Frozen Shoulder
Adhesive capsulitis, known commonly as “frozen shoulder,” is a condition characterized by stiffness, pain, and limited range of motion in the shoulder. It occurs when the connective tissue surrounding the shoulder joint, called the joint capsule, thickens and tightens, restricting movement. This results in a gradual decrease in shoulder mobility coupled with moderate-to-severe pain, often making daily tasks difficult.
Phases of Frozen Shoulder
Frozen shoulder typically progresses through three distinct phases:
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1. Freezing (Painful) Phase:
• Duration: 6 weeks to 9 months.
• Symptoms: Gradual onset of shoulder pain, which worsens over time. Pain is often more severe at night and with certain movements. Stiffness begins to develop as the pain intensifies.
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2. Frozen (Adhesive) Phase:
• Duration: 4 to 12 months.
• Symptoms: Pain may diminish, but stiffness becomes more pronounced. Shoulder movement is significantly restricted, especially during overhead or behind-the-back motions. Daily activities may be challenging due to limited mobility.
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3. Thawing (Recovery) Phase:
• Duration: 6 months to 2 years.
• Symptoms: Gradual improvement in shoulder mobility as stiffness decreases. Pain continues to lessen, and the range of motion slowly returns to normal.
Causes and Risk Factors
The exact cause of frozen shoulder is not fully understood, but several factors increase the risk:
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• Inactivity: Prolonged immobilization of the shoulder after an injury, surgery, or due to another condition.
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• Systemic diseases: Conditions like diabetes, thyroid disorders (hypothyroidism or hyperthyroidism), Parkinson’s disease, or cardiovascular disease increase the risk.
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• Age and gender: Most common in individuals aged 40-60, with women being more frequently affected.
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• Trauma or surgery: Previous shoulder trauma or surgery can trigger the development of frozen shoulder.
Symptoms
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• Gradual onset of pain: Pain is usually dull or aching, localized to the outer shoulder or upper arm.
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• Loss of shoulder movement: Difficulty reaching overhead, behind the back, or performing rotational movements.
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• Stiffness: Limited range of motion, both actively (when moving the arm yourself) and passively (when someone else moves your arm).
Diagnosis
Diagnosis is often based on:
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• Patient history: Describing symptoms and the pattern of progression.
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• Physical examination: Testing shoulder range of motion and checking for pain during movement.
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• Imaging: X-rays may rule out other conditions like arthritis, while MRI or ultrasound can show thickening of the joint capsule or inflammation.
Treatment
The goal of treatment is to relieve pain and restore shoulder motion. Options include:
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1. Non-surgical treatments:
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• Physical therapy: A structured exercise program to stretch and strengthen the shoulder, improving mobility.
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• Medications: NSAIDs (like ibuprofen) or pain relievers to reduce discomfort.
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• Steroid injections: Corticosteroid injections into the joint can reduce inflammation and pain, especially in the early phase.
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• Hydrodilatation: Injection of sterile fluid into the joint to stretch the capsule and improve mobility.
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2. Surgical treatments (for severe or unresponsive cases):
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• Manipulation under anesthesia (MUA): The shoulder is moved and stretched while the patient is under anesthesia to break up scar tissue.
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• Arthroscopic capsular release: Minimally invasive surgery to cut and release tight portions of the joint capsule.
Prognosis
Frozen shoulder is generally self-limiting, and most patients recover with time and appropriate treatment. However, it can take several months to years for full recovery. Early intervention, including physical therapy, can help accelerate the process and improve outcomes. If non-operative management has been effective for a period of 6 months,
Prevention
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• Keep the shoulder mobile: Gentle stretching and range-of-motion exercises after an injury or surgery can prevent frozen shoulder.
• Control risk factors: Managing underlying conditions like diabetes may reduce the likelihood of developing frozen shoulder.
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• Avoid prolonged immobility: Limit periods of shoulder inactivity whenever possible.
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