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Sunday, February 8, 2009

Some aspects of Frozen Shoulder with homoepathic mode of treatment

Frozen shoulder is defined as a clinical syndrome characterized by painful restriction of both active & passive shoulder movements due usually to no intrinsic cause within the shoulder . In India the problem is compounded by the increasingly sedentary life styles & general lack of exercise.

Sex- Females are affected at a slightly higher rate than males.

Laterality- Usually unilateral with the involvement of the non-dominant arm, but a percentage of patients develops the disease bilaterally.

Cause- Frozen shoulder is caused by tightening of the soft tissues, that surround the shoulder joint & gets worse over time

Risk factors-
Factors directly related to shoulder joint- A few of them are -
(1) Injuries to the shoulder like fractures & dislocations around the shoulder.
(2) Tendinitis of rotator cuff.
(3) Bicipital tendonitis.
Factors not directly related to shoulder joint- A few of them are –
(1) Diabetes mellitus, especially insulin-dependent type. Diabetics on insulin therapy for many years are more prone to this disease & have a greater chance of having bilateral involvement.
(2) Thyroid irregularities.
(3) Disc problems in neck.
(4) Illness especially heart and /or lung disease or injury that forces to keep the shoulder immobile for a period of time.

Clinical features- There is a gradual limitation of external rotation & abduction movements of the shoulder with pain more marked at night. The pain is usually dull or aching & is worsened with attempted motion. The pain is usually located over the outer shoulder area & sometimes the upper arm. The patient can not dress himself or comb the hair or scratch the back. Gradually stiffness & pain increase to freeze all the movements of shoulder with wasting of surrounding muscles. The hallmark of the disorder is restricted motion or stiffness in the shoulder. Fortunately, pain progressively decreases from the initial, inflammatory phase. With time, patients are able to use the shoulder with little or no pain, within the restricted range of motion, but attempts to exceed this range are accompanied by pain. The overall course is variable but can last 12-36 months.

(1) Blood sugar estimation both fasting and post-prandial to detect associated diabetes mellitus.
(2) Blood for T.S.H, T3, T4 to exclude any thyroid irregularities.
(3) X-ray – It may show decalcification, loss of joint space.
(4) Arthrography- Radiographic confirmation may be done by it। Compared to the normal capacity of 12ml, there may be marked reduction in the capacity of the joint & often the affected shoulder may not take more than 2-3 ml of dyए.

(5) MRI-MRI may be indicated but is not of much use.

Differential Diagnosis- Frozen shoulder is to be differentiated from the following diseases-
(1) Rheumatoid arthritis which may affect the shoulder but it is more likely to affect the small joints of hands or feet.
(2) Osteo arthritis which may sometimes develop in the shoulder but it is more common at the nearby acromioclavicular joint or in neck.
(3) A tear in rotator cuff muscles of the shoulder with development of shoulder pain & disability but it has a high prevalence in those with athletic activities & has a past history of significant shoulder injury.
(4) Serious diseases like cancer or infection but these are very rare around the shoulder.

Treatment- Treatment should be started before stiffness develops.
A] Exercises & physiotherapy- Active exercise of the shoulder like raising the arm against a wall, circumduction movement in a stooping posture is advised. Physiotherapy consisting of short wave diathermy, ultrasound etc may be continued. It should be kept in mind that active exercise is the mainstay of treatment for frozen shoulder & should be continued at least till the disappearance of the symptoms but is better to continue as long as possible even after the disappearance of the symptoms to prevent any further involvement.
B] Homeopathy- Treatment should be constitutional but specific remedies may include Bryonia (Bry) 30 & Rhus toxicodendron (Rhus tox) 30.
(1) Bryonia (Bry) - Bryonia is suitable effective in those who are suffering from severe pain, especially stitching & tearing in nature, made worse by slightest motion, compelling the patient to keep still & felt better by rest.
(2) Rhus tox 30-Rhus tox is suitable for those who have a feeling of stiffness & are suffering from tearing pain which has a tendency to spread & is worse after rest or inactivity but gradually diminishes on moving the shoulder .
Alternate use of Bryonia 30 & Rhus tox 30 with a gap of 3 hours between each dose, starting with Bryonia 30 so that each medicine is taken three times a day. The medicines should be continued till the disappearance of the symptoms & then continued for a couple of days more with a reduced number of dosage.
Besides these the following may also be tried-
(a) Sanguinaria 30 may be used in right-sided frozen shoulder where pain is worse from movement of the shoulder & better by rest & sleep.
(b) Chelidonium 30 may also be used when the pain affects the arm, shoulder, hand & tips of fingers & is made worse from movement of the shoulder as well as on touching but better from pressure or massage.

(1) Regular performance of ‘range of motion exercises’ to maintain a strong & flexible shoulder.
(2) To have prompt treatment for a shoulder injury.
(3) To engage in activities that use the shoulder joint regularly.
(4) To maintain normal movements of the shoulder through a full range several times a day after any injury to the upper extremity like hand, wrist, elbow etc or even after being confined to bed.

Prognosis- In most patients, the condition improves spontaneously 1–3 years after onset। While pain usually improves, most patients are left with some limitation of shoulder motion.

In short, Frozen Shoulder is manifested by pain & stiffness of the shoulder with limitation of both active & passive movements & is treated in homeoepathy with alternate dosage of Bryonia 30 & Rhus।tox 30.

But in every case, a doctor should be consulted.


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