Frozen Shoulder

                                 (Adhesive Capsulitis, Deltoid Pain Apabahuka, कंधे में दर्द) 

A condition characterized by stiffness and pain in the shoulder joint. The condition occurs more commonly in people with diabetes and in people who've kept their arm immobilized for a long period of time.

Symptoms may start gradually and resolve within one or three years with the right care. Symptoms some times worsen over a time. The risk of developing frozen shoulder increases if you are recovering from a stroke or a procedure like a mastectomy which prevents you from moving your arm.

Treatment involves  motion of exercises, stretching and sometimes injecting corticosteroids and numbing medication into the joint capsule. In some cases, arthroscopic surgery is used to loosen the joint capsule. so it can move freely.

There are more than 1 million cases of frozen shoulder per year in India. It is very common condition. It is treatable by a medical Professional. It requires a medical diagnosis. Lab test or imaging often required. This condition is resolved slowly.

Introduction

Frozen Shoulder, also known as "Adhesive Capsulitis", is a condition characterized by stiffness and pain in your shoulder joint. signs and symptoms typically begin gradually, worsen over time and then resolve, usually within one to three years. 

In frozen shoulder tissues within the shoulder joint thicken to restrict movement, which causes pain. Frozen shoulder can affect one or both the shoulders. Sometimes, a trauma or an injury can also cause a frozen shoulder. The longer you ignore a frozen shoulder, the greater possibility there is of a permanent shoulder disability. A frozen shoulder can be fixed in many ways, if diagnosed early.

Sometimes constant pain, or just discomfort when reaching behind your back or head. While any shoulder pain can eventually progress to a frozen shoulder, the most common cause is a rotator cuff tendinitis.

Finally, with a frozen shoulder, there is a loss of passive range of motion (what the doctor can do when manipulating the arm), as well as a loss of active range of motion (what the patient can do alone).

What causes frozen shoulder ? The shoulder joint is made up of  the bones, ligaments and tendons.. Which are encased in a capsule of connective tissue. Frozen shoulder occurs when the capsule thickens or tightens around the shoulder joint. stopping or limiting its movement.

Compared to men women are more prone to  developing this condition. It is more likely to occur in people between the ages of 40-60. People with diabetes are also at  higher risk.10-20% of people with Diabetes develop frozen shoulder. Condition such as heart disease, thyroid or Parkinson's disease are also associated with  frozen shoulder.

Why does a frozen shoulder hurts more at night?

What happens in your shoulder when you have a frozen shoulder? Painful Phase Your body increases the blood flow to your shoulder to try and lay down new tissue. This causes a pain similar to toothache and is why your shoulder is particularly painful at night and can feel incredibly painful to lie on.

Signs & Symptoms

Initial pain followed by stiffness lasting several months. As the pain subsides exercises are intensified until full recovery is regained.

●   Shoulder Pain : Typical pain of a frozen shoulder is described as a dull, aching pain. Often the discomfort surrounds the front, back, and side of the shoulder. At times the pain will extend down the upper part of the arm. Usually the pain is manageable with the arm held at your side, but even small movements may cause significant discomfort.

●   Limited Range of Motion : The hallmark finding of patients with a frozen shoulder is limited range of motion. While many shoulder conditions can cause pain of the joint, frozen shoulder is also characterized by significant stiffness. 

●   Difficulty with Activities: Many typical activities, such as brushing hair, putting on shirts/bras, fastening a seat belt, can become very difficult. The most common problem is reaching behind your back, and patients often notice that their unaffected shoulder can reach much higher up their back than their frozen shoulder.

Cause

●   Due to under use of shoulders.
●   Correction of postural abnormalities such as
●    Poor positioning of a computer screen
●    Inappropriate sitting 
●    Sleeping without adequate neck support
●   Carrying the unbalance load such as laptop, briefcase or shopping bag.
●   People who have certain diseases like diabetes, hyperthyroidism or Parkinson’s disease are more likely to develop a frozen shoulder due to high levels of inflammation. 

●   Outside of the Shoulder : 

The most common cause of pain over the outside of the shoulder is a rotator cuff problem.  There are four rotator cuff muscles that are critical to moving the shoulder. These are not the big muscles involved with lifting heavy objects, but they are critical to moving the shoulder normally. There are three main types of rotator cuff problems

1. Tendinitis
2. Bursitis
3. Rotator cuff tear 
4. 
   

While rotator cuff bursitis and tendinitis refer to inflammation of the bursa (a fluid-filled space) and tendons (which connect your shoulder muscles to your upper arm bone), respectively, a rotator cuff tear occurs when the tendons of the rotator cuff separate from the bone.

In terms of symptoms, rotator cuff problems are usually painful with activities such as reaching or throwing. In addition, the deep, aching shoulder pain from a rotator cuff problem tends to be worse or flare at night.

The reasoning is unclear, but it's not unusual for patients with rotator cuff tendinitis  or a rotator cuff tear to be awakened from sleep or have difficulty falling asleep because of shoulder pain.

In terms of mobility, a limited active range of motion is typical of a rotator cuff problem.

Since the injured or inflamed muscle will not do the appropriate work, the shoulder often feels stiff. But if someone does the work for you by lifting your arm, the shoulder moves normally.

●   According to Ayurveda : Apabahuka is a disease which affects shoulder joint. It is produced by the Vata  Dosha.

                               

Symptoms

Typically, frozen shoulder develops slowly and in three stages. Each stage can last for a number of months :

• Freezing Stage : Any movement during this phase causes pain and the shoulder's range of motion starts becoming limited.
• Frozen Stage : In this stage  the pain may start to diminish. However, the shoulder becomes stiffer and moving it  becomes difficult.
• Thawing Stage : The range of shoulder motion begins to improve

In some people , the symptom of frozen shoulder worsen at  night, disrupting sleep.

Diagnosis

●   Medical History: History of injury. 

●   Physical examination :

They'll feel for tenderness and swelling and will also assess your range of motion and joint stability.

Just raise your arm out to the side, bring your arm forward about 6 to 8 inches, and turn your hand down, like you are pouring out a can of soda. From this position, your physical therapist can gently push on your arm, and pain or weakness indicates a positive test for a possible supraspinatus tear or problem.

Your physiotherapist (PT) will perform various tests and measures to help determine the problem that may be causing your shoulder pain. Your therapist may measure your shoulder range of motion and strength. Your shoulder muscles may be palpated or touched, to help determine if there is any specific pain or tenderness around your shoulder. Shoulder special tests may also be performed. These tests help your physical therapist determine if your shoulder pain is being caused by a muscle or tendon problem, shoulder impingement, or shoulder instability

●   Tests for Frozen Shoulder

A frozen shoulder is a painful condition that involves a severe loss of range of motion in the shoulder coupled with significant pain. There really is no special test or diagnostic test, like an X - Ray, for a frozen shoulder.

The diagnosis is made by observation of the mobility of your shoulder.

 Usually, a painful loss of motion while lifting your arm forward, out to the side, and through rotation indicates a frozen shoulder.

●   Drop Arm Test : Your P.T may perform the drop arm test if they suspect that you have a rotator cuff tear  in your shoulder. The test is done by having your physical therapist lift your arm out to the side of your body while keeping your arm straight. Your therapist then drops your arm (hence the name of the test).A positive test occurs when you are unable to hold your arm out to the side and it falls to your side. This means that you might have a rotator cuff tear in your shoulder.

●   Neer's Test : Neer's test is a special test for the shoulder that tests for shoulder impingement . It is a simple test that is performed by your physical therapist by lifting your shoulder up and then adding over-pressure at the end of the range of motion.Pain at this end range means that the test is positive and that impingement of the shoulder is likely causing your shoulder pain. The test doesn't tell which structure—the bursa, a ligament, or the rotator cuff, is being pinched in your shoulder. It merely tells you that something is being pinched. Neer test has an accuracy rate of 90.59% for identifying subacromial impingement syndrome (S.A.I.S)

●  Apprehension or Relocation Test : If your physical therapist suspects that you have shoulder instability or a shoulder labrum tear, they might perform the apprehension test.The test is performed with you lying on your back. Your physical therapist then bends your elbow to 90 degrees and moves your arm out to your side. The PT then rotates your shoulder so that the back of your hand moves towards the floor. This is called external rotation of the shoulder. If you feel like your shoulder is about to pop out of joint, or if it actually pops out of joint, the test is positive. Of course, this position is likely to cause you apprehension, and thus the name of the test. The relocation portion of the test is performed by having your physical therapist place one hand on top of your shoulder to help put the joint back into place. You should feel like the joint is in the right place, and your apprehension about having a dislocated shoulder will disappear.

●   Sulcus Test : If your PT suspects you have shoulder instability from a labrum tear, they may perform the sulcus test. To do this test, you simply hang your arm down at your side, and your PT then gently, but firmly, pulls down on your arm.A positive sulcus sign is when a small divot, or sulcus, appears at the top of your shoulder joint. This means that your shoulder may be pulling away from the socket, indicating shoulder instability.

●   AC Compression Test : The acromio-clavicular (AC) joint is made up of the union of the collar bone and acromion portion of the shoulder blade. It is located on the top part of your shoulder. The AC joint may become separated in a traumatic event like a sports injury, or a car accident. If your physical therapist suspects that you have a separated AC joint, they may perform the AC joint compression test. To perform the test, your PT places one hand on the front of your shoulder and one hand on the back of your shoulder. Your therapist then pushes their hands together, compressing the AC joint. If intense pain if felt, then the test is positive and an injury to the AC joint is suspected.

●  Hawkin's Kennedy Test : The Hawkin's Kennedy test is another test for shoulder impingement. It is performed by your physical therapist who raises your arm with your elbow bent about 90 degrees. The arm is then brought in front of the body, and your elbow is then raised up while your forearm is lowered. Pain in the shoulder indicates that structures in the shoulder like the rotator cuff or the bursa are getting pinched.

 ●   X-Ray : An x-ray is usually obtained to ensure the shoulder joint appears normal, and there is not evidence of traumatic injury or shoulder arthritis.

●   MRI : An MRI is sometimes performed if the diagnosis of frozen shoulder  is in question, but this test is better at looking for other problems, rather than looking for frozen shoulder. If an MRI is done, it is best performed with an injection of contrast fluid into the shoulder joint prior to the MRI. This will help show if the volume of the shoulder joint, which may be small in patients with a frozen shoulder.

When to See a Doctor

If you are unsure of the cause of your shoulder pain, or if you do not know the specific treatment recommendations for your condition, you should seek medical attention.

• Inability to carry objects or use the arm
• An injury that causes deformity of the joints.
• Shoulder pain that occurs at night or while resting.
• Shoulder pain that persist beyond a few days.
• Inability to raise the arm.
• Swelling or significant bruising around the joint or arm
• Signs of an infection, including fever skin redness and warmth.

Life Style

1.     Rub with towel around shoulder after bath

2.     Avoid wrong  sleeping posture at night

3.     Avoid carrying laptop at the back

4.     Shoulder should not be over stressed

How do you sleep comfortable with frozen shoulder?

If you sleep on your back, place a pillow under your involved arm and allow your hand to rest on your stomach. If you sleep on your side, sleep on the uninvolved side hugging a pillow across your chest. Sit with good posture. Avoid slumping and slouching.

Others

1.     Wearing socks over shoulder at night

2.     Putting a tight cloth  band or a crape bandage around shoulder

3.     Wearing Armlet (Bajuband)

4.     Avoid exposes to cold over shoulder area

 

Herbs

1.    Hot milk with turmeric at night. Turmeric is an amazing spice with fantastic health benefits. Its anti-inflammatory properties help relieve arthritic pain, tennis elbow, frozen shoulder, and joint or tendon problems. It eases stiffness, painful muscles, and headaches. 

2.     Soak fenugreek seeds at night and eat in the morning

3.     Eat Crushed garlic in the morning

General care

Drink 3-5 litres of water daily 

Yoga

●      Seated Mountain Pose Parvatasana (पर्वतासन)

In this variation of Padmasana the arms are stretched over the head with the fingers interlocked.

Technique : 

• Sit in Padmasana.
• Interlock the fingers, and stretch the hands vertically up  over the head. Keep the head bend forward with the chin on the breastbone.
• Stretch the arm up from the latissimus dorsi  (near the floating rib at the back) and the shoulder blades. The palms should face upwards.
• Hold the pose for a minute or two with deep and even breathing. Change the crossing of the legs and the interlock of the fingers and repeat the pose, keeping the back erect.

Benefits :

• The asana relieves rheumatic pains and stiffness in the shoulders.
•  It helps free movement and to develop the chest.
• The abdominal organs are drawn in  and the chest expands fully.

●     Cow Face Pose Gomukh Asana   ( गोमुखासन )
                                                 

                                     
 Technique : Sit erect on the ground with your legs stretched out in front of you. Now gently bend your left leg, and place it under your right buttock. Fold your right leg and place it over your left thigh. Place both your knees close together as they are stacked one on top of the other.  Gently fold your left arm and place it behind your back. Take your right arm over your right shoulder, and stretch it as much as you can until it reaches your left hand. With practice, you will be able to not just reach, but also catch your left hand. Keep the trunk erect, expand your chest, and lean slightly back.

B        Benefits :

• It stretches your hips.
• It provides power to your ankles, thighs, shoulders, armpit, chest, deltoid and triceps.
• Relieves chronic knee pain.
• Strengthens your spine and abdominal muscles.
• Helps decompress low spine (during folded variation)

●  Adho-Mukha Svanasana (Downward-facing dog pose)   (अधो मुख स्वानासन )

                                              
                                  


Technique : Come down on all fours. Keep your back extremely straight. Come into your fours. Form a table such that your back forms a table top and your hands and feet form the legs of the table. As you breathe out to lift the hips up, straightening the knees and elbows, form an inverted V–shape with the body. Hands are shoulder width apart, feet are hip width apart and parallel to each other, toes point straight ahead. Press your hands into the ground wide through the shoulder blades. Keep the neck lengthened by touching the ears to the inner arms. Hold the downward dog pose and take long deep breaths. Look towards the naval. Exhale bends the knees, return to table pose, Relax.

Benefits

• Calms the brain and helps relieve stress and mild depression.
• Energizes the body.
• Stretches the shoulders, hamstrings, calves, arches, and hands.
• Strengthens the arms and legs.
• Helps relieve the symptoms of menopause.
• Relieves menstrual discomfort when done with head supported.
• Helps prevent osteoporosis.

●   Eagle Pose  Garudasana   ( गरुड़ासन )
                                                       

                                                                                                

Technique : In Sanskrit   Garuda means kidneys. First stand straight and then bring left leg forward over the right leg and now coil left leg over right leg. Then in similar manner coil both the hands together and both palms should touch each other in a position of Namaskar. Hold it for some times and then repeat its steps with another side of the body.

Benefit : 

•     Stronger arms legs, knees and ankles.
•      Open shoulder joints, creating space between the shoulder blades'
•      Open hips and IT band
•      Increased circulation to all joints.
•      Improved digestion and elimination.
•      Improved balance 
•      Improved focus.

Massage

Massage and stretching are extremely beneficial for treating frozen shoulder pain. Massage helps to relieve tension and tightness so your muscles can relax. This helps to restore mobility and improve function. It also may help improve blood flow to the affected area and reduce inflammation. Applying warm sesame oil or mustard oil, coconut oil mixed with camphor or Mahanarayana oil  can give pain relief. Warm compress with the aid of a hot towel can also help. The relief is generally slow-paced. 

To start, one of the best ways to perform a shoulder massage is by using a foam roller. Place it underneath the armpit of your affected arm and lean on a counter or table. Extend your arm out as if you're reaching for something and gently roll back and forth to loosen the muscles in your shoulder

• Tiger balm Application
• Move ointment.  
• Mustard oil seasoned with garlic and fenugreek and ajwain. 

Can a chiropractor fix a frozen shoulder?

Chiropractic is an effective treatment for frozen shoulder. Many patients see their general practitioner first to get a diagnosis and to make sure that there are no underlying conditions that should be treated before chiropractic is pursued

Chakra

Anahat Chakra or / Hridaya Chakra A heart chakra block can manifest as shoulder pain.

Stimulation of heart chakra: Make the fist of right hand keep the hand over heart and left hand folded will be kept on the arm. Take inspiration followed by expiration + pressure.

Location: It is located on the left side of the chest in between lungs. It is stimulated with help of fist.

 Mudra

Vayu  Mudra

Pressing folded index finger with the help of thumb of both the hands.

Prana mudra.

• Pain in the neck, frozen shoulder are cured by the Vayu mudra followed by Prana mudra.

Ganesh / Ganapa Mudra- Agragami Mudra

 

Ganesh Mudra, also known as Ganapa Mudra -Agragami Mudra, is named after the Hindu deity, Ganesha

Formation :

Hold the left hand palm facing outward in front of the chest with bent fingers. Hook the right hand fingers in the left hand fingers. exhale the pull both the hands in the opposite direction without releasing the grip.Then inhaling let go the tension. Repeat the six times. then place both the hands on the sternum.

Now change the hand position, with the right palm facing outwards. Repeat this 6 times.

Then remain in silence for a while.

Effect :

This mudra tenses the muscles of upper arm and chest area. All five elements joining together give power to the whole body.

Benefits :

• The shoulders pain.
• Activates heart and lungs.
• Opens the Anahata Chakra and instills the courage to face any situation. 

Marma Points

Press these Marma points for 0.8 seconds for 18 times twice a day

1.     Amsa Marma

Location and stimulation:

1 .  Amsa is an important Marma i.e. vital or delicate point in the body. It is located in the upper back, one on either side of the vertebral column  It is located in between neck and shoulder. When both the hand's touch at the back of shoulder the point where middle finger touches are amsa marma.

2.     Udharva Skanda Marma

Location and stimulation: On the shoulder just before amsa marma. At the superior aspect of the trapezius muscle, midway between the tip of the spinous process of C-7 vertebra and tip of the acromion.

3.     Adhah Skanda Marma

Location and Stimulation: It is located on the lateral side of the arm in a depression between deltoid and brachialis muscle (site of Bajuband or Armlet).

Diet

What aggravates frozen shoulder?

People with a frozen shoulder should avoid all vata-aggravating diets and lifestyle practices. Frozen food, carbonated drinks, fast food, stale food, packaged food, chips, popcorn, white flour (refined flour) products, ice cream and any form of stimulant like tea, coffee or alcohol should be avoided. Avoid meat, butter, cheese and milk as that will increase inflammation. Gas forming food i.e. Gram, Cauliflower, Arvi, Cabbage, Okra (Lady finger), Urad Dal, Lobhia, Kidney beans (Rajma) should be avoided. Excess salt intake (chatani, pickles, etc.)

What Food is good for Frozen Shoulder?

With proper exercise, rest, and nutrition, a person with frozen shoulder can find great relief from pain. To combat stiffness, avoid food, drink with caffeine.  Increase intake of raw fruits like cherries, papaya, pineapple. Garlic, ginger, south, fenugreek seeds, turmeric are good to eat.  Increase intake of raw fruits like cherries, papaya, pineapple

                                    "Consult a physician, or physiotherapist or an orthopedic surgeon."

Treatment

These frozen shoulder exercises will help increase your mobility.

• Pendulum stretch. Do this exercise first. ...
• Towel stretch. Hold one end of a three-foot-long towel behind your back and grab the opposite end with your other hand. ...
• Finger walk. ...
• Cross-body reach. ...
• Armpit stretch. ...
• Outward rotation. ...
• Inward rotation.

Exercises for Shoulder Pain

Here is a list of exercises that can help you treat a frozen shoulder at home:
1. The pendulum stretch
Stand up and relax your shoulders and let the affected arm hang down. Swing in the arm gently in circular motions for about 10 times in each direction. Slowly increase your speed everyday and add more repetitions of the exercise. You can also add a little weight to your hand to accelerate the healing.
2. Armpit stretch
Place your affected arm on a shelf of the height till your chest region. Slightly bend and straighten your knees to stretch the arm pit. Try bending your knees deeper as the your shoulder heels.
3. Towel stretch
Take a small towel and hold one side of it. Bring the towel towards your back and grab the opposite end with your other hand. Pull one arm upwards and the other downwards. Do this exercise everyday for 10-20 minutes.
4. Finger walk
Stand in front of a wall with your fingertips placed on the wall at your waist level. Keep your arm slightly bent. Slowly and steadily place your fingers upwards on the wall as much as you can by not providing too much strain on your shoulder. Perform this exercise 10-20 times a day.
5. Cross-body reach
Use your unaffected arm and with it lift your affected arm from the elbow. Bring the affected arm to cross your body and stretch the arm comfortably for 15-20 seconds. Do this exercise for 10-20 minutes every day. Stretch the arm more and more daily.
You should also provide your shoulder with a sling support while resting it. A sling support can help ease the discomfort caused by a frozen shoulder. Also, contact a physician if the pain and the condition of a frozen shoulder persists.

1 . Shoulder Squeeze

Shoulder squeeze

Sit up straight on a low back chair with your hands on the thigh and your shoulder straight slowly draw your shoulder back and squeeze your shoulder blades together. 

2 . Arm Stretch

Raise your right arm in front of you parallel to the floor and bend the elbow to touch your right shoulder. Hold the right elbow with your left hand and gently fold it across your chest to stretch your upper arm and right shoulder. Repeat on another side. 

Shoulder Flexion

Weight Shift on wall

Wall Triceps Stretch on wall

3 . Hand Butterfly exercise can be done with folded hands

4 . Arms lift forwards, up & down

5 .  Arms lift sideways, up & down 

6 .   Fingers on shoulders with elbows bent:

a.      Elbows circling forwards & up and backwards & down.

b.     Elbows circling backwards & up and forwards & down.

7 .    Shoulder bracing 

8 .   Externally rotating the shoulders- Raise the hand up beside ears and move down

9 .     Touch the shoulder with both the hands and make the round movement in one direction then reverse it 

10 .  After folding both the hands Raise upwards, sideways. Then give a pressure at the back of the head followed by sides and front.

11 .   The right-hand meeting left hand at the back.

12 . Scapula Exercise

The elimination of neck tension can relieve frozen shoulder.

Prevention

Can frozen shoulder be prevented ?

One of the most common cause of frozen shoulder is the immobility that  may result during recovery from a shoulder injury, broken arm, a stroke or mastectomy. If you have had an injury that makes it difficult to move your shoulder, talk to your doctor. Doctor can suggest exercises that maintain the range of  motion in your shoulder.

The treatment of frozen shoulder involves controlling pain and preserving the range of motion. of the shoulder. The condition can be treated with  a corticosteroid injection, joint distention, physical therapy, surgery and shoulder manipulation The doctor chooses the best method  of treating  based on the cause, severity and age of the patient

Rest

The first treatment for many common conditions that cause shoulder pain is to rest the joint and allow the acute inflammation to subside. It is important, however, to use caution when resting the joint, because prolonged immobilization can cause a frozen shoulder.

Ice Packs

Ice packs are most often used to reduce the swelling and pain from an acute shoulder injury, but they can also be used to treat shoulder overuse injuries (for example, rotator cuff tendinitis or bursitis). In these cases, the ice is applied right after the overhead activity to diminish the onset of any inflammation.

 Heat Application

Heat pads are also used to treat chronic shoulder conditions, but generally before the overhead activity is performed. Heat can relax the muscles, ease stiffness, and reduce pain.

Before applying ice or heat , talk with your doctor or physical therapist. Developing a specific plan as to when to do each treatment, and how long it should last, is important for optimizing your shoulder healing.

Heat Fomentation

Warm up your shoulder. By warming it up, you restore the shoulder with adequate blood supply and prevent any further injuries. You can warm up the shoulder by taking a warm bath and start to move it gently in circular motions. You should make sure the movement is gentle and slow. Before you start any home treatment for mending a frozen shoulder, you need to first warm up your shoulder. By warming it up, you restore the shoulder with adequate blood supply and prevent any further injuries. You can warm up the shoulder by taking a warm bath and start to move it gently in circular motions. You should make sure the movement is gentle and slow. Any harsh movement can damage the shoulder. You can also add a little Epsom salt to your bath to help with the heat provided to shoulders. For best results, practice gentle and light shoulder exercises two to three times every day. After warming up the shoulder, it is recommended to do a few exercises. These exercises can help provide mobility to the frozen shoulder and help in an adequate treatment.

Local application of heat is helpful.

Electric heating pad, hot water gel pillow :For application of heat locally.

Physical Activity

Physical activity is an important aspect of treatment of almost all orthopedic conditions. Physical therapists use different modalities to increase strength, restore mobility, and help return patients to their pre-injury level of activity.

Medications

The two most common medications used to ease shoulder pain and swelling are non-steroidal anti-inflammatory (NSAIDS)  and steroid injections.

Your clinician may recommend an anti-inflammatory medication such as aspirin, ibuprofen (Motrin, Advil), or naproxen (Aleve, Anaprox). An ice pack or bag of frozen vegetables applied to the shoulder for 10 to 15 minutes several times a day can also help with pain.

N.S.A.I.D's

N.S.A.I.D's, some of which are available over-the-counter (for example, ibuprofen), and others which are only prescribed, like Voveron / Voltaren (diclofenac), are commonly used to treat shoulder problems like arthritis, bursitis, and tendonitis.

That said, it's important to only use them for a short duration and only under the guidance of your doctor. N.S.A.I.D's are associated with some risks; be sure to notify your doctor if you are pregnant or have any health problems like high blood pressure, asthma, or a history of kidney disease, liver disease, or stomach ulcers.

• Steroid Treatment : 

Steroid Injection

With a steroid injection, your doctor will give you a shot of cortisone a powerful steroid medication that treats inflammation—into the area of your shoulder where you are experiencing pain. An injection can not only alleviate pain but help you engage in physical therapy sessions more easily.

Surgery

In some cases, surgery will need to be performed if conservative measures are not working or a shoulder injury is too severe from the start. If your shoulder requires surgery, an orthopedic surgeon should be consulted.

• TENS Stimulation : Trans-cutaneous electrical nerve stimulation. Where do you put tens pads for frozen shoulder? If you're suffering from rotator cuff injuries, bursitis, or frozen shoulder, one pad can be placed on the front of the shoulder and one can be placed on the back. This placement will stimulate the entire joint. For pain that is centralized to one shoulder, both pads can be placed on the side that is in pain

• Joint Distention

According to Ayurveda:

Snehana (both internal and external), Swedana, Basti, Siro Basti and Nasya.

Nasya karma is one of the therapeutic procedures of the panchkarmas, where the drug is administered through the nasal route. This not only alleviates the vitiated dosas but also causes complete eradication of the vitiated dosha and the disease.

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