Frozen Shoulder

Frozen shoulder, also known as adhesive capsulitis, is a condition characterized by stiffness and pain in the shoulder joint. The condition typically develops gradually and progresses through stages, leading to a significant loss of shoulder mobility. It most commonly affects individuals between the ages of 40 and 60, and is more prevalent in women than men.

Causes

The exact cause of frozen shoulder is not fully understood, but it is believed to result from inflammation and thickening of the shoulder joint capsule, which is the connective tissue surrounding the shoulder joint. This thickening leads to the formation of scar tissue (adhesions), restricting the joint’s movement.

Certain factors can increase the risk of developing frozen shoulder, including:

• Prolonged immobility: Shoulder immobilization following surgery, injury, or other conditions that limit movement can contribute to the development of frozen shoulder.
• Diabetes: People with diabetes are at a higher risk of developing frozen shoulder, though the reasons for this are unclear.
• Other medical conditions: Conditions such as thyroid disorders, heart disease, and Parkinson’s disease are associated with a higher incidence of frozen shoulder.
• Previous shoulder injuries: A history of shoulder injuries or surgeries can predispose individuals to this condition.

Stages of Frozen Shoulder

Frozen shoulder typically progresses through three stages, each lasting several months:

1. Freezing stage: During this initial stage, the shoulder becomes increasingly painful, and movement begins to be limited. This stage typically lasts 6 to 9 months.
2. Frozen stage: Pain may decrease during this stage, but the shoulder becomes stiffer, and range of motion is significantly reduced. This stage can last 4 to 12 months.
3. Thawing stage: During the final stage, shoulder movement gradually improves as the joint capsule loosens. Full recovery can take anywhere from 6 months to 2 years.

Symptoms

The primary symptoms of frozen shoulder include:

• Persistent shoulder pain: Often worse at night or with certain movements.
• Stiffness: A significant loss of shoulder range of motion, particularly when lifting the arm or reaching behind the back.
• Limited movement: Difficulty performing everyday activities, such as dressing, reaching overhead, or lifting objects.

Diagnosis

Diagnosing frozen shoulder typically involves:

• Medical history and physical examination: A healthcare provider will assess symptoms, medical history, and perform a physical examination to evaluate shoulder movement and pain levels.
• Imaging: X-rays may be used to rule out other conditions, such as arthritis, that could cause similar symptoms. An MRI or ultrasound can help assess the extent of inflammation and the presence of scar tissue.

Treatment

Treatment for frozen shoulder focuses on pain relief and restoring shoulder mobility:

• Non-surgical treatment:
  • Physical therapy: A crucial component of treatment, physical therapy involves exercises to stretch and strengthen the shoulder muscles, gradually improving range of motion.
  • Medications: Over-the-counter pain relievers, such as acetaminophen or nonsteroidal anti-inflammatory drugs (NSAIDs), can help manage pain. In some cases, a doctor may recommend stronger medications.
  • Corticosteroid injections: An injection of corticosteroids into the shoulder joint can reduce inflammation and provide temporary pain relief.
  • Hydrodilatation: This procedure involves injecting a large volume of sterile fluid into the joint capsule to stretch the tissues and improve mobility.
• Surgical treatment:
  • Manipulation under anesthesia: In cases where non-surgical treatments are ineffective, manipulation under anesthesia may be performed. The patient is sedated, and the doctor forcibly moves the shoulder to break up adhesions.
  • Arthroscopic surgery: In more severe cases, minimally invasive surgery may be performed to release the tight joint capsule and remove scar tissue.

Recovery

Recovery from frozen shoulder varies depending on the severity of the condition and the effectiveness of treatment:

• Non-surgical recovery: With consistent physical therapy and treatment, most individuals regain a significant range of motion within 12 to 18 months, though some stiffness may persist.
• Post-surgical recovery: If surgery is required, recovery may involve several months of physical therapy to restore strength and mobility.

Prevention

Preventing frozen shoulder primarily involves maintaining shoulder mobility, especially after an injury or surgery:

• Early movement: After shoulder surgery or injury, it’s important to start gentle movement exercises as soon as possible, under the guidance of a healthcare provider, to prevent stiffness.
• Regular exercise: Engaging in regular shoulder stretches and strengthening exercises can help maintain flexibility and reduce the risk of developing frozen shoulder.

In summary, frozen shoulder is a painful condition characterized by stiffness and limited movement in the shoulder joint. While the condition can be challenging to manage, early diagnosis and treatment, including physical therapy and, in some cases, surgery, can help restore mobility and reduce symptoms.