Know the Causes of Frozen Shoulders, It’s Diagnosis and Treatment by Dr. Swapnil Zambre
Thank you for joining us here, today, at Currae Hospitals. I am Dr. Swapnil Zambre, with a special interest in arthroscopies and shoulders, especially. I am going to talk to you today about frozen shoulder and how to prevent frozen shoulders.
Generally, you will find that it is a very over-diagnosed condition, everything in shoulders, if you get pain with stiffness is diagnosed as frozen shoulder. So, firstly, we need to to a certain extent understand what is a frozen shoulder and then once we understand that, we can try and look at various things that we can do to prevent frozen shoulders and various things we can do to try and treat it if we do end up getting a frozen shoulder, right.
The most important thing about frozen shoulders is there are two kind of frozen shoulders. Frozen shoulders that generally happen without any reason or some very non-specific reasons and there are frozen shoulders that happen in certain individuals because they have a certain problem with them, so the outcomes in these kind of problems are quite different. People who have diabetes or have thyroid issues, their frozen shoulders tend to be quite different as compared to people who do not have these problems. Those kind of frozen shoulders are more resistant and more difficult to treat and more difficult to recover from, as compared to people who don’t have these conditions.
On the whole, looking at how you prevent frozen shoulder, the first and the foremost thing is to have a relatively healthy lifestyle, I am sure we are all aware how important a healthy lifestyle is. Secondly, do regular exercises of your shoulder. The typical exercises that I will say to my patient is no more than 2 minutes of exercises for each shoulder, where you are looking at basically rotating your whole shoulder through its whole range of activity. Another one is to pull the shoulder right across your chest like that and another one is to pull it right behind your back like that. These 3 along with gentle rotation outside is quite important. These 3 or 4 exercises if you do, if it’s something that you regularly exercise, then 2 minutes of these exercises daily in the morning will go long way in preventing frozen shoulders.
The other problem that I tend to find is there are lot of people, when they go to gym, will do a lot of front shoulder work where they are doing bench press and push-ups and close-pack exercises, but not a lot of people work on the back of the shoulder due to which you end up getting a significant imbalance in your shoulder muscle, what you know as impingement, that is quite different from a frozen shoulder. Now, generally you will find, if you go to a doctor and you raise your arm, when you get pain, people will label it as frozen shoulder, I tend to differ on that. Generally, what I tend to say to my patient is to try and turn your arm outwards. Generally, if you can turn your arm outwards as much as you can do on the other side, the chances of you having a frozen shoulder are very low. However, if you are having trouble moving your arm out like that then the chances of you having a frozen shoulder are very high. Whereas, if you can move your arm out well but you are having pain and stiffness on raising your arm up, chances are you are having impingement and the reason why you have impingement is because muscles in the back of your shoulder are weaker as compared to the front because in our day-to-day activities, even when we go to the gym, vast majority of the time, we tend to concentrate on muscles at the front without doing much work for the back. So, establishing that balance between the 2 groups of muscles is important, that is something that you need to talk to your personal trainer if you are going to the gym, one aspect of it.
Second aspect of preventing frozen shoulders apart from the 4 exercises preventing shoulder issues. There are other conditions which can predispose you to frozen shoulder which are like you know Parkinson’s disease, cardiovascular disease, and a few other problems, including rheumatic arthritis, but in these kind of situations, frozen shoulder is a relatively easy problem to deal with, it is not as resistant to treatment as it is in diabetes and thyroid problems. So, I will generally say that it is easier when you don’t have diabetes or thyroid as compared to these other conditions.
Now, this is for prevention, prevention is where you are looking at regular warm-up exercises, the ones I have shown you and controlling your diabetes and thyroid problems, that is preventing frozen shoulders. Of course, the 3rd important part, if you are going to the gym is looking at back of the shoulder work, so that you have a muscle balance, so you don’t get impingement. Classically, what I have seen is that patients go to gym, they work on their shoulders, end up getting shoulder pain that is because they worked on the front of their shoulder, did not balance their muscles out, they get impingement, they don’t have a frozen shoulder yet, they have got impingement so when they raise their arm, they start getting pain, so they sort of adapt and stop raising their arm too much, and then over a period of time, they start getting frozen. So, an impingement syndrome can lead to a frozen shoulder as well, in order to prevent that, working on the shoulder muscles at the back is very important. So, these 3 aspects are very important: regular warm-up exercises, muscle balance front and back, and control your diabetes and thyroid. Now, in spite of all these, there is a small chance that you may end up getting frozen shoulder. It can extend from months to 3-5 years, so it is important that we try and intervene and stop that period from getting as long as it could be. And especially, again at the cost of being repetitive, diabetics and thyroid problems that patients have generally is difficult for frozen shoulders to get better on their own without intervention by a doctor.
With frozen shoulders, another thing I will also say is that seek your doctor’s appointment early, very simple reason being that early you present, the more likely it is that with tablets, with physiotherapy, and maybe a few injections, we might be able to get you on top of the problem fairly easily, whereas if you leave it for too long and you end up getting a significantly stiff shoulder, sometimes nothing short of an arthroscopic surgery where we go in and we release the necessary ligaments will work. So, early presentation to your doctor if you are getting a frozen shoulder is important, and remember, it may not necessarily be a frozen shoulder, it might be an impingement syndrome which has not yet gone to a full-scale frozen shoulder and that is even easier problem to deal with.
On the whole, prevention is mainly in terms of regular stretching and warm-up exercises and remember to balance your shoulder and to get treated properly for your diabetes and thyroid conditions and seek help early, that is another key.
I hope you have enjoyed this short and sweet talk that I have given you. If you have any queries, feel free to post them below. I am Dr. Swapnil Zambre and I am available at Currae Hospital every day, Monday to Saturday, from 7:30 to 8:30, if you need to seek further advice for any of your shoulder issues that you might have.