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07/Mar/2019

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.


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07/Mar/2019

Steroids 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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14/Feb/2019

“Frozen Shoulder” term is a big misnomer.

There is nothing frozen inside or outside the shoulder. In fact it may just be the opposite. The tissues may be inflamed to some extent for some time period.

Codman coined the term “frozen shoulder” in 1934. However, now it is loosely applied to any misunderstood painful condition of the shoulder. Scientifically speaking, frozen shoulder, also known, as adhesive capsulitis is a global restriction of movements of the shoulder, which is diagnosed clinically and with a plain X Ray without the aid of any complex investigation like MRI or CT scan.

The most important role in diagnosing this condition is that of the clinician, since this can only be diagnosed clinically.

The big question is, however, how to best treat it? Surgery? Rest? Exercise? Physiotherapy?

There are equal numbers of patients disappointed by each of the above treatment modalities.

The best way forward is very clear in my mind, after having treated several of frozen shoulders. Exercises done at home with a corticosteroid injection in the shoulder is the best way to treat it. The key point is to never opt for surgery and to remember that the patient has to work hard at the exercises by himself at home without relying on physiotherapy.

Injection of a corticosteroid is one of the key steps in the management of this condition, since the pain in shoulder does not let the patient do a whole lot of exercises. An injection in the shoulder eases the pain and in some cases the pain disappears entirely within 3-4 weeks. The site of injection, however, varies as per the preferences of the treating physician. The latest advancement in the field of pain management is to inject corticosteroid in the area of the Suprascapular Nerve, which eases the pain considerably. This is followed by a set of stretching exercises done at home regularly, which slowly increases the range of motion of the patient’s shoulder.

The onlything to remember here is that these are stretching exercises and NOT theraband or strengthening exercises.


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14/Feb/2019

After an exciting win, an Indian cricket fan’s adrenaline levels can be judged by how frantically they move their legs and shoulders in sync to the screams of joy. But as time passes by, age catches up. Cricketers retire to move into commentary boxes and the once energetic fans suffice their craze by good ole clapping. A quick switch to the news and we hear another athlete undergo surgery, while the swift urge to change channels made the shoulder scream in pain.

Injuries to the shoulder can occur from a wide number of reasons. Some of the common reasons cited are manual labour, sporting activities and repetitive movement. The shoulders tend to host a number of issues as time passes, especially after hitting the retirement mark. This is because soft tissues tend to degenerate with age.

So, if your shoulder’s been more painful that productive of late, head straight to the doctor. Trust them to understand your issue and guide you through the ‘not so dreaded’ treatment of shoulder pain. And since the process can take a while and the general patience levels towards pain is quite well known, we bring to you some easy hacks. Hacks that aim to aid the treatment of shoulder pain with better ease.

  1. Icing:Ice bags are extremely efficient in alleviating shoulder pain. Reason – The cold temperature numbs the affected area which reduces pain and inflammation. But beware; do not place ice directly on the sink. It can cause frostbite.
  2. Hot Compress:Just like icing, warm bath or hot bags help in easing out shoulder pain and other related problems. Though it is advised to opt for hot bags after 48 hours of the injury occurring.
  3. Massage:A gentle massage eases out the stress and tension build up in your shoulder muscles. It is also known to improve blood circulation and reduce swelling. Using oil like coconut oil, olive oil, sesame oil etc. provide better relief. But try to get massages from professionals who know their way around it.
  4. Stretching:A likely cause of your shoulder ache can be stiff muscles. Poor posture or lack of use of the muscles can lead to stiffening. Sore and tight muscles respond well to stretching because it reduces muscle tension, promotes blood flow and improves flexibility. Just look out for sharp pain during stretching as they may be warning signs of bigger damage.
  5. Resting:In most cases, the cause of shoulder pain is overuse or exertion. For example, lifting heavy objects over a long period of time can induce pain. Refrain from exerting activities for a few days can prove to be helpful.

The above suggestions should hopefully help you ease you through the treatment of shoulder pain. But don’t stick to this only. Because a doctor is a better candidate for treatment than internet.



Mumbai Shoulder Institute


Provides services for all Shoulder problems with the formation of MUMBAI SHOULDER INSTITUTE™ in Mumbai.




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