Frozen Shoulder.....Adhesive Capsulitis After a Broken Arm

"Things get worse before they get worse" could describe my situation after I fell and broke my arm two years ago. I had been healthy and strong all of my life and had never broken a bone, but all that changed when I tumbled into a sunken living room and became a patient at the Bone Clinic.

Every time I went to the Bone Clinic, I was amazed at the number of broken bone patients waiting to see the four orthopedic doctors on duty. The huge office waiting room was always packed. Evidently, repairing broken bones is a career one can depend on. There was always a steady supply of new accident victims. I became a member of a whole new community of klutzes, unfortunates and the reckless. Most of us had quite a story to tell of why we were there, and I found myself enjoying my new friends. Many were males from ages 20 to 70 who wiped out on their motorcycles, and now were dealing with a whole new set of troubles. Others were survivors of car accidents or falls like mine.

The bone in my arm that fractured was the humerus, the long bone that goes from the elbow to the shoulder. There is nothing humorous about a broken humerus, but the bone healed well. Within 6 weeks the splint was taken off and I was on my way. I was given a set of exercises to do, but noticed that I was having a lot of pain in my shoulder which seemed to be getting so stiff I could hardly move my arm. I returned to my doctor who told me I had a frozen shoulder.

Frozen shoulder has nothing to do with the temperature. It is a condition that causes the restriction of range of motion in the shoulder joint. It feels like the shoulder has become rigid and hard like ice, thus the name "frozen shoulder." The shoulder is a ball and socket joint. Surrounding this ball and socket joint is a capsule. For some reason the ball part of the joint becomes stiff and scarred, barely moves, and is referred to as frozen. Frozen shoulder causes the capsule surrounding the shoulder joint to contract and form scar tissue. Bands of scar tissue form called adhesions, which cause the shoulder to become very stiff and soon any movement at all becomes painful. Pain is usually worse at night .Certain movements can cause tremendous pain and cramping. .

The impact of a frozen shoulder on one's daily life activities is devastating. Simple every day activities we take for granted, like eating, sleeping, bathing, dressing, writing, working, child care, driving, meal preparation and grooming now become extremely difficult if not impossible. Perhaps for the very first time, one becomes dependent on others. Family routines are disrupted and tensions rise, as the frozen shoulder sufferer needs more and more help. Depression, conflict and chronic fatigue can result. The recovery is slow. Frozen shoulder can last from five months to three years. Sometimes it never heals. Sometimes it disappears spontaneously.

The causes of frozen shoulder vary. One cause is a traumatic injury to the shoulder area followed by prolonged joint immobilization, such as having one's arm in a cast or splint. This is what happened in my situation. Sometimes there seems to be no apparent reason. It just happens. It may have an auto immune component with the body attacking healthy tissues in the shoulder. There are other risk factors including diabetes, stroke, lung disease, muscle and nerve diseases, and heart disease. Diabetics have a particularly difficult time in recovering. Frozen shoulder rarely appears in people under 40. It occurs more often in women than men.

Treatment can be painful and difficult. It consists of physical therapy, massage therapy, electro stimulation, medication or surgery. The doctor may also perform manipulation of the shoulder under anesthesia which breaks up the adhesions and scar tissue and helps restore range of motion. Physical therapy is important in all stages of frozen shoulder to keep the contracture from increasing. It is extremely painful as the therapist measures and stretches the shoulder to increase range of motion. Pain and inflammation can be controlled with medication.

Physical Therapy is expensive and limited by most insurance companies, My HMO would only pay $1500 per calendar year, and I found myself paying for most of it myself since I needed several treatments over time. I was fortunate and extremely motivated, and my shoulder healed in four months. I was also able to perform many of the stretching exercises at home with equipment I purchased.

Management of a frozen shoulder focuses on restoring range of motion and reducing shoulder pain. Medication consists of anti-inflammatory and pain medication. Cortisone shots may also provide some relief. Acupuncture may also be helpful.

Prevention is to keep the shoulder joint moving no matter how painful, and not allow the joint to "freeze." Doctors should warn their patients about frozen shoulder. This is important for any one who breaks an arm.

Sources:

Wikipedia

Personal Experience

http://orthopedics.about.com/frozenshoulder/a/frozenshoulder 2.htm

http://orthinfo.aaos.org/topic.cfm?topic=A00071