Steemit Learning Challenge-S21W1: Frozen Shoulder"

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Imagine waking up one morning and you try to stretch your hand to get your phone on a cupboard, but you can't do so easily as you're feeling a restriction in your shoulder that prevents your arms from moving forward. The pain that results from trying to stretch makes you feel your joints are frozen and can't function properly.

You'll have to get up from your bed and reach the phone. People with similar cases suffer what we call Frozen Shoulder or in medical terms, adhesive Capsulitis. They find it difficult to lift their hands upward, sideways, or even backwards. Their shoulder is stiff and prevents such. So what's a frozen shoulder, if I may be asked?

As explained in the illustration above, a shoulder is said to be frozen when there's inflammation in the tissues around the joint of the shoulder, which makes it thicken and tighten, preventing easy movement as if the shoulder is locked. It's just as if there's a balloon under your arm that prevents you from bringing the hands down.

This frozen shoulder is sometimes caused by injury, surgery, medical conditions like diabetes, etc. that make the shoulder and arm immovable. It doesn't just happen by chance. Something triggers it. For example, in my own case, mine came up as a result of doing exercise. In the course of lifting weight, I compressed my shoulders in a way that my arms could drop straight and I could lift my arm the next day. I noticed this when I saw an inflammation around my shoulder and arm region.

My arm was bigger than the other arm. When such casualties happen, the capsule around the arm thickens and contracts in such a way that it prevents movement and brings about discomfort and so much pain. This can be illustrated if you have a flexible rubber band you can easily stretch to a distance, but in weeks to come, the rubber band is exposed to weather conditions or gets contact with a substance that makes it hard and dried out.

If you want to stretch that rubber band, you'll find it difficult to do so as the flexible one. So, it's compared to a frozen shoulder, where there's rigidity within the joints of one's shoulder. It is also caused by inflammation within the shoulder capsules, as stated earlier. Age is a major factor, as people in the age range of 40 up are prone to experiencing such.

Normal bodily function of the shoulder before it gets frozen

The shoulder is the anchor of the arm, where it's allowed to join and rest on. With the shoulders, the arms can move freely, taking any motion form. It has a ball and socket joint with the clavicle, scapula, and humerus as the major bones connected by a network of muscles and ligaments. This allows movement around the arm and shoulder region because of these connections in bones, joints, muscles, and supported tissues.

The humerus, which is the upper arm, fits head into the shoulder joint, surrounded by a network of flexible capsules of connective tissues that is aimed at providing support and motion.

On a normal level, the flexible capsule can stretch and move freely, which aids the humerus as well. In a situation where the capsule around the joint becomes inflamed and thick, preventing movements within the joints and making it difficult or almost impossible to lift and rotate the arm.

Remember, this capsule of connective tissues is a flexible and loose one, but when the capsule is thickened and tight or there's a reduction in the synovial fluid, which lubricates the joints, keeping them firm and relaxed, the shoulder becomes frozen.

Types

Frozen shoulders are of 2 types with extensions, which include;

We have the primary frozen shoulder which, as the name implies, is one that occurs without any reasonable or obvious cause for it. It affects people mostly from age 40 to 60, especially women, and when such happens, you'll notice it from the gradual changes in your shoulder's movement.

Another type of secondary is quite different from the primary because there's a cause for it, which can be injury, surgery, or the effect of medical conditions that can affect the shoulder and make it frozen. Initially, it is triggered by the source of the cause of the effect, which is then followed progressively.

Stages and Phases

• The stages involved are as follows: When there's increasing pain in the shoulder, it makes it difficult to do simple movements, and it's called the freezing or painful stage which lasts for 6 weeks to 9 months.

• The second stage is when the pain reduces but there's maximum stiffness in the shoulder, making it difficult to lift the arm in certain directions. The shoulder in this stage is stuck and rigid. It's called the frozen Stage.

• The Thawing stage or recovery stage is when the stiffness around the shoulder decreases and the capsule around the shoulder loosens, which allows limited mobility of the arm. The stages are from the most painful to gradual recovery following certain therapy physically or medically.

Diagnosing a frozen shoulder is easy, as this can be done through physical examination or medically through x-rays if advanced or severe. This diagnosis usually involves reviewing the affected person's medical history and also examining that person to see if it's something exercise can do away with or something medically inclined.

To diagnose a frozen shoulder, the doctor must first check the medical history of the affected person.

• Checking the medical history involves asking the patient questions about his symptoms, when they started, if he has experienced such before, etc. The main focus is on the intensity of the freezing shoulder and what can relieve it. With the information given by the patient, the doctor can determine which stage the frozen shoulder is.

Let's assume this is my patient, and he tells me he finds it difficult to stretch his hand behind, lift up, or even stretch, and the pain is very severe. Every day, it intensifies. From here, the doctor will perform a physical examination.

• Physical examination involves assessing the patient's shoulder with your hands and then checking the limitations of the shoulder by telling the patient to move his hands upwards and sideways to know if it's actually a freezing shoulder problem. You can assist the patient in lifting his arms in different directions.

When the patient experiences pain and restrictions from his shoulder and arms, the doctor will know that it's a frozen shoulder. After the physical examination is done, the patient would be told to do some stretches as a hallmark for assessing the shoulder.

• Tests for assessment can be carried out through forms of exercises. The first test is checking the mobility of the shoulder. The patient is to reach behind his back and try touching his opposite shoulder blade. If the patient reaches halfway up the back and finds it difficult to go further or he struggles to do so, we can assume there's stiffness in the shoulder, which is a sign of frozen shoulder.

• The next test is carried out by telling a patient to rotate his shoulder outward with his arm at the side to check for restrictions. If there's a restriction, it could possibly be a frozen shoulder, as it's a common case.

Illustrations: From the picture below, the patient is able to do so, but in a case whereby he can barely rotate his arms outwards due to stiffness, it's possible he has a frozen shoulder. An example is when the patient can't rotate about 45°, which is the normal range for arm rotation.

• Painful arc test is carried out where the patient is told to lift the arm forward to his side. An example is a patient finding it difficult to lift the arm and feels sharp pains when he does so. It's only when he lowers his arms or lifts them higher that the pain reduces. If suspending on the air, he finds it difficult, which can be diagnosed as a frozen shoulder as the stiffness prevents abduction.

• Another test is carried out internally where a patient is told to move his hands inwards to be on his abdomen mark and then stretch the lower hand forward to form an angle of 90°. If the patient finds so much pain and discomfort doing so, he has a frozen shoulder. An example is when a man tries to lift his hand to attain that angle but finds it difficult to as the movement is limited.

• Cross arm test is carried out to check the flexibility of the shoulder and joint capsule restriction. This is illustrated when the patient is told to move his arms across his body in a scissor form, trying to touch the shoulder. If the person finds it difficult to do so aside from normal body fat, he has a frozen shoulder.

In some cases, not all restrictions are a frozen shoulder cause because body size and fats in the body and arm can cause restrictions. People with short hands sometimes find it difficult to move their arms, even people who are obese because of the body fat that seems to be a suspending restriction.

Apart from these assessments, severe pains around such regions can require imaging tests, though not applicable for all cases. This imaging test, with the aid of an x-ray is used to know the exact problem and to be certain that there are no other issues with the bone that's causing this.

X-rayis used to assess the structure of the bone and carried out to exclude bone-related issues since it's diagnosed for frozen shoulder. When the imaging shows no further attachment or bone issue like arthritis, it shows the diagnosis is correct.

The ultrasound can also be used to check for inflammation in the shoulder's joint to see if there's a thickened joint capsule or not. If this is present, it's a sign of a frozen shoulder, and shoulder be taken into special consideration to avoid complications. It's not as detailed in information as the MRI scan test but shows thickening in the shoulder's capsule.

The MRI scan is used to give detailed information or a view of the inflammation and thickening in the joint capsule of the shoulder. It also helps in making a clear image of it, ruling out other shoulder pain that may arise. A CT scan is also used.

In every research work, there's always reference material. So I'm providing this material I did my research from so you can check for further details.

Reference material

From the tutorial given, about four exercises were given to practically help improve frozen shoulder. Before the introduction of this tutorial, I've been keeping fit and did participate in the just concluded season 20 exercise programs.