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NEWSLETTER Your Resource for Health, Wellness, and Caring For Your Body
JULY 2023
345.943.8700 | THEPHYSIOTHERAPYCENTER.COM MELT YOUR FROZEN SHOULDER
NEWSLETTER Your Resource for Health, Wellness, and Caring For Your Body
JULY 2023
MELT YOUR FROZEN SHOULDER
FROZEN SHOULDER by mr. sandeep kumar rajavelu balachander, rpt
2. Frozen stage: Pain might lessen during this stage. However, the shoulder becomes stiffer. Functional movement, espe overhead activities, such as hair grooming and upper body dressing/ undressing, becomes more difficult. This stage lasts from 4 to 12 months. 3. Thawing stage: The shoulder’s ability to move begins to improve. This stage lasts from 5 to 24 months. Adhesive Capsulitis (frozen shoulder) affects approximately 0.75% to 5.0% percent of people per year. Rates are higher in people with diabetes (10–46%). Following breast surgery, some known complications include loss of shoulder range of motion (ROM) and reduced functional mobility in the arm. Occurrence is rare in children and people under age 40, with the highest prevalence between ages 40 and 70. The condition is more common in women than men (70% of patients are women aged 40–60). People with diabetes, stroke, lung disease, thyroid abnormalities (hypothyroidism/hyperthyroidism), Parkinson’s disease, rheumatoid arthritis, or heart disease are at a higher risk for frozen shoulder. Symptoms in people with diabetes may be more protracted than in the non-diabetic population. CAUSES The shoulder joint is enclosed in a capsule of connective tissue. A frozen shoulder occurs when this capsule thickens and tightens around the shoulder joint, restricting its movement. The cause can be unclear for some individuals. However, it is more likely to happen after keeping the shoulder immobilized for an extended period, such as after surgery or an injury.
Frozen Shoulder, also called adhesive capsulitis, involves stiffness and pain in the shoulder joint. Signs and symptoms typically begin mildly and can get worse. For some people, the pain worsens at night, sometimes disrupting sleep. Over time, symptoms get better, usually within 1 to 3 years. However, with physiotherapy and medical interventions, this period could be shorter. Keeping a shoulder still or in a limited mobility state for an extended period increases the risk of developing a frozen shoulder. This might happen after having surgery, a fracture, or a soft tissue injury to the arm. Treatment for a frozen shoulder involves range-of-motion exercises. Sometimes treatment involves corticosteroids and numbing medications injected into the joint. Rarely arthroscopic surgery is needed to loosen the joint capsule so that it can move more freely. It is unusual for a frozen shoulder to recur in the same shoulder. However, some people can develop a frozen shoulder in the initially unaffected arm, usually within five years. STAGES Frozen Shoulder typically develops slowly in three stages: 1. Freezing stage: Any shoulder movement causes pain, and the shoulder’s ability to move becomes limited. This stage lasts from 2 to 9 months.
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PREVENTING FROZEN SHOULDER
PHYSIOTHERAPY A physiotherapist will design a specific exercise program to achieve rehabilitation goals. The exercises will help to stretch the tight joint and strengthen weak muscles. Moderate evidence points to improvements in pain management, range of motion, and functional status for people who underwent Proprioceptive neuromuscular facilitation (PNF) techniques, continuous passive motion, and dynamic scapular
If someone is at risk for developing a frozen shoulder, one of the best ways to prevent this is to engage in regular physical activity or exercise. Incorporate upper body movements or exercises like swimming, boxing, or yoga. For more information or supervision, consult your physiotherapist to maintain good shoulder mobility. DIAGNOSIS A healthcare provider might ask you to move your arm in specific ways during the physical exam. This is to check for pain and to see how far you can move your arm (active range of motion). Then you might be asked to relax your muscles while the provider moves your arm (passive range of motion). Frozen Shoulder affects both the active and passive range of motion. A frozen shoulder can usually be diagnosed from signs and symptoms alone. However, imaging tests — such as X-rays, ultrasound, or MRI — can rule out other problems and further confirm the diagnosis. TREATMENT Most frozen shoulder treatment involves controlling shoulder pain and regaining/preserving as much range of motion in the shoulder as possible. MEDICATIONS Pain relievers such as aspirin and ibuprofen (Advil, Motrin IB, or Tylenol) can help reduce pain and inflammation associated with a frozen shoulder. Sometimes, a healthcare provider might prescribe stronger pain-relieving and anti-inflammatory drugs.
stability exercises. Committing to these exercises, even at home, is advisable to regain as much movement as possible to reduce pain levels and improve range of motion. The physiotherapist applies pain-relieving modalities to a frozen shoulder, such as therapeutic ultrasound, electrical stimulation, Laser Therapy, and Extracorporeal Shock Wave Therapy (ESWer). SURGICAL & OTHER MEDICAL PROCEDURES Most frozen shoulders get better on their own within 12 to 18 months. For severe or persistent symptoms, other treatments include: • Steroid injections: Injecting corticosteroids into the shoulder joint might help decrease pain and improve shoulder mobility, especially if given soon after a frozen shoulder begins. • Hydrodilatation: Injecting sterile water into the joint capsule can help stretch the tissue and make it easier to move the joint. This is sometimes combined with a steroid injection. • Shoulder manipulation: This procedure involves a general anesthetic medication, so you’ll be unconscious and feel no pain. Then the care provider moves the shoulder joint in different directions to help loosen the tightened tissue. • Surgery: Surgery for a frozen shoulder is rare. But if nothing else helps, surgery can remove scar tissue from inside the shoulder joint. This surgery usually involves making small incisions for instruments guided by a tiny camera inside the joint (arthroscopy).
References: 1) Mayo Clinic website • 2) Ramirez J (March 2019). “Adhesive Capsulitis: Diagnosis and Management.” American Family Physician. 99 (5): 297–300. PMID 30811157. • 3) St Angelo JM, Fabiano SE (January 2020). Adhesive Capsulitis in StatPearls. PMID 30422550. • 4) Chiang J, Dugan J (June 2016). “Adhesive capsulitis”. JAAPA. 29 (6): 58–59. doi:10.1097/01.jaa.0000482308.78810.c1. PMID 27228046 • 5) Nakandala, Piumi; Nanayakkara, Indumathie; Wadugodapitiya, Surangika; Gawarammana, Indika (22 March 2021). “The efficacy of physiotherapy interventions in the treatment of adhesive capsulitis: A systematic review.” Journal of Back and Musculoskeletal Rehabilitation. 34 (2): 195–205. doi:10.3233/BMR-200186 • 6) Bunker T (2009). “Time for a new name for frozen shoulder—contracture of the shoulder.” Shoulder&Elbow. 1: 4–9. doi:10.1111/j.1758- 5740.2009.00007.x. S2CID 73273337 • 7) Lowe CM, Barrett E, McCreesh K, De Búrca N, Lewis J (September 2019). “Clinical effectiveness of non-surgical interventions for primary frozen shoulder: A systematic review.” Journal of Rehabilitation Medicine. 51 (8): 539–556. doi:10.2340/16501977-2578. PMID 31233183. • 8) Yang A, Sokolof J, Gulati A (September 2018). “The effect of preoperative exercise on upper extremity recovery following breast cancer surgery: a systematic review.” International Journal of Rehabilitation Research. 41 (3): 189–196. doi:10.1097/MRR.0000000000000288. PMID 29683834. S2CID 19086163. • 9) Ewald A (February 2011). “Adhesive capsulitis: a review.” American Family Physician. 83 (4): 417–422. PMID 21322517. “Questions and Answers about Shoulder Problems.” Archived from the original on 28 July 2017. Retrieved 28 January 2008.
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PREPARE TO SWIM SAFELY
5. Wear your sunscreen: Invest in a quality waterproof sunscreen with a high SPF to protect your skin from the sun’s harsh rays. Wearing sunscreen can make a massive difference in the fight against skin cancer and can help you avoid painful burns.
Swimming is a great way to stay active and cool as the weather warms up. However, it’s essential to take the necessary steps to ensure that you’re safe in the water. Check out these important swimming safety tips before heading out to the beach or pool this summer! 1. Ensure that a lifeguard is present as you swim: Having a trained lifeguard watching over you at the pool or beach is a must. A lifeguard can prevent you from sustaining a severe injury or drowning and can generally ensure that you’re following the best practices for swimming. 2. Swim with a buddy: Not only is swimming with a friend a great way to stay safe, it’s also more fun! Swimming with a buddy can also help you hold yourself more accountable and stay determined as you progress through your laps. 3. Never leave a child unattended: It is essential to make sure your child never swims alone– this is how accidents happen. Teach your children to ask permission before going in the water, and let them know that an adult should always be there to supervise them. 4. Drink plenty of water: It can be easy to get dehydrated under the hot sun, even if you are in a cool and refreshing body of water. Remember to drink plenty of liquids and avoid dehydrating drinks with excess caffeine.
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“Telehealth involves using telecommunications and virtual technology to deliver healthcare outside traditional healthcare facilities. Telehealth, which requires access only to telecommunications, is the most basic element of “eHealth,” which uses a broader range of information and communication technologies (ICTs). Telehealth examples include virtual home health care, where patients such as the chronically ill or the elderly may receive guidance in specific procedures while remaining at home. Telehealth has also made it easier for healthcare workers in remote field settings to obtain advice from professionals elsewhere in diagnosis, care, and referral of patients. Training can sometimes also be delivered via telehealth schemes or related technologies such as eHealth, which uses small computers and the internet. Well-designed telehealth schemes can improve healthcare access and outcomes, particularly for chronic disease treatment and vulnerable groups. Not only do they reduce demands on crowded facilities, but they also create cost savings and make the health sector more resilient. Since remote communication and treatment of patients reduce the number of health service visits, transport- related emissions and operational requirements emissions are reduced. In addition, fewer space demands can result in smaller health facilities, with concurrent reductions in construction materials, energy and water consumption, waste, and overall environmental impact.” From: Health and sustainable development – https://www.who.int/sustainable-development/ health-sector/strategies/telehealth/en/ To ensure you have a great appointment, please check the following: 1.Camera Position & Location: Your camera should be set up to allow you to move around and remain visible to your physiotherapist. 2. Device Power Source: It is best to have the device plugged in. 3.Audio: Consider using earbuds or Bluetooth headsets for more precise sound. 4.Internet Connection: It should be 15Mbps or higher. You may check your internet connection at fast.com. 5.Environment: A quiet private space free of distraction is recommended so that you will be more focused. WE OFFER TELEHEALTH
RECIPE OF THE MONTH
Ingredients: • 1 Tbsp canola oil, or high heat oil of choice • 1 small onion, sliced into strips • 2 garlic cloves, minced • 2 (20 ounce or 567 gram) cans young green jackfruit in brine, drained and rinsed • 2 Tbsp soy sauce • 1/2 tsp liquid smoke • 1/2 tsp smoked paprika • Pinch cayenne pepper to taste • 1 1/2 cups vegan barbecue sauce • Salt and pepper to taste Jackfruit Pulled Pork Sandwich
• 6 sandwich rolls • Vegan coleslaw
Directions: Coat the bottom of a medium skillet with oil and place it over medium-high heat. Add onion and cook for about 5 minutes, stirring occasionally, until soft and beginning to brown. Add garlic and cook for about 1 minute, until fragrant. Add jackfruit, soy sauce, and liquid smoke. Cook for about 5 minutes, until most of the liquid cooks off. Use a spoon to begin breaking up the large chunks of jackfruit. Sprinkle with smoked paprika and cayenne pepper. Stir and continue cooking for about 1 minute. Stir in the barbecue sauce. Bring sauce to a simmer, lower the heat, and cook for about 20 minutes, stirring occasionally. Add a splash of water if the sauce becomes too thick. While the jackfruit simmers, use two forks to pull the pieces apart to create a stringy texture. The jackfruit is finished cooking when it is tender and stringy, resembling pulled pork, and the sauce is thick. Stuff the pulled jackfruit into buns with toppings of choice (coleslaw).
www.connoisseurusveg.com/jackfruit-pulled-pork/chetta
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