ABSTRACT:
Frozen shoulder is a common condition which mainly affects females, characterized by pain & stiffness of the shouder joint. Its a painful condition causing restriction of the shouder joint movements. Homeopathic medicines reduce the inflammation of the shoulder joint, thereby relieving the pain and stiffness of the joints.
KEY WORDS:
Adhesive capsulitis, synovitis, stiffness, diabetes, Homoeopathy, Homoeopathic medicines
INTRODUCTION – ADHESIVE CAPSULITIS:
This is a painful shoulder condition of unknown aetiology that affects the capsule of the shoulder. The rotator interval between supraspinatus and subscapularis is affected predominantly. It is often referred to as “frozen shoulder, characterized by pain & restricted movement of the shoulder, usually in the absence of intrinsic shoulder disease. Night pain is often present in the affected shoulder. However, it may follow bursitis or tendinitis of the shoulder or be associated with systemic disorders such as chronic pulmonary disease, myocardial infarction & diabetes mellitus.
The first recorded description of a frozen shoulder was reported by Duplay in 1872 in his description of a “periarthritis scapulo- humeral and the term frozen shoulder was first used in 1934 by Codman.
INCIDENCE:
Frozen shoulder is thought to have an incidence of 3% – 5% in the general population & up to 20% in those with diabetes. Its peak incidence in between the ages of 40 & 60 and is rare outside these age groups & in manual workers.
Diabetes is the most common associated disease with frozen shoulder and a patient with diabetes has a lifetime risk of 10% to 20% of developing this condition.
PATHOPHYSIOLOGY:
In a frozen shoulder, the capsule has become inflamed and scarring develops. The scar formations are called Adhesions. As the capsule’s fold become scarred & tightened. Shoulder movement becomes restricted & moving the joint becomes painful.
This condition is called Adhesive capsulitis (inflammation of shoulder joint).
CLINICAL FEATURES:
Thus there are three phases of this disease
(1) Increasing pain & increasing stiffness
(2) Decreasing pain with persistent stiffness
(3) Disappearance of stiffness with return of all the movements.
Each phase Lasts from 4 to 8 months and the whole process takes about 2 years.
Stage I – The painful phase
This can last for 2 to 9 months. The shoulder becomes increasingly painful, especially at night, & by the patient uses the arm less & less. The pain is often very severe, and may be unrelieved by simple analgesics.
Stage II – The stiffening phase
This can lasts for 4 to 12 months & is associated with a gradual reduction in the range of movement of the shoulder. The pain usually resolves during this period, although there is commonly still an ache, especially at the extremes of the reduced range of movement.
Stage III – The thawing phase
This lasts for a period of 4 to 12 months and is associated with a gradual improvement in the range of motion
SYMPTOMS:
Symptoms may start gradually and resolve within one or two years
✓ Pain in the shoulder
✓ Joint stiffness
✓ Decreased range of shoulder motion
LOCAL EXAMINATION:
INSPECTION:
The patient must be stripped upto the waist and stand in front of surgeon for proper inspection. Contour of the shoulder must be noted. Note for any wasting of muscles, swelling etc.
PALPATION:
Tenderness: The shoulder joint is best palpated by keeping the arm by the chest wall with one hand and with the other hand to palpate the shoulder joint from all aspects. It is a good practice to feel the acromioclavicular as well as the sternoclavicular joints to exclude any organic disease there.
Movements: While examining for the ranges of different movements of shoulder joint, firstly the patient must be stripped upto the waist and these movements should be examined not only from in front but also from behind (particularly during abducton to see the scapular movement).
The range permitted in each movement is as follows:
Abduction 180°, flexion 90°, extension 45o and rotations – both medial and lateral – one quarter of a circle about a vertical axis; circumduction results from succession of the foregoing movements.
DIFFERENTIAL DIAGNOSIS:
- Rotator cuff tendinitis:
It is also called as impingement syndrome. Swelling of the tissues (tendons) connecting the muscles & bones in the shoulder. Overuse & injury are common causes of rotator cuff tendinitis. - Glenohumeral synovitis:
It is a rare complication of vaccination that can lead to shoulder dysfunction & prolonged pain. - Glenohumeral osteoarthritis:
It is a progressive loss of articular cartilage, resulting in bony erosion, pain & decreased function. It causes due to the damage from a shoulder injury, such as a dislocated or broken shoulder. - Calcific tendinitis:
It is an acute /chronic painful condition due to the presence of calcific deposits inside or around the tendons of the rotator cuff. It is caused by the deposition of calcium hydroxyapatite crystals commonly within the supraspinatus & infraspinatus tendons. - Malignancy:
Many studies show that primary scapula tumours tend to be malignant rather than benign. The most common types of shoulder cancer are chondrosarcoma, osteosarcoma & Ewing’s sarcoma.
LABORATORY DIAGNOSIS:
Laboratory studies are rarely required for the evaluation of adhesive capsulitis, generally a physical examination is usually enough.
- MRI is the gold standard in imaging to show in detail the tendons & capsule around the
shoulder, and help to confirm the diagnosis of a frozen shoulder. - X-ray is used to investigate and also to rule out other conditions.
- Complete blood cell count (CBC)
- Erythrocyte sedimentation rate (ESR)
MANAGEMENT:
Most frozen shoulder treatment involves controlling shoulder pain & preserving as much range of motion in the shoulder as possible.
Mobilising & strengthening exercises are the sole treatment in the frozen state.
A physical therapist can teach you range-of-motion exercises to help recover your shoulder movement. Commitment to doing these exercises is necessary to regain as much movement as possible.
Continue to use the shoulder & arm as much as possible given your pain & range. of-motion limits.
Applying heat or cold to your shoulder can help relieve pain.
HOMOEOPATHIC APPROACH:
Homoeopathic Medicine is obtained from natural Ingredients that have no side-effects & toxicity. It helps to reduce the intensity, rate of recurrence & duration of the pain with safe methods. It has demonstrated great efficacy in curing symptoms & reducing severity of frozen shoulder. The specially formulated Homoeopathy medicines for frozen shoulder are based on the individual cause & duration of pain. The treatment for frozen shoulder has been developed after exhaustive in house research & studies. Homeopathic remedies for frozen shoulder should be selected based on the individual’s symptoms and constitution.
Commonly prescribed Homoeopathic remedies for frozen shoulder are:
- Rhus toxicodendron: This medicine is indicated when the pain and stiffness of the frozen shoulder are worse in the morning and after rest, but improve with motion and warmth. There may also be tearing or burning pains, and the affected area may feel hot and swollen. Rhustox is also useful when the symptoms are brought on by overuse or
injury. - Bryonia alba: Bryonia is indicated when the pain of the frozen shoulder is worse with motion and better with rest. There may be a stitching or tearing pain, and the affected area may feel hot and swollen. The person may also be irritable and thirsty for large quantities of water.
- Causticum: It is indicated when the frozen shoulder is accompanied by a sensation of stiffness and tension in the affected area. The pain may be tearing or burning, and the person may experience weakness or trembling in the arm. The symptoms may be worse in cold, damp weather.
- Arnica montana: Arnica is indicated when the frozen shoulder is the result of an injury or trauma, such as a fall or blow to the shoulder. There may be a bruised or sore feeling, and the pain may be worse at night. The affected area may also feel numb or tingly.
- Kalmia latifolia: It is indicated when the pain of the frozen shoulder extends down the arm, with a feeling of numbness or tingling. The pain may be stitching or shooting, and may be accompanied by stiffness or weakness in the affected area. The symptoms may be worse at night and in cold, damp weather.
- Sanguinaria Canadensis: For Right Sided Frozen Shoulder. Sanguinaria Can. is a great remedy which shows an affinity towards the pains occurring in the right shoulder. Pains are present in the top of right shoulder. Pains usually get worse during the night and while attempting to turn in bed. The patient feels great difficulty to raise the arm on account of distressing pains.
- Ferrum Metallicum: For Left Sided Frozen Shoulder. It is an amazing remedy for treating a complaint of left-sided frozen shoulder. There is a pain in the left shoulder which is constantly present. Pain is of drawing, shooting, tearing and laming character.
Pains are usually shooting downward and travel down the arm and patient may feel it impossible to raise the arm. Pain gets aggravated in bed, the patient has to get up and move about slowly to get some relief. - Guaiacum Officinale: For Marked Stiffness, guaiacum can act wonders in cases where there is immovable stiffness of the joints taking place. There is a sharp stitching type of pains in the top of the shoulder. Pains are of drawing and lacerating nature which can travel down the arm.
- Phytolacca Decandra: For Right Sided Frozen Shoulder.. Phytolacca can be given in cases of frozen shoulder where the pain is present in the right shoulder. Pains in the shoulder and arms feel like electric shocks. Pains are shooting in character and travel from one part to the other. Pains usually worsen during the night and in damp weather.
Patient experiences stiffness in the shoulder that usually makes him unable to raise the arm. - Ledum Palustre: Ledum Pal suits well in the cases where the patient experiences severe pain in the shoulder while raising the arm. The pains are stitching and throbbing in nature. There is pain and pressure in both the shoulder joints which gets worse from motion.
- Calcarea Phosphorica: It can be given without a doubt in cases of frozen shoulder where pain gets worse from any change of weather. There is pain and stiffness in shoulders and shoulder-blades. Pains are dull, sore aching, bruised type in the shoulder and down the arm. Pains start from left then travel to the right and can travel downward to the arm as well.
- Chelidonium Majus: Chelidonium is the most suitable medicine in cases where there is a pain in the shoulder which gets worse on moving arm. Pain in the left shoulder feels like as if it was sprained. Pains are tearing in nature. Pain usually travels downwards with coldness and stiffness of the arms.
- Rhododendron: It helps in cases where there is marked pain in shoulder and gets during a thunderstorm. The patient usually feels pains which get worse while lying upon it and getting relieved by turning to the other side. Violent, tearing and boring type of pains occur in the shoulder which can worsen from motion.
- Syphilinum: Where Pains get worse on raising the Arms. It acts well on the patients of frozen shoulder well where the pain in the shoulder worsens on raising the arm. The patient is able to raise the arm only up to the level of the shoulder with difficulty. He fails to attempt to move the arm above the level of the shoulder.
- Thuja: Thuja can aid the condition well when there is marked stiffness of the shoulder joint. There is sticking, tearing, throbbing type of pains in the shoulder which can get worse even from hanging the arm lose. Pains can also get worse at night and by the warmth of bed. Placing the arm over the head is extremely painful for the patient. Stretching the joints produces cracking sound.
- Lycopodium: Lycopodium can help in relieving the condition of frozen shoulder where there is tearing type of pains in the shoulder joint. There is pain and tension in the right shoulder. Pain can occur even when the patient is at rest. Bruised pains in shoulders and in the region of scapula and upper arm.
BIBILIOGRAPHY:
- Bailey & Love’s short practice of surgery # 24th edt pg no: 362 edited by R.C.G Russell Norman S. Williams & Christopher J.K Bulstrode
- Harrison’s principles of internal medicine #17th edt; vol II, pg no: 2185
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4363808/
- Das S. A manual on clinical surgery # 10th revised edt
- https://emedicine.medscape.com
- www.mayoclinic.org
- www.wellinghomoeopathy.com
- https://www.vinmec.com
- Duplay E. De la periarthrite scapulo-humérale et des raideurs de l’épaule qui en sont la
conséquence. Arch Gen Med. 1872;20:513–542. [Google Scholar] - Codman EA. Tendinitis of the Short Rotators. In: The Shoulder: Rupture of the Supraspinatus Tendon and Other Lesions in or about the Subacromial Bursa. Boston
MA: Thomas Todd; 1934. [Google Scholar] - www.drhomoeo.com
- Allen HC. Keynotes and Characteristics. Rearranged and Classified. edt:10
- Boericke William, “Materia Medica with Repertory”. B. Jain. Publishers Pvt. Ltd. New
Delhi: 1994 (reprint)
