Frozen shoulder or medically known as adhesive capsulitis is a condition in which there is a pain and stiffness in the shoulder joint which makes its movement very difficult, almost impossible. This pain in the shoulder continues over a period of time ranging from a few weeks to even a few months. Frozen shoulder is generally experienced by people in the age group of 40 to 60 years and it affects more women than men.
When frozen shoulder occurs, the shoulder capsules thicken and become too tight. At this time, stiff bands of tissues, which are also known as adhesions, develop and cause pain in the area. In most of the cases, there is also less synovial fluid in the joint. All this makes it impossible for the affected person to move his or her shoulder. The condition develops in three stages:
1. Freezing
This is the first stage of the ailment, when the shoulder begins to be more and more painful. As the pain progresses, the patient finds it increasingly hard to move the shoulder. This phase usually lasts for two to nine months.
2. Frozen
The patient may find less pain during this stage but the stiffness of the shoulder continues. This leads to increased problems in performing day to day chores. The frozen phase lasts for four to six months.
3. Thawing
This is the last stage of the ailment. In this phase, as the name suggests, shoulder motion begins to improve. Complete recovery or thawing takes typically six to two years.
Causes
The exact cause of frozen shoulder is still unknown but many factors can contribute to its cause. The most common risk factors are:
1. Diabetes
It has been observed that around 10 to 20 percent of people who are diabetic are more prone to get frozen shoulder. The reasons are still not well known but diabetics are certainly at a higher risk.
2. Other ailments
Other ailments associated with frozen shoulders include thyroid problems like hypothyroidism. People suffering from heart diseases and cervical diseases are also most likely to get frozen shoulder.
3. Immobility
There are also high chances of developing frozen shoulder when the shoulder has remained immobilized over a period of time due to various reasons like surgery, fracture or any other kind of injury. That is the reason why doctors prescribe movement of shoulders after surgery or recovery of injury.
Symptoms
The typical symptoms of a frozen shoulder include usually a dull and aching pain in the shoulder and limited movement of the shoulder. The person experiencing frozen shoulder find it difficult to do usual activities which needs lifting of the shoulder like combing hair, putting on clothes, taking bath, etc. The affected person also feels pain when trying to sleep on the affected shoulder and hence find it tough to sleep well.
Diagnosis
Physical examination
The diagnosis of frozen shoulder is done by two or three methods. Firstly, the physician starts understanding the symptoms of the patient and learning about his/her medical history. Then the physician starts with examining the shoulder by moving the affected shoulder in all directions and noting the intensity of the pain and stiffness. The range of motion is determined when someone else is moving the patient’s arms. This is known as “passive range of motion”. The physician then compares this passive range of motion with the active range of motion, when the patient himself/herself moves the affected shoulder without any external support.
Imaging tests
The physician can also detect the frozen shoulder by asking the patient to undergo some imaging tests like X-ray, MRI and ultrasound. This gives better images about the finer aspects and may help the physician to understand the problem better.
Treatment
Frozen shoulder gets better with time but it takes as much as three years in getting fully recovered. The focus of the treatment is to control pain and restore motion and strength through various approaches. There are both – nonsurgical and surgical methods to fix the problem.
Non surgical treatment
Most of the patients improve with simple and non surgical treatments like drugs and exercises.
1. Anti-inflammatory drugs
Drugs like aspirin and ibuprofen help in reducing pain and swelling in most of the cases.
2. Steroid injection
Some patients also show better response when given shots of steroid injections like Cortisone. Cortisone is injected directly into the shoulder joint for instant relief.
3. Physical therapy
Specific exercises, prescribed by a doctor also help in restoring motion. These must be done under the supervision of a physical therapist or through a home program. The therapy includes stretching exercises and a range of motion exercises for the shoulder.
Surgical treatment
If the patient does not feel better with anti-inflammatory medicines and exercises then the specialists or the doctors prescribe surgical treatments also. It is advisable that you talk with your doctor about your recovery potential and risks involved with the surgery. Following are the most common surgeries for treating frozen shoulder:
1. Manipulation under anesthesia
The doctor puts the patient to sleep during this procedure and then forces the frozen shoulder to move. This process causes the capsule and scar tissue to stretch or tear. The tearing process releases the tightening and finally increases the range of motion in the patient’s shoulder.
2. Shoulder arthroscopy
In this minor surgery, the doctor will insert small instruments through small incisions in the shoulder and will cut through tight portions of the joint capsule.
Most of the times, both the surgical processes manipulation and arthroscopy are used together in order to obtain optimum results. Most patients have shown good response from these procedures.
Recovery
It is very important to follow the exercise regimen prescribed by the doctor after the surgery. Recovery time can be anywhere between six weeks and three months. Long term results of surgery are quite good with no pain at all and improved range of motion. In rare cases, the motion may not return completely and some stiffness may still remain. Though uncommon, but frozen shoulder can recur if diabetes or other such precipitating factor aggravates.
