What is Frozen Shoulder?
Frozen shoulder also known as adhesive capsulitis is a condition characterized by stiffness and pain in shoulder joint. The shoulder joint is usually covered by a thin capsule.
Causes of Frozen Shoulder
When the thin capsule at the shoulder joint gets inflammed, it causes pain and the shoulder remains stiff. This usually resolves within time.
The exact cause of inflammation is unknown. The condition has been linked to auto-antibodies that attack the joint capsule, resulting in inflammation, adhesion and eventual scar tissue formation. It may be triggered to injury (including surgery), degenerative changes in the joint, as well a, viral illnesses. This condition is also more common in diabetics.
Frozen shoulder develops slowly and in three stages. Each stage can last between three to six months:
1) Freezing stage – any movement of your shoulder causes pain and the range of movement for your shoulder is limited
2) Frozen stage – pain diminishes during this stage. However, your shoulder becomes stiffer and shoulder movements can be severely restricted
3) Thawing stage – the range of movement on your shoulder begins to improve and you will be able to do more activities. Complete resolution is the norm but up to 15% of patients may have remaining movement restriction or weakness
Symptoms of Frozen Shoulder
Signs and symptoms usually begin gradually, worsen over time.
Pain from frozen shoulder is usually dull or aching. It is typically worse early in the course of the disease and when you move your arm. The pain is usually located over the outer shoulder area and sometimes the upper arm.
You may have frozen shoulder if you experience pain and stiffness moving in all directions.
Limitations in movement of the activities listed below may indicate early symptoms of frozen shoulder:-
- Lifting your arm, either straight out in front or sideways
- Rotating your arm such as when unzipping the back of your dress or reaching for objects in your rear pocket
- Shampooing and dressing
- Sleeping on the affected shoulder
Who is more likely to get Frozen Shoulder?
Frozen shoulder most commonly affects people between the age of 40 and 60. It occurs in women more often than men. In addition, people with diabetes are at an increased risk for developing frozen shoulder.
What are the risk factors of Frozen Shoulder?
Certain factors may increase the risk of developing frozen shoulder.
Age and Sex
People who aged 40 years and above, especially women, are more prone to have frozen shoulder
Immobility or reduced mobility
People who have prolonged immobility or reduced mobility of the shoulder are at higher risk of developing frozen shoulder. Immobility may be resulted of many factors including:
- Rotator cuff injury
- Broken arm
- Recovery from injury
People who have certain diseases are more likely to develop frozen shoulder. Diseases that might increase risk include:
- Overactive thyroid (hyperthyroidism)
- Underactive thyroid (hypothyroidism)
- Cardiovascular disease
- Parkinson’s disease
Before diagnosing a treatment for Frozen Shoulder, doctors will conduct a few tests:
1) Physical Examination
After discussing your symptoms and medical history, our doctor will examine your shoulder.
Our doctor will move your shoulder carefully in all directions to see if movement is limited and if pain occurs with the motion.
The range of motion when someone else moves your shoulder is called “passive range of motion.” Our doctor will compare this to the range of motion you display when you move your shoulder on your own (“active range of motion”).
People with frozen shoulder have limited range of motion both actively and passively.
2) Imaging Tests
Doctor will conduct some necessary test for you to rule out other causes of stiffness and pain such as:
Dense structures such as bone can be seen clearly on X-rays. On top of that, X-rays demonstrates other problems in your shoulder such as arthritis
- Magnetic Resonance Imaging (MRI) and Ultrasound
These tests can have a better images of soft tissues. They are not required to diagnose frozen shoulder, however, they may help to identify other problems in your shoulder such as rotator cuff tear
Treatment for Frozen Shoulder
Frozen shoulder usually gets better over time, although, may take up to three years. The focus of treatment is to control pain and restore motion and strength through physical therapy. Frozen shoulder can be treated conservatively with non-surgical or surgical treatments.
1) Non-surgical treatment
Most people with frozen shoulder improve with relatively simple treatments to control pain and restore motion.
(a) Non-steroidal anti-inflammatory medicines
Medicines like aspirin and ibuprofen can help to eliminate pain and swelling
(b) Steroid injections
Cortisone is a powerful anti-inflammatory medicine that is injected directly into your shoulder joint
Specific exercises will help to restore motion. This can be done under the supervision of physiotherapist. Physiotherapy includes stretching or range of motion exercises for the shoulder, sometimes heat is used to help loosen the shoulder up before stretching. Below are examples of some of exercises that might be useful.
1) External rotation – passive stretch Stand in a doorway and bend your affected arm’s elbow to 90 degrees to reach the doorjamb. Keep your hand in place and rotate your body as shown in the illustration. Hold for 30 seconds. Relax an repeat.
2) Forward flexion – supine position Lie on your back with your legs straight. Use your unaffected arm to lift your affected arm overhead until you feel a gentle stretch. Hold for 15 seconds and slowly lower to start position. Relax and repeat.
3) Crossover arm stretch – Gently pull one arm across your chest just below your chin as far as possible without causing pain. Hold for 30 seconds. Relax and repeat.
If your symptoms are not relieved by physiotherapy and other conservative methods, surgery is required.
The most common methods include manipulation under anesthesia and shoulder arthroscopy.
(a) Manipulation under anesthesia
During this procedure, you are put to sleep. The surgeon will force your shoulder to move which causes the capsule and scar tissue to stretch or tear. This releases the tightening and increases range of motion.
(b) Shoulder arthroscopy
During this procedure, the surgeon will cut through tight portions of the joint capsule. This is done using pencil sized instruments inserted through small incisions around your shoulder. Shoulder surgery is not the mainstay treatment but only a last resort should all other conservative methods fail.
Benefits of Surgical Treatment for Frozen Shoulder
The benefit of surgery is to stretch and release the stiffness of joint capsule.
Recovery after Surgical Treatment
After surgery, physiotherapy is essential to maintain the motion that was achieved with surgery. Recovery time varies from 6 weeks to 3 months.
Long-term outcomes after surgery are generally good, with most patients having reduced or no pain and improved range of motion. In some cases, even after several years, the motion does not return completely and some degree of stiffness remains. Diabetic patients have some degree of continued shoulder stiffness after surgery.
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