Shoulder Pain Treatment In Delhi, Frozen shoulder treatment in delhi

 

Shoulder Pain

Shoulder pain may be an isolated problem localised to the shoulder or be a part of widespread pain as in rheumatoid arthritis. A combination of history, examination and diagnostic investigations is utilised to identify the pathology and guide further management. Diagnostic ultrasound scan is an effective bedside tool as it can reliably identify common shoulder pathologies and reduce the requirement of additional investigations. I routinely perform ultrasound scans at the time of initial assessment. This reduces the requirement of additional investigations and if required a guided injection can be performed at the same time.

Some of the common reasons for shoulder pain include

  • Inflammation, injury or weakening/tear of muscles and tendons around the shoulder joint (rotator cuff)
  • Damage to bones, cartilage of shoulder joints as in arthritis of glenohumeral, acromiocalvicular joint
  • Bursitis (Bursa allow for smooth sliding of tendons or muscles over the joint or frictional areas)
  • Frozen shoulder or Adhesive capsulitis
  • Spasm/injury of neck and shoulder muscles
  • Referred pain from surrounding areas like neck for example in nerve entrapment or neck joint arthritis


Frozen Shoulder

Frozen Shoulder

Frozen shoulder is a condition in which there is significant loss of motion of shoulder joint accompanied by pain and stiffness. The movement involving reaching straight up and rotation of joint such as while reaching behind the back may be affected first although with time all movements may get affected. Pain may be deep seated, poorly localised and constant or only at night when lying on the affected side.

In frozen shoulder the capsule surrounding the shoulder joint becomes thickened and tight thereby limiting the movements of the joint. The joint may loose some of its lubricating fluid reducing the space for the arm bone ot move. Movement of shoulder causes pain, hence one tries to avoid this which leads to further contraction of the capsule. As the condition advances scarring or adhesions may develop between the capsule and the head of arm bone further limitating the movement. With time there may be relative weakening of the muscles with loss of muscle mass (atrophy).

What causes frozen shoulder?

The cause behind the condition is not well understood. This condition is estimated to affect 2-3 % of individuals although this may be an overestimation as previously many more conditions were labelled as frozen shoulder – with it becoming more like a waste bin diagnosis. The actual incidence may be around 0.75%.

It is seen more commonly in

  • Women as compared to men
  • People over the age of 40 years, most commonly between the age of 40-60 years
  • Diabetics have approximately five times more chances of developing this condition compared to non – diabetics. (10 – 20 percent of individuals with diabetes may develop frozen shoulder and about 30% of people with a frozen shoulder also have diabetes).
  • Periods of shoulder immobilization like after a fracture or stroke (more like an under use injury)
  • Patients with overactive or underactive thyroid
  • Parkinson’s disease

How is frozen shoulder diagnosed?

Frozen shoulder is diagnosed clinically, however investigations are required to rule out other conditions which may present similar symptoms.

To diagnose frozen shoulder, your doctor will:

  • Take detailed history of your condition and look for any predisposing factors
  • Conduct a physical examination of your shoulders, arms and neck:
    • The doctor will evaluate the range of shoulder movement. In frozen shoulder both the active movements (when you move your shoulder/ arm) and passive movements (when the doctor moves your shoulder /arm) are reduced. Examination may reveal tenderness in the front of shoulder at a specific spot called the coracoid process.
    • The doctor may carry out other special tests to rule out other conditions which may present with similar symptoms
    • He may conduct examination of your neck as neck problem manifests with shoulder pain frequently
  • Investigations- X-rays of the shoulder may be requested to rule out arthritis, MRI scan and ultrasound may be requested to rule out other problems such as a rotator cuff tear. Ultrasound scan can show thickening of coracohumeral ligament or the capsule
  • Blood tests may be requested to check for diabetes / thyroid problems.




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Location: Delhi, India

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