Frozen shoulder (உறைந்த தோள்பட்டை)

Frozen shoulder, also known as adhesive capsulitis, is characterised by painful and progressive shoulder motion loss due to fibrotic joint capsule changes. This condition typically occurs in middle-aged individuals, with a higher prevalence in women.

Adhesive capsulitis develops in 3 stages: the painful, freezing, and the thawing phase, This may persist from months to years. Although it may resolve on its own, it is debilitating condition & it is an indicator that your body is not functioning at its optimal.

Source: https://www.orthopaedicspecialists.com/blog/3-stages-of-frozen-shoulder

ETIOLOGY (நோய் வரும் வழி)

Based on the etiology, this is categorised as primary & secondary adhesive capsulities.

Primary Adhesive Capsulitis (நோய் வருவதற்கான முதல் நிலை காரணம்)

This is idiopathic (சுட்டி  காட்டும்படியான காரணம் இல்லாத நிலை) & is thought to arise from an intrinsic inflammation leading to fibrotic changes within the shoulder capsule.

It is frequently associated with systemic conditions such as diabetes mellitus and thyroid disorders, suggesting an underlying systemic inflammatory or autoimmune component.

Secondary Adhesive Capsulitis (நோய் வருவதற்கான இரண்டாம் நிலை காரணம்)

This is due to an external event or condition directly affecting shoulder mobility, which includes:

• Trauma: A significant injury to the shoulder

• Surgery: Postoperative complications

• Prolonged immobilisation: Extended immobilisation after injury or surgery/ sedentary lifestyle/limited range of motion in daily activities

  
  

SYMPTOMS (நோயின் குறிகுணங்கள்)

• Restriction in movement of arm (internal rotation, abduction, adduction, etc.)

• Loss of range of motion

• Pain consistent throughout the day while doing daily activities

• In severe cases, there may be an observable loss of the natural arm swing during walking and signs of muscle wasting due to disuse or compensatory behavior to avoid pain.

Source: https://physiomobile.com/physiotherapy/frozen-shoulder-home-exercise-you-should-try/

EVALUATION (நோயை கண்டறியும் வழி)

It is primarily a clinical diagnosis; so there are no specific laboratory testing to diagnose adhesive capsulitis. However, if an underlying systemic condition like diabetes or thyroid disease is suspected to contribute to the presentation, appropriate blood tests may be conducted.

Imaging: A shoulder x-ray is often performed to rule out bony abnormalities. MRI may show some findings, ex. thickened coracohumeral ligament; however, these findings are not definitive for adhesive capsulitis.

Diagnostic injection: Diagnostic injection testing involves administering a local anesthetic, typically 1% lidocaine, into the subacromial space. This helps differentiate between adhesive capsulitis and other pain sources like subacromial bursitis or rotator cuff tendinopathy.

TREATMENT

In Siddha medicine, we typically prefer patients to undergo Varmam treatment (வர்ம சிகிச்சை), & it maybe combined with fomentation, also known as Ottradam (ஒற்றடம்).

Internal medicines such as parangipattai chooranam, thalisadhi choornam, etc. may be given to control the pain & to bring the shoulder back into its natural mobility.

Patients will also be taught strength training as well as yoga to ensure that their shoulder mobility & complete range of motion is preserved, and recurrence of such conditon is actively prevented.