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Frozen Shoulder

Frozen shoulder, also called adhesive capsulitis, causes pain and stiffness in the shoulder. Over time, the shoulder becomes very hard to move. It most commonly affects people between the ages of 40 and 60, and occurs in women more often than men.

In frozen shoulder, the shoulder capsule thickens and becomes tight. Slowly the capsule becomes inflamed and pain becomes severe.The hallmark sign of this condition is being unable to move your shoulder – either on your own or with the help of someone else.

It develops in three stages:

  • Freezing— In the”freezing” stage, there is gradual increase in pain. As the pain worsens, your shoulder loses range of motion. Freezing typically lasts from 6 weeks to 9 months.
  • Frozen— Painful symptoms may actually improve during this stage, but the stiffness remains. During the 4 to 6 months of the “frozen” stage, daily activities may be very difficult.
  • Thawing— Shoulder motion slowly improves during the “thawing” stage. Complete return to normal or close to normal strength and motion typically takes from 6 months to 2 years.

Causes

The causes of frozen shoulder are not fully understood. There is no clear connection to arm dominance or occupation. A few factors may put you more at risk for developing frozen shoulder.

Diabetes.

Frozen shoulder occurs much more often in people with diabetes, affecting 10% to 20% of these individuals.

Other diseases.

Some additional medical problems associated with frozen shoulder include hypothyroidism, hyperthyroidism, Parkinson’s disease, and cardiac disease.

Prolonged Immobilization.

Frozen shoulder can develop after a shoulder has been immobilized for a period of time due to surgery, a fracture, or other injury. Having patients move their shoulders soon after injury or surgery is one measure prescribed to prevent frozen shoulder.

Symptoms

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. It increases at night or on jerk.

Physical Examination

There is passive and active restriction of movement of shoulder. The outward rotation is the first to get affected. The strength of the rotator cuff is however normal.

Imaging Tests

Other tests that may help your doctor rule out other causes of stiffness and pain include:

X-rays: they are usually normal in frozen shoulder.

Magnetic resonance imaging (MRI) : The MRI shows inflammation and shrinking of capsule

Nonsurgical Treatment

More than 90% of patients improve with relatively simple treatments to control pain and restore motion.

Non-steroidal anti-inflammatory medicines

They help reduce pain and swelling.

Steroid injections

Cortisone is a powerful anti-inflammatory medicine that is injected directly into your shoulder joint

Physical therapy

This is the most important aspect of treatment. Physical therapy helps gradually stretch tight shoulder capsule. This results in gradual restoration of movements, decrease in pain. Specific exercises may be under the supervision of a physical therapist or via a home program.

Sometimes heat is used to help loosen the shoulder up before the stretching exercises.

Below are examples of some of the exercises that might be recommended.

External rotation — passive stretch. Stand in a doorway and bend your affected arm 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 and repeat.

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.

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.

Surgical Treatment

If your symptoms are not relieved by therapy and anti-inflammatory medicines, you and your doctor may discuss surgery. It is important to talk with your doctor about your potential for recovery continuing with simple treatments, and the risks involved with surgery. The goal of surgery for frozen shoulder is to stretch and release the stiffened joint capsule. The most common methods include manipulation under anesthesia and shoulder arthroscopy.

Manipulation under anesthesia:

During this procedure, you are put to sleep. Your doctor 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.

Shoulder arthroscopy:

In this procedure, your doctor will cut through tight portions of the joint capsule. This is done using pencil-sized instruments inserted through small incisions around your shoulder.

In many cases, manipulation and arthroscopy are used in combination to obtain maximum results. Most patients have very good outcomes with these procedures.

Normal Shoulder Joint Lining

An Inflamed joint lining of frozen shoulder

Recovery

After surgery, physical therapy is necessary to maintain the motion that was achieved with surgery. Recovery times vary, from 6 weeks to three months. Although it is a slow process, your commitment to therapy is the most important factor in returning to all the activities you enjoy.

Long-term outcomes after surgery are generally good, with most patients having reduced or no pain and greatly improved range of motion. In some cases, however, even after several years, the motion does not return completely and a small amount of stiffness remains.

Although uncommon, frozen shoulder can recur, especially if a contributing factor like diabetes is still present.