FROZEN SHOULDER SYNDROME: SYMPTOMS, DIAGNOSIS, AND TREATMENT
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Frozen shoulder or “adhesive capsulitis” is a shoulder condition common in people ages 40 to 60. It’s described as a sudden intense pain that restricts your shoulder’s range of motion. Over time, the pain gradually increases until your shoulder is tough to move.
Frozen shoulder syndrome is an inflammatory condition that causes shoulder pain and stiffness. It can be treated by physical rehabilitation or surgical removal of the scar tissue in the shoulder joint.
If left untreated, a frozen shoulder can permanently restrict joint motion in all directions. So keep reading to know more about this condition, symptoms, risk factors, and the available treatment options.
The shoulder is a ball-and-socket joint surrounded by connective tissue called the shoulder capsule. In people with frozen shoulder syndrome, the shoulder capsule can become inflamed for a number of reasons (discussed below).
This inflammation leads to the formation of bands of sticky scar tissue (called adhesions). This is why frozen shoulder syndrome is referred to as “adhesive capsulitis”. The thick inflamed capsule restricts the movement of the shoulder and leads to the typical symptoms of frozen shoulder.
Adhesive capsulitis is characterized by shoulder pain, capsular adhesions, and inflammation. Increased growth factors such as cytokine have been involved in the inflammatory process and fibrotic pathway, causing joint capsule fibrosis.
Frozen shoulder is relatively common in bedridden patients whose shoulder joints are immobilized for prolonged periods due to injury and stroke. When your major shoulder muscles can no longer perform their normal function, degenerative changes occur until your shoulder movement becomes extremely limited.
Frozen shoulder is a result of inflammation, fibrosis, and thickening of the shoulder capsule, causing the shoulder to lock and cause pain.
The pain of adhesive capsulitis is often worse at night. If you have frozen shoulder syndrome, you most likely find it difficult to lie on your side.
In general, the symptoms occur in stages that are typical of adhesive capsulitis:
- Painful Freezing Stage: The shoulder joint becomes stiff, sore, and difficult to move. The pain increases with time, and it worsens at night. It lasts for six weeks to nine months.
- Adhesive or Frozen Stage: The pain decreases with time, but the joint remains stiff. Due to your stiff shoulder, it becomes difficult to perform regular daily activities. This stage lasts for 2 to 6 months.
- Thawing or Recovery Stage: The pain has decreased, and movement improves with time. It takes 12 to 42 months, and normal strength usually returns at this stage.
People who frequently engage in particular sports and overhead activities that strain the long head of the bicep and rotator cuff are more susceptible to frozen shoulder syndrome than the average person.
Frozen shoulder generally affects 2% of the population, but some are more likely to be affected than others because of certain risk factors:
- Women above the of age 50
- Type 1 and type 2 diabetes patients
- Dupuytren's contracture
- Stroke patients
- Mastectomy (breast removal surgery)
- Parkinson's disease
- Heart disease
- Synovitis (a type of joint tissue inflammation)
- Capsule contracture (fibrosis)
Diagnosing adhesive capsulitis involves a physical exam wherein your orthopedic surgeon first assesses the extent of your symptoms. He or she will ask you to move your arm in specific directions to evaluate your active range of shoulder motion.
To compare this with your passive range of motion, your doctor may also ask you to relax your shoulder while they manipulate your arm. They may perform the physical exam with the help of an anesthetic in case you’re having severe pain.
Your doctor may also request imaging tests to help rule out other possible causes of shoulder pain. X-rays clearly show your bones, while magnetic resonance imaging (MRI) and ultrasound create a better view of your soft tissues.
The presentation of the frozen shoulder is often confused by other musculoskeletal conditions.Here are some other common causes of shoulder pain:
- Shoulder Impingement: This is a very frequent cause of shoulder pain. It’s when one of the shoulder tendons becomes injured from chronically rubbing against a bony prominence. The symptoms mimic those of the early frozen shoulder stage, characterized by pain in the joint but no stiffness or adhesions. They are especially worsened with overhead activities.
- Rotator cuff injury: The rotator cuff muscles are those that form your shoulder and move your upper arm. The tendons of these muscles commonly become inflamed, strained, or even ruptured due to overuse or trauma.
Although studies have suggested that the frozen shoulder heals on its own within three years, it can still leave some permanent damage. Your shoulder joint can become impaired, and you might experience a restricted range of motion.
Luckily, various treatments have proven to relieve early and advanced stages of frozen shoulder syndrome:
Pain management is the standard short-term treatment for a frozen shoulder. Pain is treated with non-steroidal anti-inflammatory drugs (NSAIDs) once a day, for a few weeks to a few months.
Depending on the severity of your pain, your doctor may prescribe intra-articular steroid injections that are commonly used for osteoarthritis.
Physical therapy and rehabilitation is by far the best non-operative and non-pharmacological treatment for frozen shoulders. The recovery is slow, but it provides outstanding results in the long run.
- Heating Method: Deep heat is applied to relax the thick and contracted muscle. This heat is applied using ultrasound, moist heat pack, infrared radiation, or other methods that your physiotherapist may suggest.
- Capsular Stretch: Capsular stretching aims to stimulate the production of synovial fluid, which helps for smoother movement of your joints. Your rehabilitator initially facilitates the capsular stretches, but you can do this on your own later on.
- Passive Joint Mobilization: Your physiotherapist will stretch and move your joint to its range limit. Mobilization is a more hands-on technique to improve range and reduce swelling.
In the early stages of frozen shoulder, some remedies might help ease shoulder stiffness and pain at home. An excellent method to deal with shoulder pain is to use ice packs for 10 - 15 minutes to reduce the inflammation in the joint.
Your physical therapist can prescribe a home guide plan and personalized exercise programs to treat your shoulder pain and improve your range of movement without surgery.
If you’ve tried everything and you’re still not getting any relief, surgery should do the trick. It usually provides effective and fast results, especially if you have any underlying diseases like diabetes mellitus.
You have two options for surgical treatment of frozen shoulder syndrome.
Manipulation Under Anesthesia: Your surgeon will manipulate your shoulder, causing your shoulder capsule and the scar tissue to stretch, achieving a full range of motion.
A tear in the joint capsule is a possible risk of manipulation. The shoulder manipulation is done with anesthesia, but some patients may experience pain for up to 10 weeks after the procedure because of the tear.
Arthroscopic Capsular Release: Your surgeon makes a small incision at the shoulder joint. With the help of an arthroscope (a camera) and endoscopic surgical instruments, your surgeon removes the adhesions and scar tissue from the joint capsule, freeing your shoulder.
It is hard to exactly know how long it will take you to heal from frozen shoulder. It largely depends on your specific condition and the type of treatment you get. Conservative therapy is often successful but needs more time. Surgery, on the other hand, offers a more instant relief. In many cases, frozen shoulder can heal alone, without any specific therapy.
The severity of your frozen shoulder directly correlates with the length of the recovery period. If you only occasionally experience short bursts of pain, you will most likely heal faster. However, if you frequently get long and painful frozen shoulder symptoms, then you will need more time to heal.
Frozen shoulder is one of the most common musculoskeletal disorders, affecting 2% to 4% of the general population. Its incidence increases in people who have diabetes mellitus or cardiovascular disease and in bedridden patients.
Early diagnosis and treatment by your GP, orthopedic surgeon, and/or physical therapist prevents further damage to your shoulder joint and increase the likelihood of an easy recovery.
There are certainly a variety of proven treatments that provide excellent results in treating frozen shoulder. It may be a slow process, but the long-term outcomes are worth it with a commitment to getting better.
How to prevent frozen shoulder?
You can prevent frozen shoulder by incorporating exercises into your daily routine. Sustained shoulder stretches and light exercise can help prevent frozen shoulder. Make sure to take short breaks in between to prevent adhesions.
What happens in frozen shoulder syndrome?
Frozen shoulder syndrome happens when the shoulder capsule becomes inflamed. This inflammation leads to the formation of scar tissue that tightens around the joint, causing restricted movement and pain.
Is frozen shoulder common?
Frozen shoulder affects 2-4% of the population and is common in people 40 to 60 years old. It is also common in bedridden patients with immobilized joints and patients with cardiovascular diseases or diabetes mellitus.
How much physical therapy is needed to treat frozen shoulder?
It takes around six weeks to three months of rehabilitation to treat frozen shoulder. This is largely dependent on your specific case and the severity of your condition.
Are there any proven treatments for frozen shoulder?
Early interventions to treat frozen shoulder include medication and physical therapy. If non-operative treatments don’t manage your pain, then steroid injections or surgery might be considered.
Do corticosteroid injections help in treating frozen shoulder fast?
Steroids are a proven intervention to treat frozen shoulder. The dosage is limited to 3 injections for the frozen shoulder. If your condition doesn’t improve afterward, then manipulation under anesthesia will be considered.
What to expect after arthroscopic surgery for frozen shoulder?
Your surgeon will recommend post-operative physical therapy to ease severe pain and reduce adhesion formation in the future. Physical therapy and rehabilitation help achieve a full range of motion within three months after surgery.
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