Frozen shoulder will not freeze the honor

B

y Jang Su-hee

Shoulder pain is a very common complaint especially for those in their late 40s and over. Recently, about 10 percent of in-patients complained of some kind of pain with no higher tendency in gender; slightly different from the known fact that it is twice as more common in women, especially those in post-menopause. Patients visit the hospital with debilitating pain, but many were unsure of the cause of the pain.

Commonly the pain is diagnosed as frozen shoulder, bursitis, supraspinatus tendinitis, thoracic outlet syndrome, tenosynovitis of the biceps, or snapping shoulder. Frozen shoulder, bursitis, and tendinitis are the most common causes of pain.

The shoulder joint structure is an intricate complex system of bone, muscles, cartilage, ligaments (tissues connecting bones), and tendons (tissues connecting muscles with bones) that is involved in the movement and stabilization of the arm.

The head of the upper bone of the arm, the humerus, is attached to the joint socket, the glenoid fossa, by the four major muscles of the rotator cuff. The tendons of these four muscles form a cuff by merging around the gleno-humeral joint. Think of a baseball catcher with glove in one hand and ball in the other hand. The joint socket is like a baseball glove and the head of the humerus as the baseball deeply placed within the glove.

This ball and socket joint allows the greatest range of movement in many directions and rotation in 360 degrees, including arm movements such as raising above the head, extending from the body or moving it forward or backward and across the body. This joint allows elementary movements essential for the quality of life such as grooming, brushing teeth or hair, dressing and undressing, and the washing of our face and body.

Frozen shoulder occurs with the thickening of the capsule of connective tissues forming the joint, causing stiffness, swelling and pain in the shoulder joint area. It is also called adhesive capsulitis. It occurs with no associated injury. Risk factors for frozen shoulder include diabetes, stroke, accidents, lung disease, connective tissue disorders and heart disease.

The joint cavity filled with scar tissues causes pain and inflammation of the ligaments and tissues around the joint that over time, with no space for movement due to the scarring will result in limited shoulder movement. Patients experience sleepless nights because of worsened joint pain for extended periods.

According to American Academy of Orthopaedic Surgeons (AAOS), the normal course of a frozen shoulder has been described in three stages. The “freezing” or painful stage, stage I, as a slow onset of pain that lasts from six weeks to nine months. The “frozen” or adhesive stage, stage II, as a slow improvement in pain but the stiffness remains, lasting from four to nine months. Stage III, the final stage, is the “thawing” or recovery, as shoulder motion slowly returns to normal that lasts from five to 26 months.

In Korean medicine, frozen shoulder maybe classified under the “bi” syndrome, arthralgia condition. According to “The Nei Jing,” the earliest book on Chinese medical theory compiled around 100 B.C., “a combination of three pathogens, wind, cold, and damp, invades the body, leading to obstruction and causing ‘bi.’ When ‘bi’ lingers in the bones and tendons, it remains for a long time. When it is in the tendons, one is contracted and cannot straighten. When the ‘bi’ condition is exposed to cold, it results in acute flare-ups.”

According to “The Nei Jing,” in acupuncture treatment of ‘bi’ syndrome, it follows the channels that are affected and treats the corresponding points. The acupuncture, pharmaco-acupuncture, herbal medical treatment is aimed at pain control, restoring the range of motion, and shortening the painful period.

The writer practices traditional Korean medicine at Nasaret Oriental Medical Hospital in Incheon. She can be reached at jangsuhe@gmail.com.