About frozen shoulder

What is frozen shoulder?

Frozen shoulder facts

  • Frozen shoulder is the result of scarring, thickening, and shrinkage of the joint capsule.
  • Any injury to the shoulder can lead to a frozen shoulder.
  • A frozen shoulder is usually diagnosed during an examination.
  • A frozen shoulder usually requires aggressive treatment.

What is a frozen shoulder?

A frozen shoulder is a shoulder joint with significant loss of its range of motion in all directions. The range of motion is limited not only when the patient attempts motion but also when the doctor attempts to move the joint fully while the patient relaxes. A frozen shoulder is medically referred to as adhesive capsulitis.

What are the symptoms for frozen shoulder?

Frozen shoulder typically develops slowly, and in three stages. Each stage can last a number of months.

  • Freezing stage. Any movement of your shoulder causes pain, and your shoulder's range of motion starts to become limited.
  • Frozen stage. Pain may begin to diminish during this stage. However, your shoulder becomes stiffer, and using it becomes more difficult.
  • Thawing stage. The range of motion in your shoulder begins to improve.

For some people, the Pain worsens at night, sometimes disrupting sleep.

What are the causes for frozen shoulder?

The bones, ligaments and tendons that make up your shoulder joint are encased in a capsule of connective tissue. Frozen shoulder occurs when this capsule thickens and tightens around the shoulder joint, restricting its movement.

Doctors aren't sure why this happens to some people, although it's more likely to occur in people who have diabetes or those who recently had to immobilize their shoulder for a long period, such as after surgery or an arm fracture.

What are the treatments for frozen shoulder?

The treatment of a frozen shoulder usually requires an aggressive combination of anti-inflammatory medication, cortisone injection(s) into the shoulder, and physical therapy (physiotherapy). Without aggressive treatment, a frozen shoulder can be permanent.

Diligent physical therapy is often essential for recovery and can include ultrasound, electric stimulation, range-of-motion exercise maneuvers, stretching, ice packs, and eventually strengthening exercises. Physical therapy can take weeks to months for recovery, depending on the severity of the scarring of the tissues around the shoulder.

It is very important for people with a frozen shoulder to avoid reinjuring the shoulder tissues during the rehabilitation period. These individuals should avoid sudden, jerking motions of or heavy lifting with the affected shoulder.

Sometimes a frozen shoulders is resistant to treatment. Patients with resistant frozen shoulders can be considered for release of the scar tissue by arthroscopic surgery or manipulation of the scarred shoulder under anesthesia. This manipulation is performed to physically break up the scar tissue of the joint capsule. It carries the risk of breaking the arm bone (humerus fracture). It is very important for patients that undergo manipulation to partake in an active exercise program for the shoulder after the procedure. It is only with continued exercise of the shoulder that mobility and function is optimized.

What are the risk factors for frozen shoulder?

Certain factors may increase your risk of developing frozen shoulder.

Age and sex

People 40 and older, particularly women, are more likely to have frozen shoulder.

Immobility or reduced mobility

People who've had prolonged immobility or reduced mobility of the shoulder are at higher risk of developing frozen shoulder. Immobility may be the result of many factors, including:

  • Rotator cuff injury
  • Broken arm
  • Stroke
  • Recovery from surgery

Systemic diseases

People who have certain diseases appear more likely to develop frozen shoulder. Diseases that might increase risk include:

  • Diabetes
  • Overactive thyroid (hyperthyroidism)
  • Underactive thyroid (hypothyroidism)
  • Cardiovascular disease
  • Tuberculosis
  • Parkinson's disease

Is there a cure/medications for frozen shoulder?

Frozen shoulder, medically called adhesive capsulitis, is an inflammatory condition of the shoulder that persists for more than three months. Initially, it restricts a range of motions, especially external rotations. The advanced stages limit the movements in all directions. Frozen shoulder occurs four times more in females than in males. The non-dominant shoulder is more prone than the dominant side. Planning of treatment strategy depends on the stage of the condition

Early frozen shoulder
1. In the early stages, inflammation is progressive and is well accentuated. This stage can be considered a freezing stage rather than a frozen phase.
2. Initial treatment options are acetaminophen or Non-Steroid Anti-Inflammatory Drugs (NSAIDs) for short-term relief from pain. However, severe cases may require opioid analgesics.
3. Physical therapy that involves supervised therapeutic exercises helps control pain and restore normal shoulder mobility. It comprises soft tissue mobilization and gentle stretching.
4. Doctors may also recommend a therapeutic ultrasound, cryotherapy, or transcutaneous electrical nerve stimulation (TENS) unit.
5. In case of non-response to non-operative treatment, intra-articular injection of corticosteroid is considered.

Developed frozen shoulder
1. In later stages, inflammation and pain subside, and restriction of movement pronounces more. The treatment focuses on regaining movements.
2. Physical therapy is intensified, and more invasive therapy is considered.
3. Suprascapular nerve or interscalene brachial plexus blockage may provide further improvement.
4. Capsular hydrosilylation (stretching the joint capsule by the saline injectate pressure), manipulation under anesthesia (tearing of the contracted capsule), and arthroscopic capsular release (particularly in the rotator interval) are the invasive options for patients who do not show improvement after 6 months of non-invasive therapy.

Insidious onset of pain, stiffness, and restriction of movements of shoulder
Inflammation and adhesions around the rotator interval caused by increased collagen and nodular band formation
NSAIDs and corticosteroids

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