Frozen shoulder

What is frozen shoulder?

Frozen shoulder or adhesive capsulitis is a painful condition in which the shoulder loses its range of movements. This condition is referred to as "frozen shoulder" because it becomes very difficult for a person to move his shoulder. The shoulder is not actually frozen, it is just stiff. It may follow an injury to the shoulder, but may also arise gradually without warning or injury.

What are the causes?

Adhesive capsulitis causes scar tissue to form in the shoulder region. This may occur as a result of injury. Other conditions like tendonitis (inflammation or irritation of a tendon) and bursitis (inflammation or irritation of a bursa). If the shoulder has been immobilized for a long period of time, adhesive capsulitis could develop as a result. The condition could also develop as a result of an autoimmune reaction. The body thinks it is under attack during an autoimmune reaction and will start to attack parts of itself causing an inflammatory reaction in the tissues. However, in most cases, the cause is unknown.

Who is at risk?

• The usual age of onset begins between ages 40 and 65.
• It affects approximately 10% to 20% of diabetics.
• Other factors include: - a period of immobility, resulting from trauma, overuse injuries or surgery, hyperthyroidism, cardiovascular disease, clinical depression and Parkinson’s disease.

What are the symptoms?

Initially, the shoulder may feel stiff and ache and gradually becomes very painful. This stage can last up to eight months. The second stage is referred to as the adhesive stage and this is when the shoulder becomes stiffer. This stage usually lasts 4 to 6 months and is generally less painful than the first stage. The final stage lasts about one to three months. At this time, it usually becomes easier to move the shoulder. Pain may still persist and the full range of motion may still not be got with treatment.

It hurts the patient regardless of whether he moves the shoulder or someone else is moving it for him. The movement will simply stop if there was something preventing the shoulder from moving any further. The pain may increase at night.

How is the diagnosis made?

A doctor will examine the patient and ask for his medical history to be able to accurately diagnosis his condition. Other conditions have similar symptoms to adhesive capsulitis so the doctor may need to take an X-ray.

The most common test used is the MRI scan. An MRI scan is used to create pictures that look like slices of the shoulder. This scan is used to create pictures that look like slices of the shoulder. It can show the tendons as well as the bones, and whether there has been a tear in those tendons.

What is the treatment?

Successful treatment of adhesive capsulitis include:

• Anti-inflammatory drugs
• Cortisone injections to the shoulder
• Physical therapy

Anti-inflammatory drugs and cortisone injections reduce the inflammation of the shoulder allowing the shoulder to be more easily stretched. Physical therapy is essential because it helps regain the range of motion in the shoulder.

Treatment can be a long process. Initial treatment is aimed at reducing inflammation and pain and increasing the range of motion of the shoulder. Exercise is a very important part of the treatment. Exercises will help break up the scar tissue in the shoulder and should be done twice a day. The doctor or physical therapist will show the patient what kind of exercises should be performed. Since the exercises may be painful, using ice packs afterwards may help. With all exercises, the patient should warm up before attempting to do them.

If progress is slow, the doctor may recommend a manipulation of the shoulder while the patient is under anaesthesia. This procedure allows the doctor to stretch the shoulder joint capsule, and break up the scar tissue. In most cases, a manipulation of the shoulder will increase the motion in the shoulder joint faster than allowing nature to take its course. It may be necessary to repeat this procedure several times.

Arthroscopic surgery may also help break up the scar tissue. A camera is inserted through a small incision allowing the doctor to access the damage to the joint and at the same time, aid in the healing process.