frozen-shoulder-1

 

Imagine having pain in your shoulder in every daily activity of your life like washing, wearing clothes, trying to lift an object, drinking tea etc. This is a typical complaint of a frozen shoulder patient. Another big problem is the disturbed sleep due to pain which decreases the quality of life while the patient spends the rest of his day, exhausted and tired.

However some research papers ask a pertinent question that depression and stress may have a part to play in the causation of frozen shoulder. It is not known to what extent does mood depression play a role in causing frozen shoulder or that it even has any role? In the idiopathic type of frozen shoulder, the cause is not known. In others it may be some sort of minor trauma, diabetes, preceding surgery etc. The exact cause is a subject of bewilderment and continues to be researched.

It is understood, though, that some stressor is found in some people which gives rise to this condition. It could be in the form of any minor trauma also. How this condition is related to diabetes or thyroid abnormality is not understood. Diabetics have a 30% association with frozen shoulder. The incidence of bilateral problem is also higher in diabetics and thyroid abnormality.

In this scenario it becomes all the more important to alleviate the pain first and foremost. Since pain interferes with sleep and almost all daily activities, medicines and injections with home based exercise only are the mainstay of treatment.

injectSteroids are often spoken of, in a rather dismissive tone, given its bad reputation for causing serious side effects. However, local application of steroids especially local / regional injections of steroid are one of the best blessings of the medicine world. For e.g. local bursitis or inflammation in the shoulder may take days to respond to rest, cold fomentation or medicines, but one local injection of thesteroid in the shoulder gives you instant relief.

In intractable painful conditions of the shoulder, it is even more important to give local steroid injections. The only caution to be used is touse it in the correct site and for the correct indication. For e.g. a sub-acromial bursitis will readily respond to sub-acromial injection, an intra-articular injection may be best used in tendon inflammation. Frozen shoulder responds very well to steroid injections. There are different preferences w.r.t the site of steroid injections is case of a frozen shoulder. However, unequivocally a sub-acromial injection does not seem to work in case of a frozen shoulder. Injecting in the gleno-humeral joint space (a.k.a intra articular) has been a practice with some physicians. But an intra articular injection fails as often as it succeeds. The best outcomes in frozen shoulder are obtained by injecting steroids in the Supra scapular nerve (SSN) space. There are many methods advocated to practice SSN space injection. This injection works to reduce the pain and improves the exercise range of the affected individual.

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