Do these complaints sound familiar?

• Are you unable to lift your arm to wear a T-shirt, or

• You find it difficult to raise your arm to comb your hair?

• You have to hook your bra from the front as you have difficulty hooking it from the back

• Your right shoulder hurts and you have to sleep on the left side or vice versa

• Your fingers feel numb at times, and there is a tingling sensation in them

What you have is probably what doctors would call a "Frozen Shoulder" syndrome. This is not a diagnosis - it just describes a set of symptoms; frozen here means you have difficulty moving the shoulder joint.

Medications you are likely to be given

Your doctor may prescribe some pain killers (analgesics). Some of these may be the stronger ones called NSAID (Non Steroidal Anti-Inflammatory Drugs) or newer ones called Cox-inhibitors. You probably can move the shoulder a little bit more but after a few months, the pain returns, ie it is still there.

For some people, when on those medications, they may feel very uncomfortable in the epigastric region with nausea and a feeling of "gastric pain". Some may even get gastric erosion and gastric bleeding.

When they consult the doctor again, he may order an x-ray, and prescribe stronger drugs called "steroids". He might give an injection into the joint, usually a "steroid" injection.

There will be good relief, for a few days or even longer, but the problem recurs.

That is not the end of the story. Some will probably seek massage or acupuncture treatments. Then when the problem persists, some will eventually seek help from an orthopedic surgeon, who, again may put them on some drug treatment, or suggest surgery, followed by some physiotherapy treatment.

The problem is not the joint, but the muscles and fascia

Very often, the problem of the "frozen shoulder" does not lie in the shoulder joint or bone, where most of the treatment has been directed. The problem, in many cases, lies in the muscles and fascia (the tissue covering the muscle), that moves the joint. You can do a simple test called the hand to opposite shoulder blade test. Using your normal, non-painful shoulder, try to move the hand on the back to touch the opposite shoulder blade. You will not be able to do this with your affected shoulder. If the problem is a minor one, the fault usually will lie in the muscle that sits on the shoulder blade bone (the scapula bone). This muscle is called the infraspinatus muscle. The problem arises because of an injured infraspinatus muscle which is usually shortened in a muscle band (like a tight rope pulling), causing what we would term "a range of movement restriction". Does that make sense?

That muscle band can be easily treated using myofasial therapy, involving trigger point techniques and neuromuscular releases. This, together with some simple home stretching techniques will solve the "frozen shoulder" problem for you. No drugs will be prescribed during the course of the treatment.

Sometimes, if the problem is very severe, other associated shoulder girdle muscles may be involved eg the "rotator cuff" muscles. The "rotator cuff" muscles move and stabilize your shoulder. Although a longer time may be needed to treat the whole group of muscles, an immediate improvement, although very slight initially, can be seen once treatment is started.

If the "frozen shoulder" problem has been there for years, other muscle groups may be affected e.g. on the opposite upper extremity, as well as muscles of the lower extremities. A postural assessment for the whole body will initially be done to assess the problem. All involved muscles need to be treated for a total resolution and holistic management of the problem.