book by
has not managed to get the injection into exactly the correct spot An electronic book by

Frozen Shoulder and How to Survive It

Frozen Shoulder and How to Survive It • the underlying problem is related to damage or

the underlying problem is related to damage or degeneration in the tissues of the shoulder – causing the symptoms to come back as soon as the initial effects of the injection wear off.

Where does a shoulder injection go?

Different doctors will use slightly different techniques to perform the injection into your shoulder. There is no "right or wrong" approach - only personal preference on the part of the doctor.

I usually perform injections from the back of the shoulder. I find it easier this way and it has the extra advantage that the patient doesn't have to look at the needle!

Your doctor will have decided which part of the shoulder is causing the problem. It could be the joint, the tendons or the bursa. The doctor will aim to deliver the injection solution into or around the part of the shoulder that is causing the problem.

around the part of the shoulder that is causing the problem. If an injection into the

If an injection into the Acromio-clavicular joint (sometimes called the AC Joint) is needed then it usually goes into the top part of your shoulder.

For frozen shoulder or arthritis, research has shown that it doesn't really matter if the liquid gets inside the joint or not. The results are just as good if the steroid drug is simply injected near to the joint capsule.

if the steroid drug is simply injected near to the joint capsule. An electronic book by
if the steroid drug is simply injected near to the joint capsule. An electronic book by

Frozen Shoulder and How to Survive It

Frozen Shoulder and How to Survive It Your doctor will choose the dose of steroid you

Your doctor will choose the dose of steroid you need and the size of the needle depending on your overall body size and on the particular bit of your shoulder that needs injected.

Are there any side effects of injections for painful shoulder?

Steroid injections are generally very safe and the vast majority of patients have absolutely no side effects whatsoever.

The commonest side effect after an injection into or around the shoulder joint is a temporary increase in pain. If it happens this will only last for about twenty four hours before it settles again - hopefully bringing lasting relief along with it.

Your doctor should be able to explain this to you - in my experience it only happens in about ten percent of cases.

You might experience a sense of flushing or sweating for two or three days. This is an effect of the steroid drug and seems to vary depending on the dose or strength of the steroid used.

If you are diabetic then your doctor should warn you that your blood sugar level might fluctuate for up to two weeks after the injection. If you use insulin then you may wish to check your blood sugar more often than you normally do. Discuss this with your doctor before the injection.

Rare side effects after a steroid injection include damage to the tendon such as making it weaker or causing it to tear or rupture. Sometimes the steroid can affect the skin – leaving it without pigment or thinner than normal, sometimes with a dent inwards if the fat beneath the skin changes as a result of the steroid’s action.

Some people are allergic to either the steroid or the local anesthetic although they don’t know this before the injection is given. This can cause a severe or anaphylaxis reaction.

Most doctors try to leave a gap of three months between steroid injections to try to help prevent some of these steroid-related complications but in truth there is no real research evidence to back up this position.

truth there is no real research evidence to back up this position. An electronic book by
truth there is no real research evidence to back up this position. An electronic book by

Frozen Shoulder and How to Survive It

Frozen Shoulder and How to Survive It Who can’t have a shoulder injection? The following are

Who can’t have a shoulder injection?

The following are the main reasons not to have a steroid injection into or around your shoulder

Shoulder injections (and any other injections too) should be avoided by anyone taking warfarin treatment or other anticoagulant treatment to thin the blood.

Hemophiliacs cannot have shoulder injections because of the risk of bleeding into the joint after the injection has been performed.

Your doctor will not consider doing an injection if there is a possibility of infection in or around the joint. There is a risk that steroid drugs can worsen an infection if they are injected near the infected area.

You can’t have a joint injection if you have had a shoulder joint replacement operation

Doctors will not do shoulder injections if they suspect you could have a fracture inside the joint, or severe degeneration in the joint or osteoporosis in the bones around the joint.

What does the research say about steroid injections?

All doctors who use steroid injections for shoulder pain can give many, many examples of patients who have gained benefit from this kind of treatment.

But despite this, the research studies that have been done are still up for debate on whether the injections are really helpful or not. This is probably because the research is of poor quality because the few good trials that have been done are indeed clear that the injections produce big benefits.

The American Academy of Orthopedic Surgeons has decided that steroid injections can be recommended for the treatment of rotator cuff disorders and AC joint pain. Likewise, the American College of Rheumatology says that injections should be offered to patients suffering from arthritis in the shoulder, from frozen shoulder and also those with rotator cuff pain, bursitis and impingement syndromes.

those with rotator cuff pain, bursitis and impingement syndromes. An electronic book by Doctor Gordon Cameron
those with rotator cuff pain, bursitis and impingement syndromes. An electronic book by Doctor Gordon Cameron

Frozen Shoulder and How to Survive It

Frozen Shoulder and How to Survive It Summary of Steroid Injections for Shoulder Pain • Steroid

Summary of Steroid Injections for Shoulder Pain

Steroid injections are a safe and often effective way of treating pain around the shoulder

You should try to find a doctor with experience in the techniques if you are thinking about having a steroid injection done.

Lots of different conditions can be helped or cured by a steroid injection

The evidence is good that injections work well for most but not all patients

Some patients should not have steroid injections because of a risk of bleeding or a risk of interfering with other medications.

Some people get pain after the injection but this is usually very short lived

get pain after the injection but this is usually very short lived An electronic book by
get pain after the injection but this is usually very short lived An electronic book by

Frozen Shoulder and How to Survive It

Frozen Shoulder and How to Survive It Hands On Treatment For Frozen Shoulder All of the

Hands On Treatment For Frozen Shoulder

All of the treatments mentioned above have been directed at easing the pain from frozen shoulder in the knowledge that the stiffness will eventually take care of itself. But the hands on type of treatments available from a massage therapist, an osteopath or a chiropractor are intended to both ease pain and to increase the range of movement – all in the hope of gaining a faster recovery.

The kinds of treatments you might receive from a manual therapist of the type described above include local heat, laser therapy or electrotherapy. All of these are designed to warm up the joint capsule and make it more elastic before a session of stretching, manipulation or mobilisations of the joint. Osteopaths and chiropractors also try to focus on adjusting the joints alignment.

There’s no doubt that hands on treatments for frozen shoulder can be beneficial but the downside is that they are sometimes painful and also that a large number of treatment sessions can be required before benefits are obtained. Each treatment session is also often quite prolonged.

I’ve also found that most patients in the stage two or really stuck phase of frozen shoulder simply can’t tolerate this kind of treatment because it is too painful during the stretching or mobilising phase. In simple terms, the therapist needs your joint to be a little bit stretchy – and the joint capsule to have a little bit of give in it – before he or she can make any headway in improving your symptoms. This elasticity or “give” in the capsule is present in the first stage and the third stage of frozen shoulder – but not in the completely stuck frozen stage two.

shoulder – but not in the completely stuck frozen stage two. An electronic book by Doctor
shoulder – but not in the completely stuck frozen stage two. An electronic book by Doctor

Frozen Shoulder and How to Survive It

Frozen Shoulder and How to Survive It Massage Treatments for Neck and Shoulder Pains Neck And

Massage Treatments for Neck and Shoulder Pains

Neck And Shoulder Massage

for Neck and Shoulder Pains Neck And Shoulder Massage The neck and the back and the

The neck and the back and the shoulder are the most common areas of the body that are prone to stiffness and accumulated tension. Continuous build up of stress and tension in the neck and shoulder region lead to stiff necks, aching shoulders and headaches .Desk jobs, long working hours and incorrect sitting position may all add to problems in the neck and shoulder region.

A neck and shoulder massage is primarily done to relieve the tension and stress around the neck and shoulder area. The importance of the neck and shoulder region lies in the fact that the neck is a flexible structure that connects the brain to the rest of the body. Tension in this important part of the body invariably causes overall pain and poor posture.

A neck and shoulder massage can eliminate stress and relieve the neck and shoulder of any signs of discomfort.

You can give yourself a neck and shoulder massage, ask friends or loved ones to do it or you can seek help from a professional.

Neck and shoulder massage can be given either in a seated or lying down position. If traditional massage is too expensive or time consuming then you can check out the latest electronic neck and shoulder massagers that may provide some beneficial results.

Neck and Shoulder Massage Techniques

Here’s a selection of neck and shoulder massage methods that can be done yourself or suggestions for simple techniques you can do for others:

Self Massage Techniques - For the Shoulder:

• Squeeze and knead one shoulder firmly with the opposite hand, then change sides and repeat.

firmly with the opposite hand, then change sides and repeat. An electronic book by Doctor Gordon
firmly with the opposite hand, then change sides and repeat. An electronic book by Doctor Gordon

Frozen Shoulder and How to Survive It

Frozen Shoulder and How to Survive It • Apply either the Jojoba or Massage Oil directly

• Apply either the Jojoba or Massage Oil directly on the skin to ensure smooth, frictionless movements.

Techniques to give others a quick massage for the Shoulder:

• Ask the person to lie sideways, with a pillow for head support and the top leg bending forward for steadiness

• Gently massage the arm and the side of the neck

• Hold the shoulder with both hands and gently move the shoulder up and down, then forward and backward.

• As the shoulder and arm relaxes it gets heavier, now start making circular

movements with the fingertips under the shoulder blade to release tension.

• Replace the arm and repeat with the other arm.

Self Massage For the Neck – technique one

• Hold the back of the neck with one hand and squeeze firmly to ease muscle tension.

• Shrug the shoulders and bring them up close to your ears.

• Hold the shoulders in this position and count up to 5 and release.

• Relax the shoulders down and feel the tension drain away.

• Repeat this exercise two more times.

Self Massage For the Neck – technique two

• Clasp the hands together and place them on the back of the neck.

• Squeeze hands together and press gently.

• Breathe deeply as you enjoy the stretch.

and press gently. • Breathe deeply as you enjoy the stretch. An electronic book by Doctor
and press gently. • Breathe deeply as you enjoy the stretch. An electronic book by Doctor

Frozen Shoulder and How to Survive It

Frozen Shoulder and How to Survive It Self Massage For the Neck – technique three •

Self Massage For the Neck – technique three

• Using one hand, move the fingers in a circular motion on the neck on one side of the spine.

• Apply deep pressure one feels accumulated tension in this area.

• Repeat on the other side using the other hand.

• Breathe deeply and slowly to maximize the benefits of the neck and shoulder massage.

Benefits of Neck and Shoulder Massage

Quite apart from making you feel better and reducing pain or tension there are several well known and well proven benefits from neck and shoulder massage. In no particular order they are:

• Massage brings renewed mobility in the neck and shoulder region.

• It alleviates stiff neck and/or shoulder muscles and promotes flexibility.

• The action of massage stimulates blood circulation and creates an overall feeling of well being.

• Neck and shoulder massage relieves pain and stress and it relaxes and soothes the mind and body.

pain and stress and it relaxes and soothes the mind and body. An electronic book by
pain and stress and it relaxes and soothes the mind and body. An electronic book by

Frozen Shoulder and How to Survive It

Frozen Shoulder and How to Survive It Home Exercises for Frozen Shoulder If I’m honest I

Home Exercises for Frozen Shoulder

If I’m honest I feel a little uneasy about including a section on how to do home exercises in a book like this. The best way by far is to work closely on a one to one basis with a physical therapist who can show you the techniques, do any fine tuning needed and then monitor your progress, making adjustments as you go.

But that’s not the real world is it?

I know that for a whole host of reasons, many of you would find it difficult to work directly with a therapist. So here’s my brief introduction to exercises for a frozen shoulder. You can read more about it on my website at www.jointenterprise.co.uk – or there are a number of good online programs with DVD instruction that you can tap into and gain benefit from.

So – here are a list of some simple self stretches and exercises that will help in some cases of frozen shoulder. Caution however – remember this. These work best in the third or thawing out stage of frozen shoulder. They will not have any benefit and may simply be too painful in the second or frozen stage – and in the early months of stage one, trying to do these might only serve to aggravate things and make your pain worse.

Try these exercises in order – and then experiment a bit to see what works for you. If it makes your pain worse then don’t do it and seek some professional input.

Exercise One This exercise will help loosen up the shoulder. Stand with your feet shoulder wide and bend over so you are horizontal to the floor. Slowly rotate your bad arm in small circle motions gradually increasing the width of the circles. Do fifteen rotations and 3 sets.

Exercise Two Using your injured arm, reach up and across the chest and put the arm behind the shoulder. Now place your other hand behind the elbow and apply gentle pushing.

Now place your other hand behind the elbow and apply gentle pushing. An electronic book by
Now place your other hand behind the elbow and apply gentle pushing. An electronic book by

Frozen Shoulder and How to Survive It

Frozen Shoulder and How to Survive It Hold the stretch for about 10 seconds and repeat

Hold the stretch for about 10 seconds and repeat 3 or 4 times.

Exercise 3. Sit on a chair in front of a desk or table. Place your painful arm on the table with the elbow supported. Position your chair at a distance as shown in the image below.

Let the weight of your upper body sag forwards and downwards and feel the stretch through your shoulder as you do so. Hold for a slow count of five (ten if you can manage) and then repeat x 6

Exercise Four Find a door frame or use the corner of a room. Place both hands on the edge of the frame and gently lean forward. Hold the stretch for ten seconds and repeat 3-4 times.

lean forward. Hold the stretch for ten seconds and repeat 3-4 times. An electronic book by
lean forward. Hold the stretch for ten seconds and repeat 3-4 times. An electronic book by
lean forward. Hold the stretch for ten seconds and repeat 3-4 times. An electronic book by
lean forward. Hold the stretch for ten seconds and repeat 3-4 times. An electronic book by
lean forward. Hold the stretch for ten seconds and repeat 3-4 times. An electronic book by

Frozen Shoulder and How to Survive It

Frozen Shoulder and How to Survive It New Techniques for Frozen Shoulder Treatment When I wrote

New Techniques for Frozen Shoulder Treatment

When I wrote the first edition of this frozen shoulder ebook in 2004 there really wasn’t any need for a section like this. In truth, nothing much had changed in respect of frozen shoulder in the preceding ten years or more.

All that has now changed however, and in the recent few years we’ve seen big changes in newer and more innovative approaches to frozen shoulder treatment.

The results seem promising and many people seem to be benefiting greatly – but finding enough doctors skilled in their use is delaying the roll to a wider group of the population.

First let’s look at distending the shoulder capsule with warmed salty water solution. A process called Hydrodistension or Hydrodilatation.

Hydrodilatation of the Shoulder Capsule

This treatment is sometimes also called hydrodilation or hydrodistension of the joint. I’ve also seen it described in some research as “Distension Arthrograpy.”

described in some research as “Distension Arthrograpy.” The concept was originally pioneered in the 1980’s but

The concept was originally pioneered in the 1980’s but fell from use at the time. It has made a comeback in popularity in recent years and several good quality research studies support its use.

In simple terms a doctor uses local anaesthetic and inserts a wide bore needle into the joint capsule by using an x-ray to guide the position and thus to make sure that the needle is inside the joint.

The needle is then connected to a tube and hydraulic or electronic syringe device which begins the slow process of pumping warm saline or salt water in.

The capsule of a normal joint can comfortably hold large amounts of liquid. The tight and stuck capsule of a frozen shoulder joint can hardly take any volume at all. As the warm saline is pumped in under high pressure it causes a slow stretching of the tight shoulder capsule and gradually lifts up and separates all the little sticky adhesions and pocketed areas that have formed.

Most patients find the procedure reasonably comfortable and often see an immediate improvement in their range of movement with a decrease in pain.

improvement in their range of movement with a decrease in pain. An electronic book by Doctor
improvement in their range of movement with a decrease in pain. An electronic book by Doctor

Frozen Shoulder and How to Survive It

Frozen Shoulder and How to Survive It The different doctors (usually radiologists or x-ray doctors) who

The different doctors (usually radiologists or x-ray doctors) who do the technique have different exercise and stretch routines for the weeks following the procedure but they are all intended to keep the joint mobile and to try to stop it gumming itself up again.

A scientific trial of hydrodilatation has that it works well – at least in the short term.

When it was compared to placebo it showed better outcomes at the six weeks stage. Further research showed that a 6 week course of physiotherapy following the hydrodilatation has shown to be effective to decrease pain, improve range of motion, and seems to shorten the duration of frozen shoulder.

I’ve met with many patients who have tried this treatment approach and all have found it easy to tolerate and helpful.

Manipulation of the shoulder under a general anaesthetic

OK – well this one certainly is not for the faint hearted – although the outcomes are actually quite good for the few patients who eventually undergo it.

As you know by now, the main problem in a tight and painful frozen shoulder is that the joint capsule gristle has shrunk and become sticky with inflammation. This

stickiness causes the gristle to stick to the bones inside the joint – resulting in a loss

of the normal range of movement and a loss of function.

The concept behind manipulation under anaesthetic (often shortened to MUA) is actually a very simple one: put the patient to sleep so that they don’t feel it, and then forcefully (very forcefully sometimes) move the shoulder around until you break up all the sticky adhesions and return the joint to its normal range of movement.

If you ever see a video of a procedure like this the degree of apparent violence

involved is actually quite disturbing to watch – although the end result for the patient

is often good.

The good points about this procedure are that it is quick and often effective. The bad points are that a general anaesthetic is needed with all the attendant risks that brings

and also that sometimes the force needed to move the shoulder can actually result

in

the humerus or arm bone breaking into a fracture during the procedure

as I

said, not for the faint hearted. In practice MUA is reserved for the most severe and most resistant cases of frozen shoulder.

After the procedure the joint is injected with long acting local anaesthetic and often some steroid too.

with long acting local anaesthetic and often some steroid too. An electronic book by Doctor Gordon
with long acting local anaesthetic and often some steroid too. An electronic book by Doctor Gordon

Frozen Shoulder and How to Survive It

Frozen Shoulder and How to Survive It Keyhole surgery for frozen shoulder – arthroscopic release procedures

Keyhole surgery for frozen shoulder – arthroscopic release procedures

With the rise in the skills of surgeons who do keyhole surgery or arthroscopy we have seen new approaches to operations to treat frozen shoulder.

The surgeon goes into the shoulder using the endoscope or arthroscope through very small incisions. This is why it’s often called “keyhole surgery.”

By using the camera to see what the inside of the joint looks like – and with the help of other instruments – the surgeon can divide or burn away any tight sticky adhesions and in doing so can free up the tightness in the capsule.

and in doing so can free up the tightness in the capsule. The results of Surgical

The results of Surgical or Arthroscopic Capsular Release operations are often good – although some patients see their symptoms come back a few months later. The release operation needs to be backed up by an intensive program of exercises and stretches to make sure that the operation benefits are maintained.

Recovery time is variable depending on how severe your shoulder pain and stiffness was before the operation.

severe your shoulder pain and stiffness was before the operation. An electronic book by Doctor Gordon
severe your shoulder pain and stiffness was before the operation. An electronic book by Doctor Gordon

Frozen Shoulder and How to Survive It

Frozen Shoulder and How to Survive It Other conditions that cause shoulder pain There are a

Other conditions that cause shoulder pain

There are a number of other common shoulder pain conditions which can sometimes mimic the presentation of a frozen shoulder problem. It’s not usually difficult to sort them out for an experienced doctor or therapist but the pages that follow will summarise them for your information.

What is shoulder bursitis?

What is a bursa?

The bursa at the shoulder is a friction reducing device. The body places these small fluid-filled sacs any place where muscle lies close to bone or where muscles lie over one another. The bursa is responsible for producing a gliding surface to reduce friction between tissues of the body.

The plural of bursa is bursae and in total there are well over one hundred bursae in the body although most of them are small and do not ever cause any symptoms.

most of them are small and do not ever cause any symptoms. There are several bursae

There are several bursae around the shoulder. The largest one - and the commonest one to cause a problem is called the sub deltoid bursa or the subacromial bursa (two names for the same bursa).

Sub means beneath and the bursa lies beneath the deltoid muscle and beneath the Acromion bone which is part of the shoulder blade.

and beneath the Acromion bone which is part of the shoulder blade. An electronic book by
and beneath the Acromion bone which is part of the shoulder blade. An electronic book by

Frozen Shoulder and How to Survive It

Frozen Shoulder and How to Survive It The muscles of the rotator cuff around the shoulder

The muscles of the rotator cuff around the shoulder are called subscapularis, supraspinatus, infraspinatus and teres minor are small muscles that stabilise the shoulder. Collectively, these four muscles are known as the rotator cuff.

Within the shoulder, bones and ligaments form an arch over the top of these rotator cuff muscles. In between the rotator cuff muscles and the arch is the Subacromial space, which is filled by the Subacromial bursa, a sac of fluid that is designed to prevent any friction at the shoulder.

The major bursae in the body are all to be found near to the tendons and muscles around the largest joints like the shoulders, elbows, hips, and knees.

What is “itis”

In medicine the suffix “itis” means inflammation. Tonsillitis is inflammation in the tonsils. Appendicitis is inflammation in the appendix, dermatitis inflammation of the skin and so on. Bursitis therefore is inflammation of a bursa. When injury or inflammation of a bursa around the shoulder joint occurs, shoulder bursitis is present.

How does inflammation start in a bursa ?

Any of the body’s bursae can become inflamed as a result of injury, infection (rare in the shoulder), or an underlying rheumatic condition such as rheumatoid arthritis or gout.

The bursa in front of the knee – called the prepatellar bursa often becomes inflamed due to infection after a cut or a scrape on the skin. This is called septic bursitis and the same thing sometimes happens at the elbow.

Gout is a condition related to a high concentration of uric acid in the blood. If the uric acid forms crystals then inflammation develops very quickly and the bursa at the elbow is quite a common site for this. Gout normally affects the big toe joints but when the bursa is involved it is called “gouty bursitis.”

The bursa at the shoulder is often triggered into inflammation by something as simple as lifting a bag of groceries into the car.

Bursitis around the shoulder usually arises after an injury such as a fall or as a result of unaccustomed overuse of the shoulder joint or shoulder muscles.

Sometimes the sufferer will not be able to recall a specific trigger and it can seem as if the pain just starts out of nowhere.

trigger and it can seem as if the pain just starts out of nowhere. An electronic
trigger and it can seem as if the pain just starts out of nowhere. An electronic

Frozen Shoulder and How to Survive It

Frozen Shoulder and How to Survive It Bursitis can exist on its own or in association

Bursitis can exist on its own or in association with inflammation of the shoulder tendons. Shoulder tendon inflammation is called tendonitis

I often describe an inflamed bursa as being like a deep blister under the muscles. If you had a blister on your heel then the constant rubbing of your shoe would keep it grumbling and painful. An inflamed bursa is no different – the constant rubbing effect of the overlying muscle moving is enough to keep the symptoms going for many weeks or months.

Because of its position, the Subacromial bursa can become irritated and inflamed during repeated overhead shoulder movements as a result of being squashed or 'impinged' between the muscles and the bone, Sometimes, because the bursa lies so close to the rotator cuff, it can become irritated and inflamed when the rotator cuff is injured.

Shoulder bursitis is sometimes related to rotator cuff tendon problems and disease or degeneration in the rotator cuff muscles can be a trigger for the bursitis to start. Likewise, anyone with bursitis who fails to improve with normal treatment may need further investigation to look at their rotator cuff – this might need an ultrasound or an MRI scan.

What are the symptoms of shoulder bursitis?

Shoulder bursitis is characterised by shoulder pain, and as a result the pain often causes a reduced range of movement. The pain of shoulder bursitis is located over the tip of the shoulder and it often spreads down the arm towards the elbow. Activities such as washing hair and reaching up for the breakfast cereal in a high cupboard become very restricted due to shoulder pain. There is also shoulder pain at night in people who habitually sleep on the painful shoulder or those who sleep with the painful shoulder above their head.

The symptoms of shoulder bursitis often begin gradually over some weeks or months. Pain is the main problem. Rarely the problem can start with severe pain and progress rapidly but this is not common. More often it starts with a gradual pain in the region of the outer part of the shoulder - over the deltoid muscle.

Most people with shoulder bursitis find that the pain varies depending on the position of their arm. Textbooks describe a “painful arc” of movement – no pain with

Textbooks describe a “painful arc” of movement – no pain with An electronic book by Doctor
Textbooks describe a “painful arc” of movement – no pain with An electronic book by Doctor

Frozen Shoulder and How to Survive It

Frozen Shoulder and How to Survive It the arm by the side but increasing pain as

the arm by the side but increasing pain as the arm is elevated to about ninety degrees – only for the pain to ease again thereafter as the arm goes higher.

the pain to ease again thereafter as the arm goes higher. If a doctor or therapist

If a doctor or therapist resists the patients attempt to lift their arm outwards from the side then the pain will become more pronounced.

Your doctor may perform a manoeuvre called the Impingement Test to determine whether there is inflammation in the bursa or the tendons of the shoulder.

How is shoulder bursitis diagnosed?

In most cases bursitis at the shoulder is diagnosed simply on the story the patient gives and by the findings on examination.

Sometimes there will be a visible swelling at the shoulder but most cases don’t have this.

If imaging is needed then an x-ray can sometimes show calcifications in the bursa but this really only happens when the rotator cuff muscles have been damaged or when the bursitis has been present for many months. MRI scanning or an ultrasound scan can also show enlargement of the bursa and the presence of fluid inside it.

If your doctor suspects gout or infection then blood tests might help sort things out.

How is shoulder bursitis treated?

The treatment of any form of bursitis depends on whether or not it involves infection but infection of a shoulder bursa is rare and shoulder bursitis or subacromial bursitis usually comes after injury or some form of over use of the shoulder.

usually comes after injury or some form of over use of the shoulder. An electronic book
usually comes after injury or some form of over use of the shoulder. An electronic book

Frozen Shoulder and How to Survive It

Frozen Shoulder and How to Survive It In simple terms the treatment options for shoulder bursitis

In simple terms the treatment options for shoulder bursitis include:

painkiller or anti-inflammation medication

physical therapy from a physiotherapist, chiropractor or osteopath

injection of a steroid drug

strapping or taping of the shoulder

acupuncture

arthroscopic surgery

These choices need to be tailored to you as an individual and will depend in part on the underlying cause in your own case.

One of the most important aspects of treating shoulder bursitis is to stop doing the movement or activity that provoked it in the first place. Of course this may be easier said than done but you might consider changing your technique or equipment if you are involved in sport. If your bursitis has been triggered by work then give some thought to changing the way that you tackle your job tasks and activities.

When there is no infection present then most doctors will begin the treatment of bursitis by using simple measures such as rest, ice, pain relief medications and anti- inflammatory medications.

Physical therapy treatments like strapping, taping or therapeutic ultrasound or laser will also often help.

Sometimes an injection is needed. The doctor will insert a small needle into the bursa and will try to remove any inflammation fluid from the bursa before injecting some anti-inflammation steroid and local anaesthetic. Sometimes the fluid is sent to the laboratory for further analysis to check for gout or for the presence of infection that was not previously suspected.

If the bursitis is caused by infection then this is called septic bursitis. This is rare at the shoulder but if it is even suspected then your doctor will act quickly to start investigations and aggressive early treatment with antibiotics. Sometimes this needs to be done in hospital with the antibiotics injected into the vein.

to be done in hospital with the antibiotics injected into the vein. An electronic book by
to be done in hospital with the antibiotics injected into the vein. An electronic book by

Frozen Shoulder and How to Survive It

Frozen Shoulder and How to Survive It In rare cases if the antibiotics don’t work quickly

In rare cases if the antibiotics don’t work quickly then an operation might be needed to remove the infected bursa.

Preventing shoulder bursitis or preventing recurrence of the problem

The key to preventing shoulder bursitis is to figure out if there is narrowing of the subacromial space or not. If the space is too narrow then the bursa (or the “deep blister” I mentioned above) is going to be constantly rubbed against the nearby bone as the shoulder moves – causing it to become inflamed over and over again.

In many cases the size of the subacromial space can be optimised by practicing shoulder stability exercises with a physiotherapist.

These exercises concentrate on controlling the movement of the shoulder blade, by ensuring that muscle contract in the correct sequence during shoulder movements, to ensure that the ball of the upper arm remains stable in the shoulder socket during work, sport and functional activities.

In cases where there has been damage to the rotator cuff muscles or where there is a muscle tear present then arthroscopic or keyhole surgery might be needed to fully resolve the problem.

or keyhole surgery might be needed to fully resolve the problem. An electronic book by Doctor
or keyhole surgery might be needed to fully resolve the problem. An electronic book by Doctor

Frozen Shoulder and How to Survive It

Frozen Shoulder and How to Survive It Rotator Cuff Injury Rotator cuff tendonitis is inflammation of

Rotator Cuff Injury

Rotator cuff tendonitis is inflammation of the tendons of the rotator cuff. The rotator cuff muscles have been described in detail in the early chapters of this book – they are the muscles that help move and stabilise the shoulder joint.

Rotator cuff injury can be caused by overuse, by repeated impingement of the tendons against the bone above and also by shoulder joint instability where the muscles and tendons of the rotator cuff are called upon to stabilize the shoulder joint over and above the call of duty due to loose or weak ligaments.

People who regularly participate in certain sports are more at risk of rotator cuff injuries than others. Swimmers, pitchers (or others who engage in sports involving a lot of throwing) and weight trainers/bodybuilders are particularly at risk.

Whatever the cause of rotator cuff tendonitis it can be a very unpleasant and restrictive injury giving pain with various everyday arm or shoulder movements. Movements with the arm over the head are particularly likely to cause problems. Even while sleeping if you happen to sleep on the injured side a rotator cuff injury will be likely to wake you up in discomfort.

Rotator cuff inflammation often causes a sense of weakness in the affected shoulder and can take a long time to heal and at worst it may become chronic. If there is a tear in the muscle as well as inflammation then the weakness will be more severe and the condition will not ever properly recover without surgical treatment. A rotator cuff tear can be diagnosed using an ultrasound scan or an MRI scan.

Treating Rotator Cuff Injury

There are a number of treatments available for rotator cuff injury – these range from physiotherapy to anti-inflammatory medications and cortisone injections and in very extreme cases surgery.

As with most soft tissue injuries there is no “magic pill” to fix the injury and while there are a number of things that can help, unless the injury is extreme the best thing

of things that can help, unless the injury is extreme the best thing An electronic book
of things that can help, unless the injury is extreme the best thing An electronic book

Frozen Shoulder and How to Survive It

Frozen Shoulder and How to Survive It you can do is give your body every possible

you can do is give your body every possible chance to utilize its amazing capacity to heal itself.

You can encourage self healing in a number of ways including, applying ice or heat to reduce pain and speed healing, avoiding certain movements and activities until the injury is healed, exercising to strengthen the muscles and gentle stretching to keep the muscles flexible and the joint mobile.

At the first sign of rotator cuff tendonitis, especially where the culprit is likely to be overuse or repetitive strain, the most important thing to do is stop doing the activity you suspect to be causing the problem. Now this may seem like common sense but often athletes will try to “train through” pain or “train around” an injury by just going lighter on the weights or trying to train body-parts around the affected area.

Don’t keep training with a shoulder injury

If you suspect you have rotator cuff tendonitis from overuse then continuing to train regardless will just cause further aggravation and intensify the injury and make it take longer to heal.

Tendons take a long time to heal in any case. Unlike rich red muscle the white and shiny tendon has only a low level blood supply. This means they take a longer time to bring in the new cells and create the scar tissue that is needed for healing to take place.

Tendon injuries often take at least 4 to 6 weeks to heal and often even longer depending on how long the injury has existed. If you continue to train while injured then this time will be prolonged even further.

So – again - the first and most important thing to do is stop whatever is causing the problem.

Applying ice packs can help numb the pain in the acute stage of a rotator cuff injury and may also help speed healing but be careful in the way you apply the ice so as not to cause “ice burn”. No more than fifteen minutes at a time is my rule of thumb.

Physiotherapy can also help speed up recovery as can gentle exercise and stretching (not in the acute phase of an injury) and also applying heat to the injured area. If you regularly sleep on your side you may want to try sleeping on your back or at least avoid sleeping on the injured side.

on your back or at least avoid sleeping on the injured side. An electronic book by
on your back or at least avoid sleeping on the injured side. An electronic book by

Frozen Shoulder and How to Survive It

Frozen Shoulder and How to Survive It Everybody is different so it is important to listen

Everybody is different so it is important to listen to what your own body is telling you and adjust your actions accordingly.

As a general rule: if a movement hurts (especially if it causes sharp pain) - don’t do it. Also remember that, as with all overuse injuries, by the time you start feeling the pain the problem has already existed for some time so the sooner you take remedial action to manage and treat the injury the better.

you take remedial action to manage and treat the injury the better. An electronic book by
you take remedial action to manage and treat the injury the better. An electronic book by

Frozen Shoulder and How to Survive It

Frozen Shoulder and How to Survive It Closing words So – here we are at the

Closing words

So – here we are at the end of this book.

You now know pretty much as much as I do about frozen shoulder and that makes you pretty much a bona fide expert too.

In the first few pages of this book I told you that knowledge is power when it comes to dealing with physical pain and I hope that you are now in a position to agree and are well on the way to a full recovery – or at least have found a way to get your life back in the meantime.

In the box below I’ve summarised what I think are the most important points about frozen shoulder and then below that in the appendices you’ll find copies of four of my expert reports relating to shoulder pain issues.

I hope you’ve enjoyed this book and found it helpful.

I look forward to hearing from you by email or to meeting you online in one of my web seminars.

Until then - Be well

Gordon Cameron

in one of my web seminars. Until then - Be well Gordon Cameron An electronic book
in one of my web seminars. Until then - Be well Gordon Cameron An electronic book

Frozen Shoulder and How to Survive It

Frozen Shoulder and How to Survive It Frozen Shoulder Your main take home messages • Always

Frozen Shoulder

Your main take home messages

Always seek expert help to make the diagnosis of your shoulder pain

Get professional help to plan the best course of treatments for you as an individual

Try to stay positive – you are recovering every day even if you’re not always aware of it – every day that passes takes you a day closer to being fully better

Simple frozen shoulder is not arthritis and does not develop into arthritis

Most treatment options are intended to relieve pain and will probably not do much to improve or lessen the stiffness

Surgery is still only rarely required for frozen shoulder but the surgical techniques available are becoming much better and the outcomes more predictably good

Don’t forget the simple measures like keeping your shoulder warm and sleeping with a pillow

Lastly – and most importantly

Don’t let it get you down – nature is the best healer and you will be well again soon – and that’s a promise

and you w i l l be well again soon – and that’s a promise An
and you w i l l be well again soon – and that’s a promise An

Frozen Shoulder and How to Survive It

Frozen Shoulder and How to Survive It Websites for further reading about frozen shoulder and other

Websites for further reading about frozen shoulder and other aspects of shoulder pain

www.jointenterprise.co.uk

www.painfulshoulder.org

http://orthoinfo.aaos.org/topic.cfm?topic=a00065

http://orthoinfo.aaos.org/topic.cfm?topic=a00065 An electronic book by Doctor Gordon Cameron Page 84
http://orthoinfo.aaos.org/topic.cfm?topic=a00065 An electronic book by Doctor Gordon Cameron Page 84

Frozen Shoulder and How to Survive It

Frozen Shoulder and How to Survive It An electronic book by Doctor Gordon Cameron Page 85
Frozen Shoulder and How to Survive It An electronic book by Doctor Gordon Cameron Page 85
Frozen Shoulder and How to Survive It An electronic book by Doctor Gordon Cameron Page 85