January 16, 2014

Frozen Shoulder – Diabetes Related?

This is a topic I have been requested to write about by a reader, but since I have been fortunate not to have this problem, I will be pulling information from several sources. Basically, at present, there is little known as to the cause and often this cannot be determined. Yes, they know what happens – inflammation and the arm is stiff and difficult to move freely.

Most of the time there is no cause for frozen shoulder, but the risk factors include:
  • Cervical disk disease of the neck
  • Diabetes
  • Shoulder injury
  • Shoulder surgery
  • Open heart surgery
  • Thyroid problems

These are the most known and there may be other reasons for frozen shoulder or adhesive capsulitis as it is medically named. I think that the Mayo Clinic oversimplifies when they declare - “Treatment for frozen shoulder involves stretching exercises and, sometimes, the injection of corticosteroids and numbing medications into the joint capsule. In a small percentage of cases, surgery may be needed to loosen the joint capsule so that it can move more freely.”

The U.S. National Library of Medicine gives the main symptoms as:
  • Decreased motion of the shoulder
  • Pain
  • Stiffness

Frozen shoulder without any known cause starts with pain. The pain prevents you from moving your arm. Lack of movement leads to stiffness and then even less motion. Over time, you become unable to do movements such as reaching over your head or behind you.

Frozen shoulder occurs:
  • After surgery or injury.
  • Most often in people 40 to 70 years old.
  • More often in women, especially in postmenopausal women, than in men.
  • Most often in people with chronic diseases.

A doctor will normally ask you for symptoms and examine your shoulder and let you demonstrate the range of motion. Often the doctor will make a diagnosis when you are unable to rotate your shoulder. Some doctors will x-ray the shoulder and others will use an MRI to look for inflammation. X-rays are used to eliminate other problems, such as arthritis.

Treatment will also vary by the doctor. Many doctors will only treat the pain with nonsteroidal anti-inflammatory medications (NSAIDs). Others will treat with steroid injections and refer you to physical therapy, which often improves your motion.  I can only trust that it takes a few weeks to see improvement and up to nine months for a complete recovery. Physical therapy can be intense and needs to be done every day. Some have said that if left untreated, the frozen shoulder often becomes healed within two years with little loss of motion.

Risk factors for frozen shoulder, such as diabetes or thyroid problems, should also be treated. Surgery is recommended if nonsurgical treatment does not work. Shoulder arthroscopy is done under anesthesia and scar tissue is released to bring the shoulder through a full range of motion. This surgery may also be used to cut tight ligaments and remove the scar tissue. Pain blocks are given so participation in physical therapy is not hampered.

People with diabetes that maintain excellent management are less likely to get frozen shoulder, but some still do even with excellent management. Always contact your doctor if you develop shoulder pain that limits your range of motion. Early treatment and physical therapy helps prevent stiffness.

Tom Ross at Not Medicated Yet published a blog review of his episodes with frozen shoulder on January 13, 2014. You may also wish to read a 2004 blog by David Mendosa.

No comments: