Introduction
Frozen shoulder, also referred to as adhesive capsulitis of the shoulder, is a condition marked by pain and stiffness in the shoulder joint. It is commonly associated with gradual loss of movement or persistent immobilization of the shoulder joint. The person with a frozen shoulder sustains three stages with unique signs and effects:
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Freezing Stage: Pain gets worse, and the phase lasts for six to nine months.
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Frozen Stage: Here, the stiffness worsens with increased movement restriction. The phase lasts for four to twelve months.
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Thawing Stage: Getting back to normal. The stage lasts for six months to two years.
Signs of Frozen Shoulder:
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Shoulder pain.
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Decrease in range of motion. Range of motion (ROM) is the shoulder joint’s capability to undergo its full spectrum of movements. So, the person is impaired with the distance stretching of the body with the joint or muscle.
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Joint stiffness.
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The pain often radiates to the upper arm, restricting the functions.
Why Is Transcutaneous Electrical Nerve Stimulation Used for Managing Frozen Shoulder?
Transcutaneous electrical nerve stimulation (TENS) is a technique in which a low-voltage current is applied right through the intact surface of the skin where the nerve pathways flow. The TENS for the pain management of a frozen shoulder operates in the following two ways:
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Blocking the Pain Signals: The TENS stimulates the concerned nerve for pain while applying the electric current. The underlying stimulated nerve straightly sends the signals to the brain and spinal cord. This results in the reduction of pain and relaxation of shoulder muscles.
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Production of the Body’s Opioids: In another way, the stimulation through electric impulses stimulates endorphin production in the human body. As endorphins (natural painkillers) are hormones that relieve pain and stress, one could attain shoulder pain relief.
So, the TENS manages the pain accompanying the frozen shoulder. When the pain gets relieved, the joint stiffness diminishes over time. The muscle spasm of the supporting shoulder joint is alleviated then.
How Does Transcutaneous Electrical Nerve Stimulation Work?
A transcutaneous electrical nerve stimulator, a device for TENS, is a compact battery-powered device connected to the skin's target points through electrodes. So, the device has leads attached to the electrodes or sticky pads. The therapist first attaches the sticky pads directly to the skin of the shoulder aspects concerning the nerve behind. Next, the machine is switched on, and the low-energy or tiny electrical impulses are delivered to the targeted area. The person feels the electrical impulse as a tingling sensation, not pain. Then, the nerve is stimulated, attaining a gradual relief from pain.
The more the integrity, the more will be the effects over pain. Nevertheless, some people show intolerance and are uncomfortable with the great integrity of electric impulses. In contrast, others experience skin irritation with the persistent stimulation. So, the TENS is advised with the intermittent break from the process. Conventional TENS is generally considered safe and can be administered throughout the day with a few on and off.
Sites for TENS Electrodes: TENS should not be applied straightly to the pain site and the highly hypersensitive skin. However, conventional TENS types can be administered, but with previous assessments over the tolerance of TENS tingling effect. In addition, the specific sites for pain management include:
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Close or proximal to the pain site.
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The peripheral or superficial aspect of the underlying nerve.
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Spinal nerve roots.
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Other acupuncture points.
Where Is the Transcutaneous Electrical Nerve Stimulation Technique Contraindicated?
Medical healthcare professionals wholly assess the pain, yet the patient’s history and medical status before employing transcutaneous electrical nerve stimulation (TENS) trial. In addition, TENS holds specific safety guidelines eventually with certain contraindications. Therefore, TENS is contraindicated in the following people for any aspect of the body:
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People who seem allergic to the gel, tapes, and electrodes.
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People with pacemakers.
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Heart conditions.
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Cognition and comprehension impairment.
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Other cognitive disorders.
Subsequently, TENS is contraindicated concerning local areas or regions with the following states:
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During pregnancy, the pelvis, abdomen, and uterus.
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The neck and head regions of people with epilepsy and stroke.
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Areas with any recent hemorrhage to avoid further risks.
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Varicose veins.
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Bleeding disorders.
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Thrombosis and ischemic (diminished blood flow) areas.
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Skin with irritation, inflammation, and dermatological lesions.
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Active malignancy aspects.
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Transorbital aspects across the eyes.
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Active epiphyseal aspects in cases of children.
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Anterior region of the neck or carotid sinus.
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Certain aspects of the chest could increase the risk of pulmonary ventilation.
How Effective Is Transcutaneous Electrical Nerve Stimulation for Managing Frozen Shoulder?
TENS is a therapeutic approach that involves the application of electrical current through the skin tissue. This procedure helps alleviate muscle spasms and pain associated with the frozen shoulder. It also helps enhance the range of motion in the shoulder joint. TENS can effectively aid in the healing mechanism by improving blood flow to the affected area. Though this approach provides certain relief for frozen shoulders, the efficacy can vary from individual to individual. TENS is included in a comprehensive treatment plan comprising stretching exercises, physical therapy, and medications.
Precautions for Transcutaneous Electrical Nerve Stimulation:
Transcutaneous electrical nerve stimulation is employed in a safe setting, though. Nevertheless, some precautions are to be taken for the avoidance of risks.
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Electrodes are not to be positioned over or through the eyes.
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Electrodes should not be inserted through the mouth.
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TENS should not be employed while driving.
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And not in aspects of other hazardous devices.
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Also, not to be used in water.
Limitations:
Some people get betterment of pain and muscle spasms, and some don’t, as it depends on the individual and the severity of the condition. In addition, shreds of evidence to prove the efficacy of TENS over pain relief seem deficient. While it requires additional research and clinical trials, they have been going ahead. The other limitation is TENS provides short-term pain relief that is confined to the use of the equipment.
Conclusion:
Shoulder pain is a common concern a person would experience with a frozen shoulder. TENS is the best yet safe intervention option for pain relief with or without medical treatments. Subsequently, the therapist or healthcare professionals would provide the person with the TENS equipment, which can be self-administered with appropriate guidelines.
